Dom in South Africa: Fire starters and other things.

The "San Clan" - a 30 foot installation at Afrika Burn

The "San Clan" - Burning

The past month things have felt rather quiet at Holy Cross. I think this can be put down to the fact that the on call rota has become very user friendly, rather than our population becoming less dependent on the local health care system. On call is the time when our minds and bodies are pulled, twisted and pummelled. One is spat out the other end either a nervous wreck or a well composed, pragmatic and rounded individual. One learns what is achievable and the goal posts for treatment aims are adjusted. I guess there are two extremes – everyone must be cured or no one can be saved. I think I sit somewhere in a happy medium.

This may sound rather ambiguous, but let me give an example. When I first arrived at Holy Cross I was a little flummoxed at how we managed our hypertensive (high blood pressure) and diabetic patients. “It just isn’t right,” I used to tell myself. People were walking around with a systolic blood pressure of over 200 (that’s rather high) and blood sugars or 25 (it should be between 4 -6). But, then what is right? I see plenty of patients who present following a stroke and I expect a large proportion of them are secondary to poor blood pressure or diabetic control. The difficulty is that, with any population, getting them to attend regular checkups, take their medication and adhere to lifestyle advice is a massive dilemma. Just like back home, it is the same likely characters that re-present time and time again until eventually they give up. As clinicians, one cannot dictate how someone else should run their life, but maybe give a few well informed words of advice. So, when a patient walks in the door with a ridiculously high blood sugar or pressure I try to let them decide how we can manage their body, unless of course they are desperately sick, only then I shall try to run the show. However, try is all I can do – most of the time, it’s a brief admission and then “see you again in a month or so – same again yeah?”

***

I am forming a love hate relationship with the female medical ward, which I now run since leaving paediatrics. There are a couple of fantastic nurses and several less so. I do daily ward rounds to show my team that I mean business – because it seems that unless a doctor or one of my driven nurses show their face, then things just stay in limbo and patients either die or get better on their own accord. They could do that at home. To drum up a bit of morale, the plan is to try and organise a fortnightly morning meeting where we can teach one another about several important issues. I shall be using biscuits to lure my colleagues in before locking the door and not letting anyone out until we are all on the same level playing field. Watch this space.

A gentleman with massive gynaecomastia as a result
of an HIV drug he was once on. Unfortuately the
only "cure" would be a mastectomy.

The ward can be a bit of a head banging affair. Often I become a little frustrated with my own lack of medical knowledge, of which I theoretically should have a bit from all my UK training. The patient’s that we admit can be so incredibly complicated, but also immensely fascinating and warming. This week I have been treating a Sangoma (traditional healer) who is HIV positive and came in with severe exfoliative dermatitis with a super infection on top (it’s basically a nasty form of eczema that engulfs every little last bit of skin and is accompanied by a weeping infection that, if not adequately treated, can be life threatening). I think she was rather pleased with our efforts, although I am not so convinced about her commitment to taking her antiretroviral (HIV) drugs. I have another patient that is desperate to go home, again HIV positive, who came in with multi organ failure and is now in comparatively great shape. However, I know that if I let her go she will just deteriorate again. I am carefully balancing the doses of her medications to her gradually improving renal function and treating her severe anaemia. Just one more week I keep telling her – I’m keeping my fingers crossed.

The lady with exfoliative dermatitis
at the start of her treatment. She was unable to straighten her arms or legs.

..and towards the end of her therapy.

***

On a side note from work – I have been having the most delicious weekends exploring this energetic country. I spent the last weekend in April experiencing the wonder of Afrika Burn – a festival set 120km down a dirt road in the Karoo Desert, near Cape Town. It is based on The Burning Man and works on a “gifting” economy, i.e. money is worthless there. Everyone had to contribute. Mitch had his fist outing with his new hat and the snorkel was put to good use as we drove through a road that had turned into a river during a massive storm on the way up. There wasn’t a sour vibe to be found in the whole shebang and I largely spent it with an exciting pack on new friends. I literally jumped on their bandwagon, which was a tea trolley come sound system – a “chai-wallah” disco on wheels. So, as we dished out the big beats and sweet treats other revellers would offer massages, haircuts, cinema screenings, DJ sets, drinks, games, art, dance, theatre: you name it, they had it. And, just as I thought the world couldn’t be any smaller – I met not one, but two people from the small town of Lewes from where I originate.

Last weekend almost topped Afrika Burn as around sixteen of us descended on the Mkhambathi Nature Reserve at the end of my road here at Holy Cross. I had no idea there were Zebras in the park until we nearly ran some over driving down on Friday night. The reserve has, in my opinion, one of the best kept secrets in South Africa – it is home to a truly magnificent waterfall that spills over directly into the Indian Ocean: a visual and acoustic explosion of the senses.

So, April and May have been my relaxation and party months after a busy festive season of work. It all feels very fitting as I have just moved into my “late twenties.” I actually tried to hijack the weekend in Mkhambathi as a pre-birthday party. I didn’t need it, however, as my lovely colleagues baked me not one, but two cakes and around fifteen of us shared a scrumptious braai (barbeque). I think I could get used to this lifestyle...