Kosi Bay

Sunday, February 23rd

The next day after the Marula Festival, we spent some time at Kosi Bay. We had been camping nearby so it was a short four wheeling expedition away. The bay was huge, with tons of little cesspools of marine life and places to snorkel. I had to really hold myself back from brining home all the cool shells I found because the majority were inhabited by hermit crabs and snails. 

Back at the campsite we cooked a massive breakfast Sunday morning for everyone in the campsite communal kitchen.

Some of the PTs, OTs, and Dieticians.

Exhausting weekend for sure, but made my time in Mseleni just that much more special!!

Umthayi Marula Festival 2014

February 22, 2014

Upon much convincing by the Zulu sisters (nurses) at the hospital, Fem and I were coaxed into attend one of KwaZulu-Natal's annual traditional celebrations. The annual uMthayi Marula festival (i.e. the "first fruit festival") is an age old tradition where all residents under the Tembe traditional leadership bring their first batch of brewed amarula beer to present to Inkosi (the Zulu king), who will sample the first drink of the season before the whole community can join in. Amarula is brewed from the local Marula fruit, which ripens on trees between December and May.

Sister Nyawo, one of the nurses, supplies us with traditional Zulu Festival clothing, which consisted of sarong wrap skirts and lots of colorful beaded jewelry. 

As soon as we arrive, we found that we were quite the attraction being, literally, the only white people for miles! Everyone was so flattered that we dressed in their traditional clothing that we received endless requests for pictures. Clearly this form of flattery had not been seen by the Zulu people before.

The festival was surprisingly well organized, with a proper stage for music and dancing and tents with table settings for lunch. 

We spent much time watching the musicians and dancers, who ranged from very young to quite elderly. The dancing especially was fantastic to watch... If only I could move like that!!! 

Some women in our tent wearing traditional beaded Zulu hats and jewelry.

As the day went on, government officials arrived from Swaziland and Mozambique.

 The Zulu King made an entrance in a tribal sort of chanting/dancing presentation of the first Marula fruit harvest and Amarula liquor. He is the shorter man in the center facing me? With the white and black ring on his head.

This was quite possibly one of the nearest things I've ever watched. After this presentation dance/chant, government officials used the venue as an opportunity to give speeches to the people about plans for the upcoming year. Then we were served food and the music started up again full force! One of the singers/dancers actually asked Fem and I to take a picture with him! Haha. When he went on stage to sing, the people were so excited they screamed and pushed over an entire steel gate so they could be closer to the stage! 

After the gate was pushed over, this seemed to be the beginning of the crazy drinking and dancing. Fem was almost tackled by an old Gogo who had had a little too much Amarula, but was enjoying herself dancing so much! She was adorable.

Being the sort of festival celebrities it seemed, we were even interviewed by the South African National News! ...not my favorite part haha...

In the end we were fortunate enough see a very historical part of African Zulu culture and spend the day with our Zulu nurses. 

Definitely a day to remember!! 

Ponto do Ouro, Mozambique

Sunday February 16th, 2014

(Sorry for the late posts! Internet has not been working well enough to upload!)

This past weekend, what felt like the entire hospital staff and I, took a little road trip to a small town at the southern-most tip of Mozambique. Doctors, physical therapists, occupational therapists, and medical students all together, it was a neat feeling to have such a sense of family with the other staff. 

It was only about an hour drive to the border between South Africa and "Mozam", as everyone called it. At that point the paved roads quickly ended and we came upon the border patrol station. After what felt like a billion questions, three passport stamps, and a visa later, we were finally set free into the outback of Mozam. 

It was odd, as there was not one road, but about ten different paths through the sandy dunes that would all take you to the same location...from the border patrol station to the next site of civilization, Ponto do Ouro. This quickly became a four-wheeling race between the three vehicles we had in our group of people. The drivers motto? If we fell/crashed, there was nothing but a soft landing (sand) surrounding us! ... I just held on tight and could not stop laughing as we bobbed up and down through the sand! It was so much fun :).

Eventually we made it to the town of Ponta Do Oura, Mozambique. It was a small place full of color and movement, with food markets and clothing linings the streets. Still no paved roads, the only vehicles that were around where diesel four wheel drives, like ours, and tractors! It was easy to see the eclectic mix of cultures on this town... A mix between South African, Portuguese (mozambique was once ruled by Portugal, and Portuguese is their only official language), and the Indian influence of nearby Durban. 

