Thunderbolts and Lightning

On the beach at Kosi Mouth

Today the rain came. Not dribbly, pathetic pommy rain but dramatic, black, thunderous intimidating rain with fantastic, fierce forks of florescent lightning that makes your hair stand on end and caused a ripple of excitement through the hospital. It has been so dry and the heat has come, so that the rain was desperately needed and received with joy.

We were just sitting down to one of our monthly OPD meetings listening to the furor outside when I was called urgently to the Resusc. Area…some children had been struck by lightning. A 16yo boy was thrashing around on the gurney, white foam frothing from his gaping mouth and sweat pouring from his contorted face. Anguished groans emanated from his throat and it took about five of us to restrain him. Amazingly he appeared to have no burns but it took substantial doses of analgesia and sedation to settle him. About then we realized that he was only the advance party because a school had been struck by lightning and we had up to 100 school kids through the department within an hour. Fortunately for us most had no injuries but a few had minor burns and many had painful limbs or joints. There were many tears and much wailing as lightning has strong links with witchcraft in Zulu culture and my lasting memory of this incident will be of this thrashing teenager, water dripping through our leaking ceiling and the elderly pharmacy assistant wailing and praying at the foot of his bed!

Margot in our new pool (with spectators!)

What I’m loving about being out here in this amazing little hospital is that one is being constantly challenged. Every day there are firsts; something new comes up. New cultural experiences; like when I rushed on to my ward today to set up a suction dressing on my rotten leg chap (which we had planned to amputate but his blood count was only 5 so postponed it and now his leg is getting better! I think he has leprosy as he has lost a few toes, is depigmented and didn’t seem to feel too much when we plucked out rotten bits of tissue from his leg) Anyway, got to the ward to find about 20 staff having a church service of sorts; amazing singing and prayers and then a very animated priest who, clutching his bible and to vigorous support, was, I think, sharing the power of Jesus with these ailing patients. I came back later to do the dressing

A visitor to the ward. She made the entire outfit herself.

New surgical experiences like yesterday when I did my first manual removal of placenta (MROP) and then later an orchidectomy and orchidopexy (removal of testicle and then ‘fixing’ of the other). The MROP is a fairly gruesome affair and involved 15yo lass whom I was called for in the middle of the night. There was no fetal heart and I came up to confirm this on Ultrasound. She was then allowed to labour and delivered a stillbirth in the early hours. The placenta was not delivered and required removal under sedation in the OT and plenty of personal protection for what is often a somewhat messy process. The orchidectomy was fascinating. The testicle is a pendulum and has this uncanny knack (pun not intended) of tying itself in a knot, which has the unfortunate consequence of strangulating itself and dying. The only remedy is to remove it and then to ‘stabilize’ the remaining one by creating a pouch for it and suturing it in place. It was fantastic to do this procedure myself (carefully guided by an experienced colleague) having made the diagnosis many times and always referring on to the urologists. Our nearest urologist here is 4 to5 hours away! Or coming back from clinic last week and stopping to pick up Kobus at his clinic and finding him engrossed in circumcisions. He had a few to go so I joined in and we got them done chop chop!! (sorry!). Circumcisions are said to reduce HIV transmission by 50 to 60 % so are presently in high demand. We do them under local anaesthetic and they take about 15minutes to do.

Bull elephant at Tembe. We followed him for about 20minutes.

This week-end was a blast. We headed out to Manguzi, a small border town about 45min north of here. First stop was at the Tembe family home of one of my colleagues. He reminds me that the Tembe tribe was here long before the Zulus and ruled from Maputo in Mozambique to Matubatuba in SA. They were defeated by King Shaka and have been suppressed ever since. His home is amazing; an incredible example of social living where all family members help out, livestock tendered, veggies grown and cooking still done on an open fire. Water is from the borehole and the toilet is a longdrop. He takes us on to a market straddling the SA-Moz border. Guards are present on both sides but they wave you through a gap in the fence and we revel in this cultural confusion. Portuguese rum, local ‘Lala palm beer’, fatty buns, nuts, coconuts, veggies, risky looking herbal remedies, plastic containers, tapestries, food…..we lunch on crisp, fresh, fried fish probably caught in the Kosi estuary and fried in bubbling oil in black lids over wood fires. Delicious. We return home loaded with fresh spinach, cabbage, fish and coconuts. From there we head for Kosi mouth and set up our tents in a tranquil campsite and then walk the few kilometers along the estuary to the mouth. The scene is spectacular with dozens of spiraling fish traps punctuating the azure waters of the lagoon, fish eagles circling hopefully overhead and Pied kingfishers catapulting into the water to nail their prey. The mouth is pristine and kept that way by a quota system that only allows 20 vehicles per day down to the water. The snorkeling is sublime and safe and Margot and Zara glide effortlessly above Morey eels, Lionfish and knots of inquisitive Clown fish.

Then, as if this hasn’t been enough we strike camp and head for Tembe Elephant Park. Straddling the SA-Moz border, this park boasts some of the largest tuskers in the world. We opt for the luxury of a game drive and are rewarded with many sightings of Nyala, Zebra, Giraffe and even the elusive Waterbuck. But at sunset, as we sip on chilled beers, the grand finale arrives and a massive bull elephant steps out and gracefully stomps along the road in front of us giving us spectacular pics of him with the bronze rays of the setting African sun.

On top of Isandlwana. The cairns mark the sites of mass graves.

Then last week-end we set off for the Battlefields of Kwa-Zulu-Natal and an historical account of the Anglo-Zulu war of 1879. What a fabulous experience. I last visited Rorkes Drift and Isandlwana as a 10yo lad on a prep school history tour and so it was poignant to be sharing this incredible experience with my family and Margot, now 10, who was fascinated by the tactics of both the Zulus and the British and the masses of white cairns marking where men fell. We travelled in luxury staying at Fugitives Drift in an historic cottage with giraffe and antelope grazing amongst aloes beyond our verandah, and enjoyed gripping and theatrical tours of both Battlefields. The accounts of the phenomenal Zulu victory at Isandlwana and then the staggering bravery of the British at Rorkes Drift brought tears to our eyes and as I stood on top of the mountain at Isandlwana with Ilda, Margot and Zara, I felt deeply emotional and incredibly proud at being part of this dynamic and rich country.