Living the Dream, No power and HIV.

Seeing Zara caressing her first chameleon, Margot debating whether the antelope she has just seen is an Inyala or a Kudu and Ilda negotiating with the roadside Zulu hawkers over a fly covered fish, I am constantly reminded that despite significant adversity, we are indeed, living the dream. Monday was a public holiday, Human Rights Day to be precise, and no better day than to bundle into our trusty Pathfinder and head out on another adventure. We are spectacularly situated here with a dozen game reserves or parks within an hour’s drive and golden beaches isolated and wild beyond belief. This time we are headed for Tembe Elephant Park and joining us are Susie the OT and Cathy, a volunteer doctor, from California. We negotiate a scrappy road punctuated with potholes, the Mozambique border not far off to the North. Ilda has visited the park with the girls once before and directs us on sandy tracks straight to the hide, perched near to a busy water hole. We settle down with breakfast and binoculars and what follows epitomizes why we are here, my family and I back in Africa.

A majestic Kudu bull strides gracefully by, his elegant spiralled horns held proudly aloft; two young bull elephants saunter down to the cool water and drink thirstily; skitterish Nyala probe the water, forever alert to danger; a menacing crocodile cruises, two evil green eyes survey the waters edge hungry for a kill; a massive bull elephant with tusks and penis brushing the ground, grooms himself; powerful jets of water blast ticks from his belly and then a sand bath provides the finishing touches; beautiful fuzzy waterbuck with their comical buttock target and graceful curving horns strut about; a wooly necked stork stands erect as if in prayer, sunning himself and showing off his iridescent plumage; frisky Wildebeest frolic and their playful calves buck, kicking up showers of sand; there appears to be some sort of natural roster at the waterhole as animals silently come and go and an incredible natural order seems to exist, with beasts and birds comfortably cohabiting; playful Zebra, each adorned with the mandatory Ox-pecker, spar and roll gleefully in the warm red dust; another bull elephant with massive curved tusks jets plumes of refreshing water onto his huge belly and back; mum and four baby warthogs wallow in sticky black mud and then prance about with their antennae ever twitching and look hilarious painted half black, half grey; then stage left yet another elephant, smaller but virile, virtually charges towards the water and sucks and spills noisily; and right beneath us dainty Nyala cows and calves nibble on green grass and new leaves, their earlobes heavy with red ticks; and all around this incredible stage, the acacias lie thick, concealing, just, another beast awaiting his turn and above the blue sky is peppered with puffy white clouds.

We reluctantly leave and drive off into the park glowing from this phenomenal show.

My w/e on call was hectic as ever and my survival strategy involves expecting the worst and any sleep or food is a bonus. Obstetrics remains my most anxiety provoking area and this w/e proved no exception. It started on Friday evening with a maybe 24 weeker with heavy PV bleeding; she was sweaty and pale with a pulse of 120 and BP 85/55, massive clots protruding from her vagina; placenta praevia was likely and we wheeled her round to theatre more to save her life than the child. My colleague was to cut and I was in charge of anaesthetics and baby which was a bum deal as her BP dropped to 50 and she was looking somewhat agonal; I had pilfered the last unit of blood in the hospital and squeezed it in with 100mg of Ketamine, no time this time even to pray. Baby came out blue and lifeless but thankfully bigger than predicted and I abandoned mum to the nurse; it was surreal to see her stretching out her hand towards her uterus in her light state but more drugs settled her down. The baby had a pulse and intubation and oxygen perked her up. I catheterized her umbilical vein, gave fluid and after about 30minutes she was able to breathe for herself. Amazingly she survived. Even more amazing was that mum survived thanks to some very skillful surgery and haemostatic control and her Hb of about 5 didn’t seem to worry her!

The drama continued and decision making around suppression of labour in a 32 weeker paled into insignificance. I got another of those stressed labour ward calls; this time a term pregnancy, fully dilated and marked fetal distress. The head was low enough so that a vacuum extraction seemed reasonable. After the first pull the power cut! Now what? We don’t have forceps and, anyway, I’ve never used them so it was off to theatre again. The power then came back on and with a big cup and a snip of the cord around the neck, baby was born. My O&G diploma didn’t prepare me for this!

Finally, HIV. Of course no one calls it that…..E-tick (after the Elisa test), RVD, ‘the test’ and anything else but HIV. The stigma is still massive and reluctance to test or be treated huge. The government is pushing testing hugely this year and we are all to learn to do circumcisions in an effort to curtail the spread. It absolutely amazes me that despite how rampant this disease is and how lethal, there is yet an apathy about it with regards prevention and protection that leaves me speechless and perplexed. One of my colleagues pointed out that there are those who invite the disease because they will qualify for a disability grant once treatment commences, but that is beyond belief.

On my ward they all seem to die in a similar desperate fashion. They present gaunt, pale, dehydrated and desperate. Diarrhoea has ebbed away their last reserves and TB or PCP has taken control of their lungs. We take desperate measures; we put up lines and infuse fluid to ease their thirst, we shower them with antibiotics, give steroids to support and provide oxygen but again and again, to no avail. Too little too late; too futile. We must start earlier. At school, maybe primary school. The message is blunted and stunted and until the stigma is shot we are fighting a losing battle.