I recollect writing a while back that we were expecting the arrival of three doctors in November. Unfortunately, they still haven’t arrived. There seems to be a big problem with delays from the South African health board. Their process of certification is extremely convoluted and puts a lot of potential health care workers off. It’s absurd really: a country so desperate for doctors that has a massive brain drain makes it incredibly hard for foreign medics to come work. I understand that checks need to be made to ensure that you’re not employing Dr Nick from the Simpsons, but in some cases it has taken over a year for the applications to be verified. Together with this, one only needs to give a month’s notice before leaving a job here. Hence, there are plenty of hospitals, like ours, that are running on cotton threads. It’s not just me who thinks this is a problem – the papers are plastered with stories of local hospitals threatened with closure due to a lack of doctors.
I am really enjoying my work here, but am often frustrated with the poor care that we offer for many of our patients. There is a lot that can be improved at Holy Cross – all it needs is a little direction and leadership. Unfortunately, there aren’t too many folk here that are motivated enough to try and salvage this sinking ship – maybe it’s not that bad, but it certainly feels like that sometimes. I hope that the arrival of new doctors will help us rejuvenate this once successful hospital and spur the staff into being a bit more pro-active.
I think being “pro-active” is a bit of a taboo subject here. Earlier this week I arrived in casualty to start seeing patients. At the front of the queue were some very well looking people; slumped in a wheel chair in the middle of the department was a dreadfully sick looking girl of about twenty. To be quite blunt, the triage here is crap. The nurses were sitting and gossiping at their station (a familiar site) and hadn’t blinked an eye at this young female with her mother. It is not uncommon to see cases like this – they often have end stage HIV and already beyond the grave. However, one should never assume that the point of no return has passed. I whisked her onto a bed – myself and her mother; no help from anyone else. Before asking any questions I resuscitated her – she was septic and in a state of shock. I went through my A-B-C (d.e.f.g. “don’t ever forget glucose”) – her blood sugar was dangerously low. She responded well to my treatment and went from an almost comatose state to being able to tell me how poorly she had been. It turned out she was HIV positive, not on treatment, and had just been diagnosed with multi drug resistant TB. The latter diagnosis carries a pretty poor prognosis, but only time will tell. It made me wonder, though: how many other incredibly sick people get brought to our hospital and are left with the assumption that they are far too gone. But then, is my treatment just prolonging the inevitable? Prevention is better that cure. However, you try and tell some of my clientele the importance of condom use.
I feel like I am having a go at my nursing colleagues – I don’t mean to. Many of them are amazing and I love them to bits. Without them, we would be completely stuck here.
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I saw a gentleman last weekend who managed to chain saw his own knee – putting it back together was a bit like a jigsaw puzzle: “This flap here seems to fit with this one there. This tendon fits with that one...” I was quite keen to admit him to the ward so that I could refer him to the specialists the following day. However, he was more concerned about going home to make sure his money and gun were secure. I let him go as long as he promised to return – he stuck to his word and was back later the same day.
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A lot of the time things get lost in translation – my Xhosa is terrible and the Xhosa to Zulu to English translations often get a little skewed. Last week I saw this old fella who was complaining of a sore throat. My first thoughts were: “Come on mate, you’ve travelled how far for me to tell you to take some paracetamol, drink some orange juice and maybe gargle some aspirin?” As the diligent doctor that I am, I had a quick peak in his throat. However, it wasn’t a sore throat he was complaining of, it was a sore mouth. He was a lifelong smoker and had this nasty ulcerating lesion under his tongue – cancer I expect.
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I saw a fifteen year old in casualty yesterday who was making these very bizarre jerking movements of his limbs, especially when I looked at him. I was pretty convinced he wasn’t having seizures and it didn’t look like a chorea. Basically, I didn’t really know what was going on – so, what did I do, I sedated him a little with some valium, checked his HIV status and did a few blood tests. The same evening I was walking through casualty to do a c-section and there was that same boy being, from all accounts, exorcised by one of the nurses. The whole room was shouting and praying; the nurse was screaming in the boys face: “GET OUT..... LEAVE HIM.....GET OUT.....I COMMAND YOU.” I couldn’t help but smile as I walked through – just what if this works. Sure enough, the next morning he was fine. Maybe they should add Exorcisms to the medical school curriculum.
Photos to come when the internet connection improves. i.e. when I am somewhere other than Holy Cross.
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