Dom in South Africa: One Year On

Morning after the rains - view from my window.

The sun is shining and the weather is fine. Yes, that’s right summer is just around the corner for those that live in the southern hemisphere. My daily ritual of signing death certificates is made just that little bit easier when it’s bright outside. The death rate in the medical ward is abysmal, but something that I am sure rings true of many hospitals in this part of the world. Our job would be a lot easier without the burden of HIV and TB. However, it is here and we must face the music and dance. Before this week even started I admitted two young HIV positive individuals who arrived on a bus: one from Durban and the other Cape Town – both very far away. They had nothing but the clothes adorning their wasted bodies. Both had an infection around the brain associated with HIV: cryptococcal meningitis. Unfortunately, neither of them survived.

A young HIV positive man with lesions all over his groin.
It may well be Kaposi's Sarcoma, a rare cancer often seen in HIV.
I have taken a biopsy and await the results.

I see similar stories all the time – young people returning from the cities, their places of work, far too sick to even walk. Each time I am amazed at how they managed to get on a bus. Most of the time, they are beyond hope, but occasionally they bounce back. I always wonder what their stories were: Did they know they were sick? Did they know they had HIV? Had they taken HIV drugs and then stopped as they felt better? Did someone just dump them on the bus home? Does the family know their situation? Why didn’t they come sooner? Were they scared? I could go on. However, the last question is something that I have thought about a lot today.

Today is my one year anniversary at Holy Cross Hospital – to celebrate I thought it only sensible to perform an HIV test on myself. I don’t have any cause for concern and am yet to needle stick myself, but I do occasionally wonder. For example, did any of that spurting arterial blood which just shot past my face get in my eye? Or, did that piece of glass I just found in this guys chest go in my finger or not? My answer has always been: I don’t think so.

My negative HIV test.

A rapid HIV test is a bit like a pregnancy test, except you don’t wee on a stick – you need a drop of blood. As I walked off into the car park with my test I had a sudden surge of anxiety as I paced around waiting, for what felt like a very long time, as it processed – HIV would completely change my life; how could it not. Fortunately, the test was negative. However, I don’t think that I have ever felt so unnerved. Yet, here at Holy Cross we are telling people that they are positive on a daily basis. I can almost see why young people don’t test: for fear, denial, but probably more than anything, that feeling of invincibility. How can something you can’t see affect me?

***

Jan - a running machine. The others are nowhere to be seen.

Last weekend I partook in the Madiba Mission – a 32km run created a few years ago by a British doctor who worked at another government hospital similar to Holy Cross, called Madwaleni. For those that don’t know, Madiba is Nelson Mandela’s Xhosa name. From what I gather, the distance is what he and his mother had to walk to get from their house to the nearest clinic. Not a lot has changed, mind – many people around Holy Cross still travel similar distances. Yes, there is transport, but often one cannot afford it or they are too sick to travel, and ambulances are thin on the ground.

Jan - Winner

Madwaleni is the hospital that I mentioned in a previous post. A friend who worked there had created a petition directed at the Eastern Cape Department of Health, urging it to employ medical staff. As of yet, nothing has happened and the situation is grim. The hospital is now left with one doctor. The amount of death certificates she signs each morning dwarfs my pile. It is a sad state of affairs and the people who are suffering are those at the receiving end.

Disclaimer: When I say I “partook” in the Madiba Mission, I didn’t run. I have the lurgy (fingers crossed it’s not TB – don’t worry Mum, it’s flu season). Instead, I was the water boy for my Dutch friend Jan, who is a doctor at a hospital down the road. He won the race by a mile; all thanks to my superb coaching and water dispensing technique if you ask me.

Kids holding the finish line tape - everyone wanted a piece of the action.

An impromptu sing and dance welcomed the runners at the finish line.

People know how to sing and celebrate here.

***

I occasionally jot down some of the bizarre events that occur down in the hospital. I’m not sure if you will find these amusing or sad – for me it is usually a bit of both. However, you can decide:

Xenon lights guide the way.

· I found out last week that the giant Xenon (i.e. really expensive lights) cross that stands on the hill by Holy Cross at the church was funded by our hospital. I’m not surprised, but could think of some more fitting places for those funds. However, if it makes the community happy, then I’m happy. I just don’t know if it does.

· I received a call whilst on duty the other night: “Doc, there is a patient here. He is talking plus plus plus.” Maybe he just wanted a chat. Turns out he was exceptionally manic and believed he owned and ran the entire municipality.

· A member of staff walked into casualty then proceeded to drop to the floor in wailing agony. The thing is I don’t think she was in that much pain, or at least had an exceptionally low pain threshold. My suspicion is that she is a budding thespian. The first thing she asked me was how much sick leave she could get – she probably wanted to go for an audition. I’m not a cynical guy, but sometimes I do wonder.

You can see the healed fracture on the right hip
(left side of the picture).

· A six year old girl hobbled into my consulting room with her mum. She was fine except for a very short right leg; she fell over in 2008. She had fractured her hip, but was never brought to hospital – maybe it was too far or expensive at the time.

· The theatre was completely flooded with water at morning handover last Monday. Some young boys who had been stabbing each other the week before and admitted on surgical ward got bored. They plugged up the sinks in the toilets with tissue and let the water run all night. How this wasn’t spotted until the morning, I don’t know. There are plenty of staff on duty at night; I hear it wasn’t very busy, so they were probably sleeping.