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.

Are you a doctor?

So I started working in the Mselini hospital on Tuesday and it's wonderful.

There are around 15 other doctors who work here on and off and all that I've met so far are great. They are from all over the world and live here in a doctors compound/ apartment complex right here at the hospital.

I'm still trying to get used to being called "doctor" and having the nurses asking me to tell them what to do!  I get quite a lot if autonomy which is nice, but it's still pretty scary coming from a place where you always have at least 4 other people checking your work and you actually make no decisions on your own.  I've found out how much I rely on being able to look things up when I'm not sure of dosing or need to figure out what a South African medication brand name is equivalent to in the states (no wifi in the hospital and computers are pretty useless as far as internet goes). It's difficult to carry books everywhere you go too but that's pretty much what I have to do is wear a backpack around all day. (No one wears white coats, it's too hot!)

I've been working with a 28 year old surgeon named Fem from Holland who has been in Africa for about 2 years now (still haven't figured out how she's so young). She is so much fun to work with! Very goofy and upbeat yet very practical in her approach to care. 

The hospital has decent resources but there are still a lot of things in short supply. Paper towels to dry your hands after washing, it seems, is not a necessity . Another basic item in short supply is medical tape. You surely have to become creative when you run out of that! I was excited to see the hospital has one suction machine. Yesterday we fashioned a wound vac out of it (the nurses had never seen this technique before) by autoclaving seat cushion sponges for inside a gigantic pressure ulcer then we used an nasogastric tube for the suction. This lady's wounds are huge (previous Guillan-Barre syndrome left her a paraplegic) however, and we don't have anymore chair cushions to cut up so we may try autoclavibf kitchen sponges for future dressing changes. Hopefully they don't melt inside the autoclave!

Aside from satisfying my creative side, I have seen so much pathology here it's unbelievable. Since 35% of the general population here is HIV+, somewhere around 70% of the hospital patients are infected. My first day on the wards I saw Kaposi sarcoma, genital warts down to a woman's knees, and a breast cancer that had engulfed the lady's entire breast down to her chest wall and had ulcerated and was draining. This woman told us she had maggots eating at her wound (just from outside, the hospitals aren't advanced enough to actually use them for controlled wound healing here), and she had collected them in a wad of paper and put them in her purse. Unfortunately when she went to show us her little friends they had all crawled away.... 

A man came into clinic Tuesday who had caught his leg in a tree grinder and the other doctors had no time to really look at him or sew him up so they left it to me to figure out what to do... Ahhh!! It was a pretty deep wound on his thigh so I cleaned it out the best I could and sewed him up. Hopefully he will not come back to us with a massive infection on his thigh. 

The house I'm staying in is great, it is the home of Dr Fredlund and his wife, and there are about 10 other people living here. Three medical students (myself and twins from the UK), a teacher, and some local girls aged 16-26 who are finishing high school.

Most of these local girls have one or two babies, who live back at their homes with the Gogos (an endearing term for a granny). It seems having babies around here is more of a fashion statement then an act of family planning, and it's not uncommon to see a 17 year old on her 3rd pregnancy. They just hand the babies back to the Gogos to raise. Anyways, this house has a thatched roof and somehow had wifi, which is really nice. There is a chicken coop out back where we get our eggs and a sort of mini mart down the street where we can buy bread, peanut butter (which is quite the staple around here, we have a 5 gallon bucket of it here at the house), and milk or soda. They have little packages lunches with bread and some sort of meat there as well, but it sits out all day on the counter and is a little hard to stomach eating, lol. More substantial food is found in a town about 20 minutes by car away called Mbatswana or from the locals selling their farmed goods. We also eat a lot of the mango and guava fruit that grows on the trees outside.

 That is, as long as all the little boys from the town don't come knock them out of the trees for themselves before we can get to them! Haha.

This is the room I'm staying in. Mosquito nets are a necessity at night!

There is some great plant and animal life around here! 

Giant snail I found in the trail to the hospital.

Cactus blooms this morning after it rained.

Flowers growing wild outside the hospital.  

Last night the other medical students, the occupational therapists, and the doctor, Fem, and I all went to the  Tembe Lodge Elephant Game Park after work, about an hours drive away. It is normally a vacation lodge but the owners are very fond of Mselini hospital and will let the doctors in for free game drives whenever they want! We also stayed for a three course dinner! Yum! Here are some highlights:

This is not a joke... Apparently they are endangered or rare here and you are supposed to avoid running over them with your car.

Here is one working away on his ball of elephant poo. They roll them to try to impress the female dung beetles who will the lay their eggs in the ball and bury it. 

Above is an Impala.

Some male Kudus.

Looking for game at the hide.

Doc Fem and the twin med students, Ally and Kirsten, from the UK.

At the Timbe camp before dinner.

NOW I'm in Africa!

Holy cow, culture shock!!!

So I arrived in Durban yesterday afternoon to find that the "guide" who was supposed to meet me at the airport thought I was coming in March (whoops!). Nevertheless he wasn't there. I got lucky, however, and the doctor and his wife that runs the hospital in Mselini happened to be taking vacation time in Durban. They came ans picked me up and we stayed the night at his sons house.

This morning I was brought to the minibus station, which was SUPER sketchy, where I sat with all my American suitcases and waited for this minibus/taxi to accumulate enough passengers. I felt pretty silly, as no one else carried a bag that even resembled a suitcase, let alone two huge rolly 29" cases I had brought for this trip half empty to full with souvenirs, lol. ALL I KEPT THINKING WAS GAWD I HAVE SO MANY WHITE GIRL PROBLEMS. The people here carried their belongings on their heads and homeless people went from van to van selling pens and superglue. Oh, and AXES.... comforting.

In the midst of waiting for two and a half hours where very few people spoke english, I was grateful when an elderly women waiting with me offered to walk me to a bathroom.

When the minibus did finally get on its way, we jammed to some sort of African radio station for the next four hours. The woman sitting next to me, who was dressed quite promiscuously for African culture, sat counting her 20 rand bills ($2 bills), so I could only take a wild guess what she did for a living. Later, another elderly woman joined next to me who spoke pretty decent English. She told me that she was going to Mselini hospital too. For urinary incontinence. I just hoped she wouldn't have any problems with the long ride.

Highlight of the long ride by far was seeing a wild giraffe!!

Ill write more tomorrow about the house I'm staying in as it is late and the girl I'm rooming with is already asleep. Here's a preview: