My South African Adventure: 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.