Sangomas, stabbings and surprise caesars.......

On Thursday I had my favourite patient. She was a Sangoma or Zulu traditional healer; a slightly shy pretty young lass with braids, cowhide bracelets, colourful costume and mandatory dried gall bladder perched high upon her head She initially seemed reluctant to talk but on gentle prompting from my nurse interpreter, revealed that it would be ok for me to question her without paying a fee, but that on her return home she would apologize to her ancestors! (It is usual custom to pay the Sangoma before you can speak to her). I felt deeply privileged and asked her about her seizures. It seemed that her control was not good and I modified her regimen. I did reflect on the fact that she was daily delivering traditional Zulu remedies so alien to our scientific prescriptions, and yet, here she was happy not only to consult me, but also to swallow our poisons! We parted on great terms!

Being on call here is no relaxed affair! After your day of ward rounds and Outpatient clinics and perhaps time in the OR, when everyone else is trotting off home, your day is just starting! Invariably OPD (outpatients, GP surgery and ED all in one) is heaving and patients anxiously await your arrival. Many have been there since the morning. The work is very variable from desperately ill to desperately mundane, including the dreaded Disability Grants or ‘DG’s’. Rumour has it that the DG is the top income earner in this area. Basically it is a sickness benefit and is preyed upon by all, particularly those with HIV who frequently are entitled to it during their first 6 months of ARV treatment when they are likely to feel pretty bad and are unable to work. This week OPD is heaving and a 2 week old infant is carried in by a seemingly nonchalant mother. The child is deathly pale and has every sign of respiratory distress possible. Her respiratory rate is about 80 and pulse rate about 200; her feeble frame trembles with the effort and we hope to save her with antibiotics, fluids and oxygen. Miraculously she survives the night and is transferred to a tertiary hospital for ventilatory support in the morning.

We wade through wounds, fractures, foreign bodies and disgusting suppurating abscesses but mostly it is HIV and its complex array of pathologies. Most are concentration-camp-like in their appearances, gaunt, cachectic and wasted, with protruding bellies and stick-like legs. I admit for iv rehydration, maybe antibiotics, perhaps an ascitic tap, but it seems somehow futile; hopefully their last days will be more comfortable. At last I trudge back in the dark to our Park home hoping to see the girls before they are asleep.

Hardly have I drifted off before the next call comes; “Doctor gun shot wound to foot….”. He is stable, has an exit wound and is cleaned and dressed and can wait for morning. Barely an hour later; “Doctor, stab wound to back and loin”….”OK, I’m coming”. Amazingly he too is stable with a deep wound beneath the tip of his left scapula and another about 10cm long across his left loin. I delicately probe to assess depth and both are deep. I clean and suture and a chest x-ray excludes nastiness. His urine is clear. Given our isolation, I elect to transfer him to our referral hospital 2 hours away. I don’t fancy doing a thoracotomy at 04.00! I steal a few hours sleep and then am back at 06.30 to mop up the stragglers. My family joins me to listen to the angelic singing of morning prayers…the angst of the night is forgotten.

My caesarian section score now rests at six. I still tremble and consider this a pretty scary business. On the w/e my colleagues had one that went bad and she ended up being transferred and losing her uterus. My 3^rd section was twins, which other than the power cut as we were about to cut, went well; my 4^th section was alarming because mum became hypertensive and breathless after her spinal…..thankfully that settled; my 5^th oozed and my 6^th was spectacular. The uterus looked odd and yes it was….she had two! Baby came out of one and the second, about the size of a pear, bore the left ovary and tube and connected to the main one just above the cervix. Bicorneate uterus I think!

And so life here goes on. Nothing is as it seems. Also expect surprises!