CT Angiogram on friday, canoe marathon on Saturday

Our flip-flop-jandal collection now covers a large section of our fence. All picked up from our local beaches. The sunflowers have been fantastic.

You know one thing I love in life is variety. Too much routine is tedious and surprises are great. Anyway, a routine GP visit to my longtime varsity mate Mary Mac last Friday, gave me a wee bit more variety than I had bargained for. My medical insurance will end when I finish my job here and I thought it timeous to go for a “general check-up”, run a few bloods and, because I had had a few niggles in my chest (not exercise related) and a father who had had a triple bypass, do an exercise ECG. It was all a bit of a jaunt until I saw Mary’s face looking somewhat pale and gazing at my ECG with distinct depression of 3 of the ECG leads. Before I knew it I was lounging in the plush waiting room of a cardiologist and soon thereafter had had an echo (normal) and was on my way to the CT suite. The CT was fine and I held my pulse obediently below 45 until, that was, they gave me contrast which was somewhat unpleasant and felt vaguely like someone was trying to throttle me and shove a red hot poker up my anus at the same time. This had the not surprising result of pushing my pulse up to 75 and rendering the CT void because of movement artifact! Anyway all was repeated an hour later with a different contrast and my heart and vessels on 3D reconstruction looked pristine and the cardiologist has put it all down to ‘athletes’ heart which I suppose I can be proud of. While all this was going on we also fitted in Yellow fever jabs for our imminent Africa trip and Ilda managed to have a pretty sever allergic reaction to antibiotics she had just received for an ear infection. Anyway to celebrate my warrant of fitness we set of for the Drakensberg to take part in a canoe marathon.

The girls Kids club trip to Sodwana was a fantastic success. We saw a few Loggerhead turtles, had interesting talks from a turtle expert, sand-animal competition and lots of snorkelling. All on our doorstep.

There had been quite a bit of rain in the mountains and the river was flowing strongly. The Umzinkulu is a beautiful river running clean and fast and so it was a real pleasure to be joining Guy Henderson, a long-time school and varsity mate, for this fantastic 2 day marathon. We had a near perfect first day negotiating some fairly impressive rapids and surveyed with interest the canoe carnage that littered the banks. Day 2 continued well for us and we had fun shooting weirs and some tricky rapids. A momentary lapse in concentration nearly meant grief for us about 5k’s from the end when we found ourselves tightly pinned on some rocks and had to abandon ship and swim for it. Luckily the canoe remained intact and we were able to finish well up in the field which is no small achievement for us veteran paddlers with about half a dozen training paddles between us. Of course my true satisfaction was doing a real stress test and finding my myocardium well up to it. Who needs CT?

On the work front, I have just tendered my resignation. Not through any dissatisfaction but just because the time is right to move on. I think I’m scared that if we stay here another year then we might still be here in 20! New adventures await us and we leave for a 6 month trip around southern Africa at the beginning of March. Our plan is to go as far as Rwanda spending a month there and then back down the east coast back to SA. We fly to France on 22^nd August.

This is the snake that joined me in the pool one morning. I think that it fell out of the Mango tree above. Certainly gave me quite a fright and I was happy to release it through the hospital boundary fence.

Work is definitely seasonal here and the summer rush is gaining momentum with wards bulging and nurses grumpy! From February to September last year I didn’t see one case of Malaria but almost as the rain came so did the Malaria. We have had about a dozen cases with one infant death. Certainly not a disease to be taken lightly. Snakes are out in abundance and our wards are full of swollen hands and feet. Fortunately most of the bites are from Puff adders which tend to only cause local tissue damage and, for most, a few days on the ward settles things. We did have a death a few weeks back though. It was probably a Boomslang, which is a lethal snake whose venom causes bleeding. This poor chap apparently waited about 6 hours for transport at a remote clinic and bled out soon after his arrival at hospital. Anti-venom for that snake is only available from Johannesburg, a 2 hour flight away, and will only be released and flown down on positive identification of the snake!

The other thing that I have had a run of on my ward is badly beaten buttocks! Community justice is strong here and if someone does wrong he is dealt with by the community and then handed over to the police. These guys come in severely injured and I have had to take three of them to theatre recently to debride inches of rotten flesh from their buttocks which will take weeks to heal. The fourth chap wasn’t so lucky and his severe beating caused massive muscle breakdown leading to rhabdomyolosis and renal failure. His lungs didn’t like our vigorous fluid management and heart failure followed his kidney failure with his creatinine soaring to over a 1000. The day I had him organized for transfer to our referral hospital there were no ambulances and miraculously I managed to get him choppered out first to ICU and then to Durban for renal dialysis. I’m not sure if he survived.

Margot and Zara drawing water at a local well in the Lebombo Mts. overlooking Swaziland. So good for us to experience what the locals have to do everyday to get their water. It was the most delicious water too.

Speaking of trauma, we have witnessed a number of horrific motor vehicle accidents recently. South Africa has more road deaths over a holiday week-end than New Zealand does in an entire year. Not too surprising though with the shoddy state of vehicles, drunk driving, incredible speed and phenomenal overloading. Driving back after Christmas we were on the scene of a 2 car head-on collision which must have happened shortly before our arrival. It was sickening with bodies hanging out of the wreckage and even before emergency services had arrived, a sizeable crowd of spectators had converged. What alarmed me was my reaction. To stop and help or drive on? Although this is what I am trained for this situation was different. Firstly, by stopping in an uncontrolled environment like this my family would have been at enormous risk; both from other cars and also from looters hanging around. Secondly, I was desperately ill equipped. At the very least I needed gloves and probably goggles, but not just one pair, as one would need to change gloves after each casualty I touched. (HIV has been transmitted in this way!) It all looked futile and I was relieved to see lights and hear sirens approaching as we eased away from the scene. Call me a coward but family first.