Since there were so many of us, we rented two houses near eachother. The one I stayed in was the larger of the two. It had a nice African, "on-the-beach" vibe to it, and we were all surprised that the bedrooms had air conditioners (quite a luxury here)!!

The weekend included a valentines dinner out with the entire group, lots of time spent walking on the beach and snorkeling off the shore, and a traditional South African braii (barbecue) on Saturday evening. 

Valentines dinner and celebrating one of the occupational therapist's birthdays.

Live local music at dinner.

 

Chilling at the local smoothie bar.

The mozambique latte, a "galao"... Very cinnamon-ey

A local that we found making beautiful rugs and blankets out of recycled fabric in a garage next to a petrol station. His wife was working hard in the other corner spinning all of the yarn onto spools, and another woman worked to cut up old clothes into strips for a different type of rug. A kind lady down the road sold his rugs in her shop. 

The beach. For only $10 a day, we rented a "gazebo" aka tailgating-type tent to hide from the hot hot HOT sun under. This tent rental service was another method the locals used to earn money. 

Mozam made for a great weekend away. The only snaffoo we had was almost getting held up at the border post on the way back into South Africa on Sunday. Apparently we hadn't filled out the proper paperwork for the car we drove. Luckily some sweet-talking in Spanish did the trick and we were home bound. :-) 

My only complaint: Monday came a bit too early!

Frustrations Abound

Fem and I were consulted to a case today of a 31 year old woman with a large "abcess" of her inguinal region. When we went to see her, we found a large, actually visibally pulsating mass that was causing this woman to have severe burning pain down her leg. Amazed that the nurses didn't realize that abscesses normally don't pulsate and that this woman had been sitting there since the day prior, we quickly realized the severity of the situation. A dissecting femoral artery aneurysm of this size could burst at any moment, and our hospital is not equipped for a major vascular surgery such as this other than clamping the artery off completely to prevent her from bleeding to death. After finding out that no ambulances would be available for at least 8 hours (EMS service here is stretched thin/ is more of a non emergent transport system), we made arrangements to have the helicopter come and pick her up and take her to a larger hospital. This was only to be followed by a phone call back from the helicopter service telling us that the accepting surgeon, who had never spoken to us or seen this patient before, refused to have her transported by helicopter, as he did not feel this was an emergency. How frustrating!! 

After much arguing over the phone and attempts at convincing the helicopter service that we could not afford to wait all day for the ambulance. We had no choice but to book her the next ambulance for transport. With all of the speedbumps and dips in the roads out here this woman will likely be lucky to make it alive to the next hospital. I hope luck is on her side tonight. Sometimes I just feel like everyone is working against us here. I don't know if this doctor just did not trust our diagnosis or was overwhelmed already with his own patients and did not want another, but I can't help but think about how lucky we are back home to have such a relatively excellent health system. 

On a happier note, I was able to successfully perform my first LP (lumbar puncture/ spinal tap) today completely unassisted! Also saw a woman with probable miliary TB.... Her chest X-Ray was incredible! 

Back home at the house I'm staying in, it is extremely busy. 16 people showed up for dinner tonight and the Fredlunds have a brand new kareoke system that has been being put to very good use. For dinner we had traditional maize meal with a peanut sauce and mashed butternut squash, which was delicious. 

Back of the Fredlund's home.

View from the back deck...

...and now I'm off to bed!!

There's a Snake Where?!

 A patient showed up today with a tourniquet on his finger claiming he had been bitten by a snake. Around here, snakes are extremely dangerous, and any bite is taken seriously. As such, it is important to identify the species of the snake to know how serious the bite may become. After examining the elderly mans finger, which was only mildly swollen, I asked the man if he saw the snake that bit him (in attempt to identify what type it was). He did not speak a lot of english, but he said something to me in Zulu and pointed to his pocket. Then to my surprise, he pulls out a wadded up grocery sack and hands it to me. It was tied tightly shut and I had the hunch of what might be in that bag. 

I was right! He had the snake in his pocket! Eeek! Luckily it was very dead. 

One of the other doctors who is quite the snake expert came and looked at it and identified it as a "stiletto" snake, which can be quite dangerous. This man had managed to kill it before it had injected too much venom, however, and he seemed to be okay for now. 

Only in Africa would your patient bring the snake that bit him in his pocket. Haha.

