The kids are (not) alright.....

This is my house (yes, it is rather big for one person as I said) and the massive red thing on the left is the most petrol thirsty beast I have ever driven. Sadly, it's not mine. It belongs to Jelleke, the dutch doctor who's currently on leave until November. I'll upload some hospital pictures soon.

I’ve been delegated the task of looking after the paediatric ward, as well as assisting in Out Patients and Casualty.  After all, I did tell the boss that I wanted to get more emergency department experience.

I’ll start with paediatrics. Looking at my CV, I could kid myself into thinking that I have a little bit of experience – I had a rewarding rotation as a medical student, spending 3 weeks of it at the King Edward Memorial Hospital in Bombay. However, I seem to remember spending most of my time watching cricket and sitting on our apartment rooftop. Maybe I should’ve paid attention. The only real experience I have had is doing paediatric A&E at King’s in London and my Advanced Paediatric Life Support course (a last ditched attempt to kid myself that I would be fine down in South Africa). So far, I’ve had no major catastrophes. Kids are pretty simple: when they’re sick, they look sick; when they’re well, they punch you in the balls and then hide behind their parents. The main problem I’ve had is knowing what to do with the kids who are somewhere in between castrating you and knocking at deaths door. How do I really know if that infant has TB? What on earth do I do when there’s a child with cardiac failure or nephrotic syndrome? When do I start HIV treatment in a child who’s looking close to heaven? These are all questions I pose my two bibles – one is yellow, one is blue. So far, they’ve been my guiding light as some of my colleagues don’t give me a straight or very helpful answer. Actually, that’s not true, but it’s a pain to discuss every single patient.  When they’re really sick, I just phone the referral centre for advice/transfer. However, sometimes they’re just too sick to be transferred. This was the case with a 2 month old bubba I admitted with a severe pneumonia secondary to probable HIV infection. I was sure she would pick up with aggressive treatment, but she died within a few hours of admission. HIV is an absolute epidemic here and kills a remarkable number of infants. Often the mothers don’t know they are HIV positive themselves until they present to hospital in labour, where HIV testing is routine. I still have so much to learn about HIV management.

Out patients, or OPD as it’s called, has only one word to describe it: INSANE. I’ve seen people with undiagnosed end stage HIV all the way through to someone with a minor sniffle and sore throat (but one does always wonder if that’s the patient seroconverting – for the non medically inclined, that’s when someone first gets the HIV virus). Most of the time I feel like I don’t really have a clue what’s going on, but if they look unwell I keep them in and just make sure I’ve covered ALL the bases with treatment and hope they improve. This may not be quite evidence based or the best use of resources, but it seems to work.

Casualty is like any other emergency department, just with a load more knife and gunshot wounds than I’m used to (even coming from Camberwell in south east London – supposedly an area with the highest proportion of gun and knife crime in Europe). If you don’t know what I mean, then you should go hang out in one some time. It’s incredibly fun.

On the way to work each day I walk past the “mental ward” and get asked by the patients: “eh Doc, you gonna come discharge us today?” Each time I sheepishly reply “Uhh, no, I’m not the doctor looking after you, but I’ll ask him.” I eventually asked him today and he said that they say the same to him, but they’re just not ready to be discharged yet. However, I must say I haven’t seen him visit the ward in a while, so maybe he’s not being straight with me or his patients.

Here is something you might find interesting; something I find quite odd. A couple of the doctors do a prayer before commencing a caesarean section, or any procedure for that matter. Now, I don’t know about you, but if I heard the doctor/surgeon praying just before cutting a nice big hole in my belly I would not be reassured at all. However, maybe that’s just one of many cultural differences.

This week I have been trying to get my head, and hands, into obstetrics (amongst other things). Within the next two months or so I need to be efficient in managing obstetric emergencies and competent at performing a number or procedures including caesarean sections. The idea of this is quite daunting when I think about everything else I am quickly attempting to absorb. On the other hand, it's very exciting too. However, the glutinous blob of jelly that sits in my skull is fully saturated after a week of work and reading. So, as a treat I've left the countryside and arrived in Durban. I'm planning on eating a lot of curry (there’s a big Indian contingent here) and see if anyone wants to sell me a car.

Domx