I have just returned to Holy Cross from my two week anaesthetic jaunt in Port Elizabeth (PE). What a rewarding experience that was. I was surrounded by enthusiastic, mainly young, anaesthetists and mentored by an inspirational consultant, Dr Smith. I have come back feeling energised, full of knowledge, new skills and a slight sun tan. I am not expecting to walk into work tomorrow morning and have lying before me a patient that needs to be intubated. But, just in case there is, I am ready – I just need to make sure I know where the tools and drugs are to perform and make emergency anaesthesia safe. Hence, I’ve written a check list that I hope to use in the coming weeks so that I can pester the management if the hospital is lacking certain drugs or equipment.
During my fortnight in PE I gave my sinuous pins a good workout, hence the slight tan. Most evenings I went running on the beach, whilst the sun was still warm. The crashing of the waves and salty air did wonders for my psyche as I bounded along the walk ways and firm sand of the shoreline. One evening jog was made even more magical as I looked out to sea and saw a whale do it’s “breathing” thing followed by that nonchalant: “Oh, I think I’ll just poke my tale in the air and slap it down on the ocean with a big splash. Oh what fun.” If whales could converse as we know it, then I expect that is what they would say. For some reason I was reminded of The Hitchhikers Guide to the Galaxy in the scene where a whale suddenly finds himself falling from the sky and the thought process he has as he descends to his quick demise. These are some of the things I think about when I am running. Maybe I need to start running with other people so my mind doesn’t veer off track so often.
As I said, I met several anaesthetists in PE; almost a new one every day. I remember one conversation with one of the younger trainees, who is my age. We were talking about the difficulties many of the hospitals have, especially in the Eastern Cape (this is my only point of reference). As usual, the same problems were highlighted – poor management; no leadership; terrible stock keeping; substandard nursing; lack of pharmacists, physios, occupational therapists, dentists, doctors etc. Often a problem that we see here is that a lot of the staff, be it managers, nurses, porters, handymen and, shamefully, many doctors, do not often seem to know what is in their job description. You get doctors who go to work, see twenty patients (that’s their daily limit) then go home at midday; nurses who sit at nursing stations all day socialising; porters that need to be called every time to begrudgingly transfer a patient or take a blood sample to the lab; handymen that just sit in the shed all day and don’t do anything “handy” at all. Worst of all, there are very highly paid managers sitting in their office in Bisho (the administrative capital) laundering money from the health system. Well, this is what the anaesthetist had to say and I did have to agree with him on many of his points. I think, however, times are slowly changing and a big shake up of the way the health system is run here is slowly being addressed – at least this is what the politicians are saying, so many remain sceptical. I hear the chaps in Bisho are all getting the boot or a kick up their arse to actually do their jobs and come and work in the local hospitals rather than sit in their nice air-conditioned office.I have just heard that Holy Cross is expecting some new well trained nurses to make sure our team here work efficiently and proficiently. I wonder whether this will change things - I hope so.
The chat about the difficulties the health system is facing wasn’t really my point though. Whilst we were talking, I started talking about the high number of organophosphate overdoses (incredibly lethal) I have seen at Holy Cross or the difficulty I have had managing diabetic emergencies. Both of which are treatable with the right resources. He was shocked when I told him that we often have no way of monitoring blood sugar, no trained staff to nurse an intubated patient and suction their airway and other, what he felt were bog standard, requirements. I was slightly taken aback by how surprised he was, even though he, being a South African, was talking about the problems hospitals in his country have in acquiring the correct materials. I had similar conversations with other anaesthetists in PE and most had a similar response. I am amazed, but not surprised, that some doctors don’t know quite how difficult it can be to work in the rural hospitals within their own country, as theoretically they should all be well stocked. After all, there is plenty of finance here. It is almost laughable: at Holy Cross we have about eight new fancy defibrillators (a machine to shock the heart back into rhythm), but no soap or paper towels to wash and dry hands with. I am still clueless as to how the hospital procures items, but when I do, I hope I will be able to address a few essential issues. Number one will be making sure we have enough high calorie milk to feed our malnourished children; it is extremely embarrassing and frustrating when we admit a child and cannot feed them as we have run out of feed.
So, enough about the disastrous management here, what about my own? After weeks of complaining about my lack of organisational skills to stock the house with beer, I now have a very attractive looking stock cupboard filled with various pilsners, cider and a bottle of wine (I had 3, but managed to break two – dropped one and the other popped in the back of Mitch, probably as I hurtled over a few pot holes). I got back to base last night and found out that we have no water supply. Oh, what sweet irony. I guess I shouldn’t complain too much as I have a very large rain collector outside. However, I seem to have put a small hole in it whilst trying to work out how to turn the tap on. What makes the situation even funnier is that it is raining cats and dogs outside and there is a massive thunderstorm with more lightening than you can shake a stick at. A massive bolt of electricity has been illuminating the hills every minute for the past hour or so. It is an amazing spectacle, as I sit here gazing out from the safety of my sitting room. But it means I can’t even go outside to shower in the rain for fear of being struck.
Back to work tomorrow. I hope the water supply fixes itself soon so that we can wash our hands, whether or not we have soap or towels.
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