Vacancies.

Vacancies - please submit your CV.

There is a lot of excitement in my household at the moment and, seeing as it is only I who lives within this abode large enough for a family of four, I can dance around with as much glee as I care. For in exactly one month, I shall be saying goodbye to Holy Cross and embarking on a little overland trip with a friend in Mitch, the four by four off road machine, up to Uganda and back. I am sure I will be giving out plenty of snaps from the trip when the time comes and maybe a few tales too. Fingers crossed Mitch is good for it.

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After originally being struck by the amount of HIV and young people dying in all manner of undignified ways, although I am not quite sure what is a dignified way to go (at home, in bed I suspect), something else bothers me far more. Just the other day I was counselling a girl of 15 who had a threatened miscarriage. One cannot stop people from having sex, even at this young age. However, she, like many before her, laughed when I mentioned the importance of an HIV test and said that she was not ready for one. After a bit more discussion she agreed to the test. If getting young people to test for HIV is difficult, then surly it is even harder to encourage them to practice safe sex.

Last week I performed a sexual assault examination of a 14 year old girl who was abducted and taken 100km away to a location near Holy Cross. However, despite this distressing story, she had clearly been sexually active for some time: her genitals were covered in warts and there was a very offensive discharge. It transpired her boyfriend was not very keen on condoms and that he probably had a few other girlfriends too.

It is always the woman that we see in clinic with the sexually transmitted diseases and early pregnancies. Rarely one sees the men coming for sexual health related issues. It is the men that really need to be educated, and, therein lies the problem. There are a few good initiatives nationwide, but I am not aware of any around here. There is a very successful clinic run on Saturday mornings near Johannesburg led by all male nurses. I expect many men around here have difficulty discussing their “man-hood” with female nurses as local culture still dictates a divide amongst the sexes.

Talking of family planning – there are a lot of dogs that roam the roads of the Eastern Cape; there are also a lot of flat dogs that line these roads. A colleague pointed this out the other night - how can there still be so many dogs. The boss replied: “It’s canine family planning. Without it, they would overwhelm the area.”

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On every casualty or outpatient card there is a brief history of the presenting complaint. Often I take a quick glance, but a lot of the time something has been lost in translation. For example, it may read: “15 year old, has been coughing for 5 days, is severely dyspnoeic and unconscious.” A brief inspection of the patient reveals that they are awake and breathing just fine. However, this week I forgot to read the “blurb,” and just dived straight into my history:

Me: What brings you here today?

Patient: I have a cough.

Me: Oh, how long have you had this cough for.

Patient: Since 1982.

Me: *my face scrumples up, I give him an “are you serious” look*

Patient: *gives me “I am deadly serious” look back*

At this point, I decide to read the outpatient card – he had come to pick up medication for his epilepsy. However, now I had started on this cough story, I had to finish. I think I cough more than he does, but, nonetheless he wanted me to give him something for it. It was almost as if he was bargaining with me – he had a pretty good poker face. However, once I agreed to dispense my secret weapon (paracetamol) he relaxed immediately and I advised him to test his sputum at clinic for TB.

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I would like to end this little piece with a small plea. Perhaps I should have started with it, however, if you are still reading now then you must have, at the least, a small tickling interest in the health system here. Budget constraints or, more likely, mismanagement of funds (what some may call corruption or fraud. This is only my guess and I would never accuse the Eastern Cape Department of Health of such things) has had a visible effect on local health services. Similar tunes are being echoed in the British NHS.  However, it seems as if things are going from bad to worse: the health department has said that they cannot fund any new posts for doctors, or at least this is what I have read in articles and heard from various mouths in management.

Holy Cross, comparatively, has it pretty good at the moment with eight doctors. We are expecting two more, but news has just arrived that they may not be able to work here (despite vacancies) as there is no money. It is likely they will be wooed by one of our neighbouring provinces, such as Kwazulu-Natal. Of more immediate concern, however, are the hospitals that, come August, could possibly be with no clinicians at all. It is a very real possibility and unless the government steps in (who at this moment are piloting a national health insurance scheme) or the local department of health gets its act together, communities shall be without emergency medical, obstetric and paediatric care that could have grave consequences.

So where best to start: a petition. A good friend of mine, who is working in one of these soon to be “doctor free” hospitals, has petitioned the Eastern Cape Department of Health. Please log on, sign it and spread the message.

The link is:

http://www.change.org/petitions/eastern-cape-department-of-health-south-africa-provide-contracts-for-doctors-needed-to-provide-essential-services-4?utm_campaign=friend_inviter_modal&utm_medium=facebook&utm_source=share_petition

If the link does not work, please let me know.

My hand is on the left and on the right is a patient who has a haemoglobin of 2 (severe anaemia). I checked mine and it was 16. Needless to say, she received a blood transfusion to help her gross fatigue and exertional breathlessness.