Strikes, Bites and commuting in style.

South African World Cup hangover


Today our nurses are on strike. The fact that the labour dispute going on in the country has nothing to do with them is irrelevant. Actually the teachers and other government employees throughout South Africa are on strike and nurses have sort of tagged on and, to be fair, many have been intimidated by the toy-toying picket outside the hospital gate. We live within the hospital grounds so have been relatively unscathed by the activities outside, although the protests have been somewhat peaceful. The hospital itself has struggled and although all the doctors are here, there has been a severe paucity of nurses with only a handful onsite bravely manning the wards, OPD and theatre. There has been the usual drama and the patients, as always have suffered. The young first-time mum with her massive post partum bleed and coagulopathy survived but her baby didn’t. She was transferred by helicopter. The young man with his distal femur shattered by a bullet was less fortunate. The road ambulances were unable to access the hospital and we have been unable to refer him on for tertiary level care, so have admitted him to our ward. He is being well resuscitated and I am very proud of his leg traction which is weighted by a discarded sack and five bags of iv fluids. Yet another adolescent Mum with a placental abruption and dead baby has done ok despite minimalist nursing input. We have had to be strict in OPD/ED with only those in dire need being admitted. Tonight staffing is better but we know not what tomorrow brings.


Mseleni Hospital from the Chopper

Despite this inconvenience Africa and Africans are resilient and life goes on. The doctors remain upbeat and the team work is fabulous. I have had some wonderful cases lately and was so proud of my first amputation that healed and went home. His below knee amputation rotted and so I amputated again, this time above the knee, and thankfully this healed well, with smiles all round. Yesterday I did a twin caesarian section. What a thrill to deliver, not one but two, bleating infants and for it all to go well. Then on Friday a 10yo lad comes in with a day history of sore throat. He can’t talk too well and has laboured breathing. His tongue, lips and throat are swollen. Incredibly his mother presented 5 days earlier and needed a Bic pen to her airway to save her life. She is still struggling in a Durban intensive care unit and we suspect some allergenic ingestion. Despite the usual anaphylaxis remedies he fails to improve and we elect to intubate him and secure his airway. As he drifts off into a propofol induced slumber I slip the laryngoscope between his teeth and over his dusky tongue and gasp at the sight I behold. His airway looks like a cervix! No sign of the vocal cords at all and I go for the os rewarded with a misty tube and improved oxygenation. Unfortunately it is now late and we need to ventilate him in our operating theatre overnight awaiting chopper retrieval in the morning.

Me and Joseph off to work!

Speaking of choppers I got to fly in one last week. One of our neighbouring hospitals in the ‘mountains’ and about 2 hours drive away has been desperate for staff and we were volunteered to help out. To our amazement one of the NGO’s came to the party and just happened to have a very neat little Robinson Helicopter available and offered to fly us there. What fun it was to walk out of my front door onto the runway (literally 25 m in front of our house!), buckle in and get whirled off into the hills! We were dropped off on the lawn in front of the OPD and sauntered up into the building with stethoscopes idly draped over our necks. Unfortunately the second week the chopper wasn’t available and we had to settle for the fixed wing!

Ilda's nasty tick bite

The girls have been well and with a long string of visitors have enjoyed a long 5 weeks of holiday. They are now itching, I hope, to get back to work. Ilda has been acting as a professional guide for French friends and she too is fired up to get the teaching on the road again. The girls have been in fine form but Ilda had a bit of a scare recently. On our trip up to Kruger Park she was hot and had a headache and a nasty black bite on her forearm looked suspicious for Tick Bite fever. A quick stop at a chemist in Komatipoort for some Doxy went well and the astute pharmacist flogged me a neat quick-test for malaria which was thankfully negative.

Thankfully it was negative!

Last night we ran down to the Lake for sundowners. A Giant Heron waded in the shallows and Pied Kingfishers dive-bombed their unsuspecting prey. The warm copper sun cast long shadows across the dappled lake and we laughed at the joy of it all.

Amputations,Lion Cubs and Bok Drolletjies.

Cheetah brothers on the hunt

It is at times like this that I wish our life here would go on forever. We are having so much

fun! Yesterday I dashed back from my clinic (about an hours drive from the hospital and mainly GP reviews and lots of ARV starts) changed and jumped onto my bike. I was off to join Ilda and the girls at a lovely lodge near the sea where they were staying with her sister. The road was sandy and dusty but I was helped by a downpour which firmed things up a bit and got there before dark and in time for a cool beer. We had a fabulous dinner and evening there and Ilda ran me back to work in time for the morning rounds at 07.30! The hospital was thankfully calmer than usual, largely due to the fact that we have decanted anyone we can in preparation for a looming government employees strike. So far the nurses are not involved.

African soccer world cup

Work has been fascinating as ever. Yesterday I cut off a chap’s leg. He was a longtime smoker and his foot was dry rotting thanks to no circulation. Zulu scarification had failed to help and he was relieved to part with it. The operation is carpentry simple and after mobilizing a healthy flap to provide padding for a future prosthesis, I use a cunning corrugated wire called a ‘jiggly saw’ to hack through his tibia and fibula bones. Bleeding is not a problem! I saw him today tearing around the wards in his wheelchair with a big smile on his face and still stinking of tobacco.

