“This house believes that Holy Cross can be saved. Discuss”

Trying to blend into the background at work.

“Good chairperson, would you kindly open this meeting? Shall we start with a short prayer?” I feel as if Holy Cross has become the venue for a public speaking debate, except for the doors are closed and no public or press are allowed to get a whiff of our heated discussions. The Eastern Cape Department of Health has been getting some bad press recently, and probably rightly so. There have been almost daily meetings – some productive, some not – discussing issues that make a few of us a little warm under the collar.

It is an exciting place where I work and we have personal from all over the globe with many different beliefs and values. Recently the notion of us offering a TOP (termination of pregnancy) service was debated: a very sensitive issue, whatever side of the fence one stands. We encounter too many mothers, young and old, who present following an illegal abortion. Without the correct aftercare, a woman could develop severe sepsis or bleeding, potentially resulting in death. As it stands I have been nominated to undergo the training. I think that my values are strong, yet I have no fixed religious beliefs. If a potential mother cannot see any other option but a termination, I would much rather that she does it in a safe and controlled environment. However, what is of more importance than offering this service is good public health measures to prevent women getting pregnant in the first place. This can be difficult in a country where many men see ejaculating (masturbation does not count apparently) as a necessity - otherwise, the semen will back up and congest ones brain, or so I am led to believe.

In addition to the multitude of discussions, from how can we improve infant mortality to where we should put the new volley ball net, the boss delivered a very compelling talk to his seven strong team of medics. In a nutshell he was telling us that same old story of how Rome wasn’t built in a day. We all have very different views on how to run a department and come from different backgrounds. I myself stand by the chief – I believe that if change is to be made one must go slow, mould a partnership trust and keep an open relationship with staff; discussing and debating issues as they come, before things get to a boiling point. Unfortunately, many of us foreigners only stay a year or two. Saying that, the boss is a foreigner too, but has somehow had the gusto to stay for over twenty years – he retires next June. I honestly am not sure if we can make any lasting changes. Things are good now, but who knows how things will be next year.

***

Breaking news rippled through the corridors of Holy Cross last week – the national stock of Tenofovir, an essential HIV drug, had run out. This is a very, very bad thing indeed. HIV drugs are often given in a combination of three and work to suppress the virus. If doses are missed or even delayed a few hours, then the clever bug may have time to develop a mutation and become resistant. Fortunately, some of our meetings have been productive and we seem to have a fairly robust contingency plan using old the drugs that were being phased out as an interim measure.

***



Myself closing up the sebaceous cyst wound - if
only this were "smell-o-vision."
 Only then would you be able
 to appreciate the cheesy smell.



On a lighter note I was excising a sebaceous cyst last week – quite a satisfying procedure. The trick is not to burst the cyst as what lays inside smells like an exceptionally ripe stilton. Things were going rather well, and then “kaboom,” out shot a stream of creamy-cheesy-goo, narrowly avoiding   my face (don’t worry Mum, I had my goggles and mask on – safety first) and landing in a big gloop on my trousers. I repeated that same manoeuvre three times before I decided to put some gauze over the cyst and give my mildly saturated trouser leg a shake. The smell followed me around all afternoon, which is probably why some of my patient’s weren’t too keen to stay for a chat.

What happens if you are tetraplegic? I didn't find any parking for them.

For anyone interested, I have now become a pea growing specialist. The trick is to forget about them for a while and then leap with joy and glee when the fruits of your lacklustre labour reward oneself with the sweetest little jewels of bursting goodness.

A young mother who has developed a severe skin rash (Steven-Johnson's Syndrome/Toxic Epidermal Necrolysis) as a result of one of the HIV medications she was taking. Her skin is basically falling off - it can be fatal in upto 50% of cases. Fortunately she is doing rather well. (Note: image used with patient consent).

The classical "target" lesion of Steven-Johnson's Syndrome.



There must be a rabid sheep on the loose - this is it's third victim.



A sixty year old smoker with critical ischaemia of his left foot. Notice his black toes.

Black toes - this is what happens when your arteries fur up with crud.



A 10 day old girl with severe neonatal conjunctivitis secondary to a sexually transmitted infection the mother had in pregnancy. The white stuff coming from her eyes is pus.



Mangrove swamps in the Wild Coast.



Fishy, fishy, fishy.



Friend's enjoying the beautiful coastline of the Eastern Cape.