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:

Cape Town - Day 4

A bit of a trying day here in Cape Town, as my camera was stolen/lost (not sure what happened), but overall we were able to see quite a lot. Unfortunately my pictures from the day have also disappeared, so this will be my least favorite type of blog until I figure something else out (words and no pictures).

We had planned to take a full day peninsula tour today to see the Cape of Good Hope, botanical gardens, boulders beach, and the penguin beach. Up bright and early, we grabbed a quick traditional breakfast of yogurt with muesli and fruit to go. The coffee here is delicious. There are Starbucks quality shops everywhere with drinks at half the price. Back in my days at working at Panera, I always found it odd when people ordered an Americano (water mixed with a shot of espresso), but behold! It all makes sense now! In Cape Town, it seems, you can't just order a cup of traditional American style coffee (hot water brewed over coursly ground, unpacked coffee beans). It literally does not exist. Instead, everything is made with espresso (hot water brewed over finely ground, compressed coffee beans). So when American visitor asks for coffee, they will give you an "Americano", which is essentially watered down espresso. Is this their notion that we are wimpy coffee drinkers? Maybe. But I'm fine with the fact that they still give you a little square of 70% cacao dark chocolate to drop right into that wimpy Americano! It's possible that this is all old news to all your coffee aficionados out there, but I was fascinated by my little discovery.

We waited for almost an hour for our guide to pick us up. Turns out they never showed, and upon calling the company we found out that when our shark dive was cancelled due to weather that they accidentally cancelled our day tour as well! (Whoops!)

We ended up rescheduling with the company to take a half day tour instead, so we had the remainder of the morning to do as we wished. I dont know if Chris shared my enthusiasm, but I was pretty pumped to wander around in some local clothing stores. Everything is SO CHEAP here! I got a nice Nike-esk running jacket for R220, ($22), and four other workout shirts for around $8 each, which will also.be nice to wear in this heat. I'm not sure if I packed enough extra empty suitcases for all of my purchases! Hah.

When 2 o'clock rolled around, we once again set out to wait for our tour. And once again, it didn't show. So after about 20 minutes of waiting we decided not to waste any more of our last day in Cape Town. We headed to the local bus stop so that we could find our way to some of the scenic spots ourselves. Just as we were about to leave, however, along came our minibus tour company! An elderly British couple on the tour informed us that if we wanted to be picked up in a more timely manner, that "next time, you need to just need to flap your pants a bit at us!!" (in the heavy Susan Boyle-ish/Dr Brown accent, of course). She helped demonstrate her method by taking the corner of her giraffe-print pants and waving them around at me. Lovely. Lesson learned, I guess.

Anyways, we were off to Camps Beach, another beautiful bay with tons of sand and pretty turquoise colored water. We then went to a small fisherman's wharf where the locals had managed to learn to make money from the tourists by luring the sea lions up onto the dock. It was literally like a unofficial sea world, as they had actually trained some of the sea lions to wait on command to take fish right out of our hands (and grossly enough, out of the local's mouth!). It was easy to see that they thrived off of this, as the sea lions were HUGE, at least 700 pounds.

After this quick stop, our driver urged us to get back into the minibus so we could hurry to the next spot, the Cape of Good Hope. This was a very rough ride with lots of bumps and windy roads... I just held on and hoped I would get car sick! The views were worth the trouble. I just wish I had the pictures to convince you of that! We saw baboons, tons of cute little penguin, a whale jump out in the ocean, lizards, and some really pretty plant life.

Dinner was back down by the waterfront, and we opted for some African braii (barbecue)! The dinner special? Grilled zebra, of course!. They also had warthog, ostrich, oxtail, beef, mutton, and various seafood choices as well. Although I was feeling adventurous, I couldn't quite bring myself to eat zebra or ostrich yet... at least knowingly so. So I ordered the bobotie, described on the menu as minced meat with an egg-based topping, mostly because that way I had no idea exactly what kind of meat I was eating and wouldn't freak myself out. I also asked for a side of traditional South African pumpkin pie, because seeing that it.was listed on the menu as a side item versus a dessert, I found that to be the perfect excuse to try some.

The bobotie, to my surprise, was delicious and not at all what I was expecting. I thought it would be more like a grilled meatloaf, but instead it was like a sloppy Joe casserole topped with a baked egg layer. It was served with a chutney and rice. The meat had a hint of sweetness, which I believe was small pieces of dried fruit, with a hint of mild curry flavours.

Bobotie (not my picture)

BI am told this dish originated from the  Dutch East India Company colonists in the 1600's, but has since become a traditional African dish in South Africa, Kenya, Botswana, Zimbabwe, and Zambia. Traditionally it was made with mutton and pork, but now it is more often composed of beef or lamb. Anyways, I was glad I ventured to try it, and I will definitely look to order it again before I leave Africa!

Chris and I will be off to our final destinations tomorrow morning! Wish us luck!

Cape Town - Day 3

 So to continue the windy city theme here, we unfortunately found out last night that our shark diving adventure was cancelled today due to high winds making it unsafe to dive. Sad news, but maybe this was someone out there trying to prevent me from getting eaten by great whites ;-)




Even though the sharks were a no-go, the cable car up to the top of Table Mountain reopened today. So we headed back up to the base station this morning and were able to get some even more amazing views of Cape Town. The cable car was interesting as it rotated as it was being hoisted up the mountain. It had a 7,000 liter water hold underneath it that acted as a ballast in the wind! There was a nice little restaurant at the top and a large walking area where you could see the plethora of mountain plant life. It was definitely worth the trip back!

On the way to the mountain we met a local white dude on the bus who was very interesting to talk to. He was traveling with a young African boy to pick up new shoes. He had lived in South Africa all his life, between Cape Town and Johannesburg. After explaining to him that our trip in Cape Town would be short because we actually came to Africa for medical rotations, he was keen on explaining his differing experiences between even South African cities. Cape Town, he explained, is the gem of sorts of the post-apartheid era. I am looking forward to seeing the difference in cultures when I arrive in Durban on Sunday.

To the right you can see some of the interesting plant life I found up on Table Mountain.

 Another great view looking down the back side of table mountain (to the South).

The man on the bus recommended Clifton Beach for afternoon relaxing, so we headed there next. It was actually four beaches separated by these beautiful black granite boulders that had almost pure white sand crystals within them. These four beaches all had a unique vibe, so we were glad that the man on the bus directed us towards the most fitting one, haha.




African men roamed the beaches selling drinks and umbrella rentals for extra income. There was a group of boys there playing rugby. Even though their ethnicity varied from white, African, Indian, and Hispanic, all had exactly the same skin tone! I guess that's what the African sun will do to you! Awesome!

 I buried Chris in the sand.



This is what is left of him... :)

To top off the day, a feast of half price sushi! 23 rand for a dragon roll!?!? (That's $2.30)... good thing I love to eat! YUM!