Today the ward round is fun! My first patient needs a lumbar puncture. He has AIDS and TB and had a seizure. I am concerned that he may have TB meningitis or

something more sinister like cryptococcal meningitis or Toxoplasmosis, all prolific opportunistic infections that prey on the immunocompromised. His cerebrospinal fluid drips out clear but the lab will analyze it. His neighbour is groaning with pain. A dignified elderly Zulu gent who has a large painful mass protruding from his liver. I prep the skin, instill local and plunge a large-bore needle in. Thick yellow pus surges into my syringe. 50mls later he is much more comfortable and grins his appreciation. The young man in the corner speaks good English but even the most trivial effort leaves him breathless. His body is riddled with the smooth nodules of

Kaposi Sarcoma. A ruthless cancer associated with HIV. A chest x-ray reveals a heart the size of a football and we confirm fluid around the heart with our rickety

ultrasound machine. For the third time I splash chlorhexidine on his skin and this time, after piercing the skin just below the sternum, aim my needle at his heart.

The monitor bleeps reassuringly but I am relieved to see bloodstained fluid gushing into the syringe. 1000mls later he feels much better. The next man has such bad heart failure that we are juggling with maximal diuretics and poisoning his kidneys. His belly is like a drum and legs elephantine but slowly he improves. His neighbour had his belly drained yesterday. Nearly 4 litres eased his discomfort and yet a clear diagnosis evades us. Amazingly he is HIV negative. And so it goes on. I receive a call from OPD. Patients are gathering there and no doubt more to fill the beds

only just vacated.

Phinda game Reserve

Our recent trip to the Kruger National Park was quite an adventure. We travelled via the kingdom of Swaziland staying at the Royal Hlane national park. The Park was memorable for the wall of snares at the entrance, a grim reminder of desperate days when game in Swaziland was hunted to the brink of extinction, and also for the, literally, procession of rhinos and hippo at the waterhole across from the restaurant. At night we were entertained by ethnic dancers bashing drums and kicking up sand in a fashion that would make Can-Can dancers look amateur. The next morning there was quite a stir in the camp. The King’s mother was there for lunch, Impala steaks I gather, as well as the Kuwaiti royal family and a sprinkling of Yanks. We beat a hasty retreat. It was fun crossing the borders and memorable for me for being the first time ever that I have traveled on a South African passport.

Kruger Park is South Africa’s flagship game reserve and as such is frequented by herds of tourists. The atmosphere at Lower Sabie camp, where we stopped to stretch our legs, was more like a European ski resort, with all its bling, glamour, curios and excitement. On the road game rage is rife and competition to view Big Five is fierce. We were rewarded with some fabulous viewing though, the most memorable being a sunrise encounter with six lion cubs whose parents were away hunting and so we were entertained by their antics for nearly two hours. Leopard

still elude us but an Impala balancing high up in an Acacia tree confirmed that they were not far. At our camp at night Hyena skulked around the perimeter fence in search of BBQ bones discarded by careless campers. Their persistent nocturnal whimpering was eerie and disconcerting.

Rhino procession, Swaziland

Our Game reserve experiences reached new heights last w/e with Ilda and me entering a 56km mt. bike ride across Imfolozi Game Park. Besides being an incredible game viewing experience it was a cultural one second to none and culminated in the “Bok drolletjie spoeg kompetisie” (impala droppings spitting competition) in which Zara excelled, with a creditable 1m effort.

The winner ‘spoeged’ his brandy weighted bundle of crap a spectacular ten meters! We were camped in the race village fully equipped with bucket showers with piping hot water from the ‘donkey’, fully equipped bar, massive flat screen TV’s for fanatical Safricans to watch the rugby (and a few of us to watch the Tour de France!), porta-loos with an attendant who wiped it down between each customer and even a kids club with entertainment, swings and free t-shirts! Our camp site was encircled by an electric fence to keep big things out but it did make that late night pee a wee bit more challenging. Our bikes were transported to the start and we were bussed there shortly after sunrise and were spoiled by some spectacular viewing. Beside the ‘regular’giraffe, antelope and rhino, we were very lucky to see a pack of Wild Dogs fighting off three wimpish Hyena and, a little further on, a Cheetah checking out some plump Warthogs.

Wild Dog costumes at Imfolozi Mt bike race

The ride was rough and exciting and Ilda saw elephant, fortunately some way off. I was nearly mown down by a herd of panicky Impala but otherwise, I think, fluorescent lycra is a pretty good deterrent for most game. Ilda had a great ride but I was crippled by cramp with 10km to go and was a pathetic sight pushing my bike and dragging a leg and would have been easy picking for any hungry carnivore.

Ilda and the girls are in Pietermaritzburg this w/e with my Dad after dropping her sister in Durban to return to France after their SA holiday. We have a French family arriving for 2 weeks on Monday and so the party continues!