Dom in South Africa: Tales from the sky.

"Heritage Day." Everyone dressed up in traditional attire.

I cannot complain – life is not bad. Not bad at all. Right now I am sitting on a flight to Cape Town cruising at 30,000 feet en route to see friends for the weekend. However, for much of the community that I see at Holy Cross on a day to day basis, I often wonder how they manage.

It appears the security guard has been using the
Holy Cross sign to do a little mathematics.

For the simplest task, patients must put in a lot of effort. Every evening a group of about twenty line the floor and benches of our outpatient department to get the patient transport vehicle to be seen by a specialist in our referral centre four hours away. If the bus hasn’t broken down or the driver lost the keys (an all too common mishap) then they set sail at about 4am and return later the same evening. Sometimes it is a wasted journey – maybe their appointment was lost; they got lost; the specialist was on leave; the scanner was broken – a whole host of reasons. Then, it’s another sleep on the bench before making the long trip back home or waiting in another long queue to see one of the Holy Cross doctors for whatever reason.

We have just had six medical students from the local university on their first hospital placement. Their main objective was to find out about the area demographic and disease profile. Despite only living four hours away, they were aghast to find that there are people living in their own country who do not have a clean and reliable source of water or regular food supply. I am sure there are plenty of similar issues that I am naive to back home, but at least water is abundant and plentiful. At least, that is what I am led to believe.

Translation: Take a Condom. Written underneath in pen: Where?

There are some commendable initiatives led by a selection of our staff. They are all church based groups, but then that isn’t unusual. One programme is aimed at giving patients who have been discharged a bit of spiritual guidance, going to their homes to see what conditions they live in and providing food parcels and clothing donations as deemed fit. For all the difficulties I see, I really admire the compassion that much of the community hold. One thing you will never see here is someone on the street – it just doesn’t happen. The idea of a homeless person is unthinkable. So, if you have any clothes you were thinking of throwing out or giving to a charity, why don’t you send them to me. At least this way you know the clothing will go to people who need it, rather than landing in the hands of a local entrepreneur to sell on.

If you do want to send out clothing, my address is on the first page of the blog. To make things easier, I’ll write it again:

Dr Dominic Craver

Holy Cross Hospital

Private Mail Bag X1001

Flagstaff

4810

RSA

The tomatoes from my garden just don't stop coming.

***

Work is back in full swing and I must say that I am really enjoying it. This “amazing experience” stuff that I spoke about in my first ever post still rings true. However, it is tough. Really tough. They say people that work in the medical field need to detach themselves from getting too emotionally involved in cases. I hear that if we open our hearts too much then there is a possibility that we may all crumble into a big sloppy pile of blubbering jelly like wrecks. However, how can one not get involved: we are all human after all. As long as there is someone to talk to, to open up to, then things will be all right. But, I think a cry now and then is just fine.

Seeing a child die is probably one of the darkest encounters there is. It is a privilege that I have had on far too many occasions; I remember every single one. This week another such event happened. I was in casualty on Wednesday and just finishing up when I walked passed a two year old boy lying on the gurney next to his mother and gogo (grandmother). Initially I thought he was sleeping, especially as there wasn’t too much concern coming from the family. However, he had stopped breathing – without even asking, I grabbed the child, snatched a nurse and brought him into resus. He was in respiratory arrest.

My colleague Dingerman came from home (a paediatric resus is difficult at the best of times, but on your own is almost impossible) and helped me stabilise the kid. And there the little fella was – helpless and covered in tubes: on the ventilator; a needle shoved into his leg giving him fluid and antibiotics; a catheter coming out of his small penis. Our plan was to keep him overnight and get the helicopter at day break. Unfortunately the weather was too bad and the ambulance was not able to respond fast enough with the correct equipment – they needed a ventilator for the four hour drive. We are not specialists, none of us are intensive care doctors, nor paediatricians. All we do is try our best. At four pm the next day, with no sign of any transport and the child showing signs of irreversible brain damage we had a very difficult discussion with the mother. I couldn’t help but shed a tear as I watched her hug and cry goodbye to her baby, her only baby, before we switched off the ventilator.

This was possibly one of the hardest decisions I have ever made, but not one I did alone. I have asked myself a couple of questions since: Did we have the right to make the decision to turn off the ventilator? Should we have kept it on and waited another day and see if the weather improved? I don’t think so and stand by the decision that we made as a team. Most of my colleagues would not have even begun the resuscitation. However, children can bounce back as quick as they go down. We were just a few minutes too late. The other question is why was he sick? The most likely cause is that the enema and medication he was given by the gogo and sangoma (traditional healer) poisoned him. It is a sad, but all too common cause of childhood morbidity and mortality: herbal intoxication.

"Peau d'orange" and an inverted nipple in a lady
with confirmed breast cancer.

***

On a slightly light note, I walked onto the ward yesterday to see that the old schizophrenic patient I had admitted for a 72 hour observation (our holding period on a medical unit before transfer to the psychiatric unit) had an oxygen mask on. For a second I thought the heavy sedation required to calm him down had knocked out his breathing. However, it turns out he was running around the ward earlier and was wearing the mask as the latest fashion accessory.