African Potpouri

I sit here now in the fresh dawn listening to the dogged tapping of a woodpecker in its quest to ferret out bugs from the tree bark and also a myriad of other shrill and sonorous chants that make up the dawn chorus. We are camped in the thick bush of one of the many private game reserves that abound here in Northern Zululand and this morning were treated to a Nyala doe and her calf grazing near our tent. Ilda has gone for a bike ride, which is an option in these smaller non-“Big 5” game reserves, although there are elephant here which I hope she avoids! I am relaxing in post Comrades bliss and the girls are still tucked up in their tent awaiting more sun.

The 89km Comrades Marathon from my old home town of Pietermaritzburg to Durban, on the coast, was the realization of a childhood dream. The highlight for me was not so much the finish, where members of our sub-9hour ‘bus’, whom I had run with for about 60 of the 89km, locked arms and finished together in a bunch of about 30 exuberant runners, but the start in PMB. Huddled together with about 23 000 other excited runners in the chilly, dark predawn under the magnificent floodlit city hall, we sang together. First it was “Shosholoza”, then the national anthem and finally Vangelis and the theme tune from Chariots of Fire. It was a stirring start to the ‘Ultimate Race’ and this year there was even more pomp and ceremony as it formed part of the preparations for the World Cup Soccer. Thank you so much to those who sponsored my run in support of the local Aids Children’s Home.

The World Cup Soccer is about a week away and the sound of the “Vuvuzela” is already deeply engrained in our psyche. Someone seems to be blowing one at least 24 hours per day! Given the traffic chaos at the end of the Comrades, a mere 2km from the soccer stadium, I have grave concerns for the fluidity of the World Cup and recent coverage in the press suggests that the local Durban Emergency Departments are barely equipped to manage a major car crash let alone a stadium disaster. We have elected to follow the football from the comfort of our neighbour’s living room!

Things have definitely brightened up on the home front and our loo is flushing again and the septic tank has ceased discharging. Ilda even started one day with “do you know what I love about living here?.....the simplicity of our life!” I nearly fell over and at last all the frustrations seem to melt away. The girls are still plagued with various ailments and although the sandworm has left Zara, ringworm has infested Margot! Home-school is going very well and I loved Margot’s comment “I love playing with Serena because they don’t have a TV and she has imagination!” which suggested that we were on the right track. Zara too, after I had turned her light out came in to our room sobbing “but I’ve got the reading bug and HAVE to read……!” Everyday I am thrilled with what they have done and they earnestly recite poems or demonstrate the latest bugs or paintings. It is fabulous too not being restricted by school terms so that we can travel and explore ad lib. They both had a day at Cowan House in Hilton recently to get a taste of ‘real’ school and absolutely loved it.

I am now spending more time in the OPD/ED and have been able to get more involved. This week I continued my quest emptying out filthy cupboards with rotting bandages and POP and continue to try and get some order into the place. We introduced a triage system, which amazingly is an alien concept here, where time of arrival means everything and how sick you are irrelevant, if you got here first. The World Cup soccer has been the catalyst as we had an order from on high to introduce a triage system and so thankfully I am not the bad guy.

We have had some fascinating and tragic cases. A 30 yo woman lit a candle in her hut early one morning unaware that her husband had placed a leaking barrel of petrol nearby. She had about 80% burns to her body but thankfully managed to fling her young baby to safety. She survived long enough for us to get iv access via a cut-down and give her much needed morphine to ease her agony. A 13yo boy came into my clinic with strange depigmented patches over his extensor surfaces, spoon nails and stumpy fingers. He probably has leprosy. My quick ward round last Thursday before my clinic turned into an epic. A 16 yo paraplegic boy who had previously had a tumour cut out of his spine now presented with a relapse of his leukaemia. His kidneys had failed and his biochemistry was pre-terminal. He was groaning in desperation and we were only able to palliate him with morphine. Right next door a 55yo man was struggling to breathe as an aneurysm of his carotid artery encroached on his airway. An oropharyngeal airway eased things and the vascular surgeons in Durban were happy to see him. He didn’t survive the 4 hour ambulance trip. Then there was the 34week pregnant woman with the headache who fitted in the waiting room. Her BP was a catastrophic 145/110 and we treated her with the mandatory magnesium, first iv and then 2 massive injections into her buttocks. We induced her, as delivery is the only definitive cure, and she had a healthy daughter the next morning. Or the snakebite chap whom we all saw and discharged and who then represented 2 weeks later with his fracture-dislocated ankle that we all missed! The 30 yo woman who presented short of breath and with the aid of our now-working ECG had atrial fibrillation. We successfully cardioverted her only to see her relapse the next day and despite an hour of CPR and a multitude of shocks for every rhythm imaginable we lost her. We think a nasty cardiomyopathy was to blame and, as always, HIV.

The HIV saga continues and although we have spanking new guidelines, introduced in 2009, we don’t have the drugs to go with them. Our promised new dream drug, Tenofivir, has failed to materialize and our pharmacy has a mere 1590 tablets, enough for 20 patients for about 2-and-a half months! Circumcision has been mooted as the next wonder ‘cure’ for HIV as it is supposed to dramatically reduce transmission and so we will all be vigorously chopping of foreskins in an effort to make a dent in this catastrophe. Then hidden under the HIV coat-tails, TB is taking a grip like never before and is cleverly disguised so that all the tried and trusted drugs are failing and resistance is escalating dramatically.

Enough, I think. Let me leave you with images of early morning runs along dusty red tracks, heavy mist and speckled Mguni cattle suspended motionless. Figures emerging in the dawn light with bucket on head or school books tucked under arm. Then the golden African sun appears, majestic and warm, arcing up into a cloudless sky, mist dissipates and the cocks stop their incessant crowing and the day begins.

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