Work Hard, Play Hard

I've been a bit delayed posting recently because the internet here has been working off and on and I also went away for the weekend to camp out at the beach.

I always have so much I can write about I never know where to start. So this first part will be about work. I'm still having a blast in the hospital and I think I FINALLY have the proper Zulu greeting down with all it's variations! Luckily the greeting doesn't have any words with clicks or smacks (which are really hard to incorporate into without chopping up the word), I can say sawabona, unjani, and nilapila without getting laughed at :-).

I worked a little all over the hospital last week. Even got to ride to Mbibi Clinic with Dr. Boot (Fem). This was quite a trek, it was an hour of bouncing around in the sand and flying through puddles four feet deep and hoping we didn't get stuck! The pharmacist, a nurse, and receptionist rode with us out there, so we basically had the whole clinic in one car. 

We only say probably ten or twelve patients, which I am told is quite a lot for that clinic. It was extremely rural and the clinic had its own water basin/tower thing that allowed them to have running water. My favorite patient was a 100 year old gogo who was almost blind and extremely hunched over but she still moved relatively quick and wore the brightest colors and the most different patterns out of anyone there. All she wanted was her hypertension medication too. The women here are so strong. You can see how hard she has worked her whole life and it's amazing to see someone won't so few resources make the most out of what they have and still make it to a century old with no disabling problems. I tried to get a picture with her but she was too fast out of that place to catch, haha.

Back at Mselini Hospital, there was much going on as well. We admitted an 8 year old girl with a recurring laryngeal papilloma that was blocking her airway and causing her to struggle extremely hard to breathe. A baby boy, a few weeks old, also was admitted by a family member because he was extremely lethargic and not feeding well. This boy has admittedly captured my heart a bit. The staff tells me that when he was born, his mother took one look and literally ran out of the hospital with the nursing staff chasing after her. She never came back and wants nothing to do with the boy. Her family has kept him since but is not committed to taking care of his special needs. He has clubbed feet and scoliosis and a very narrow rib cage, making his body look contorted. His ears are small and sit low on his head, which is full of curly black hair. He has huge brown eyes as well and will sit and stare at you for hours of you hold him without making much of a peep. He has micrognathia (small, recessed lower jaw with a small tongue), which might be part of the reason he is not feeding well. We don't know what is wrong with him but it is presumably some sort is genetic syndrome that we don't have the resources to test for. 

He is doing quite well now that we are tube feeding him and correcting his electrolyte imbalances. When he was brought in, he has small, strategically placed razor blade scratches all over his body. This told us that his family had made an attempt to "rid him of his demons that made him look different" by taking him to the traditional Zulu healer, the Sangoma. While Sangomas can do wonders with their herbal remedies, or "muti", curing diarrhea and some cases of pneumonia, for babies muti can be lethal. Dr. Boot has seen it all too often and I see her counsel patients every day about giving their babies Zulu muti that can cause liver failure and a wide assortment of other issues depending on the ingredients used. The people seem to understand our concern and we do our best to respect their traditional practices and continue to encourage the use of the safer varieties. 

Off the topic of medicine, I was able to go away this weekend to Sodwana Bay, which is about a 20 minute drive from here. A beach that is largely untouched by tourists, I really felt like I was seeing an untouched part of nature. 

The beach went on forever. The locals use it for primarily swimming, snorkeling, and scuba diving, so we took advantage of all of these opportunities. 

Since I don't have enough time here to get my diving certification, I decided to ride along on the dive boat with Dr Boot and went snorkeling above where they were diving. It was beautiful! I saw two sea turtles, a sting ray, and thousands of colorful fish. 

Femke i.e. Dr Boot (left) and our friend of the day, Kurt, who is a local, hanging out on the stumps.

My not-so-elegant attempt at the stump sitting.

Fem and I at dinner (notice how happy Fem is to be the landing pad for some gecko poop on here right arm!!)

Oh, and we stayed at Coral Divera Backpackers, a little lodge with cabins and tents you can rent for $30 a night. It was such a relaxing way to spend the weekend. 

...until the monkeys start stealing swimsuits off the clothesline and putting them wayyy up in the trees (happened to the gal in the tent next to me!) haha. Here's monkey waiting for me to wake up so he can try to get into my tent to see if there is food in there...

Fem calls them "cheeky", in her Dutch accent :-)

What a great week of working hard and a great weekend of playing hard!! Couldn't ask for any better of an experience with any better of people.