Anyway, enough for now and after my call tonight a blissful ten days of holiday await us starting with a train trip to Cape Town. We can’t get enough of this beautiful country.

Swim Training with the bungee from the fence. I last about 15 minutes max! The pool has been fantastic and we all live in it!

Needlestick, Caring for a king and Mango mania

Oh, Sh#@%&t!........ Elephants have been here.

Last week I got my first needlestick injury. It was quite surreal and you just don’t believe that it has happened. HIV carriage rate here is about 30% but probably around 50% for those in hospital. We spend our lives avoiding needlestick injury and other hazardous exposure by double gloving, disposing of sharps in the sharps containers and never resheathing needles but, like the butcher who eventually chops off his thumb, we eventually get nailed. I was flushed with enthusiasm having just opened up and controlled my first solo ectopic pregnancy. Her belly was full of blood and after a short rummage around in the pelvis I located and plucked up the offending fallopian tube. It was a mess. The tube had ruptured at its insertion into the uterus and as such had the appearance of a lunar crater. It was massive and bleeding briskly and needed wide clamping. I had only just done this and was about to insert my first haemostatic suture when my instrument slipped from my grasp. The prick was hardly painful and despite the double layer of latex I knew I was done. The tell-tail trickle of blood within my glove confirmed all and I felt a sickening feeling. ‘Shit, I’ve pricked myself’. I looked anxiously at Jo doing the anaesthetic and asked her what this woman’s status was. ‘Pretty sure she’s negative’ she said paging through her folder. ‘Yes!’ I could have hugged her across the theatre drapes! A repeat HIV test the next day confirmed her negativity and I was spared a month of gut churning antiviral “PEP” or post-exposure-prophylaxis. During my year here there have been about 4 doctors taking PEP and they are not a pretty site with diarrhoea and vomiting and feeling miserable. Only this week a medical student had a needle from an HIV + patient dropped into his leg by a nurse and was catapulted into a month of PEP and all its misery as well as 6 months of anxiety that he won’t seroconvert and become HIV+.

Impala preschool

On a more positive note, this week I looked after a Zulu king or Inkosi as they are called. King seems to be used fairly loosely here and there seem to be a number of them around, but nonetheless it was an honour and a privilege to look after such a mighty patient. He was a calm and pleasant man looked after meticulously by his nursing sister wife and his dehisced and infected open cholecystectomy wound did very well.

Waterfall in Highmoor in the Drakensberg















Daily mango collection at home

Margot said last week that she is ‘mangoed out’! We have had an extraordinary crop and our three massive trees in our front garden haven’t stopped dropping fruit. They fall day and night and frequently we are awoken by loud crashes on our tin roof. The lawn is littered with them; they squelch between our toes, fall in the pool and lie in heaps fermenting in the warm African sun. We have them for breakfast, lunch and supper. We’ve had them raw, frozen as ice-cream, mango fool, mango juice, mango chicken and this week, Ilda made a dozen pots of delicious mango chutney. The hospital staff at large, make frequent sorties into our garden and raid our trees and lawn by whatever means possible. They come with long poles, sticks, wire contraptions and nets to secure their share of this delicious succulent fruit. That’s another thing I love about this land of milk and honey; the abundance of fruit and the way that it belongs to all and everyone. They’re not our trees, we’re only baby-sitting them for a short time. The granadillas are already turning a fresh yellow so the next course is nearly ready.

I have just worked all of the New Year period and it didn’t live up to expectations. Not that I am complaining. We got to have some good down time, swims with the girls, braai on New Year’s Eve and generally not hauled out of bed too much. I had expected the worst and had spent the 31^st preparing our little Emergency Department with boxes of chest drains and endotracheal tubes for the inevitable carnage that was to eventuate. After mopping up the department and clearing a number of minor cases, I was happy to get out of there and slipped into bed at about 10pm. I argued that New Zealand had already celebrated New Year some 10 hours before so that I wasn’t being totally pathetic and besides, Ilda was already sound asleep! The first call came at around 02.30 and I excitedly thought that the action had begun. “I have a case for you Doctor’. “Yes what is it?” “A rape case, an 80 yo gogo (grandmother)”. I felt sick and despondent. My worst call possible and so far from what I expected. The nurse also had a chap who had blown up his hand lighting fireworks “crickets”, whom I spent some time with in theatre on New Years day. We took three of them to theatre that day, all of whom required finger amputations of varying degrees. New Year’s Day passed in a blur of the usual spectrum of pathology with a paucity of road trauma until about 9pm when half a dozen came in from a three car pile up. One driver was so drunk that he hardly knew where he was so I was delighted to take blood from him for the police. The injuries were not too bad; a lacerated knee, a fracture-dislocated hip and an impressive facial laceration like a lightning strike down the middle of the face with bits of fractured nose peaking out. I was certainly happy to see my colleagues on the morning of the 2^nd.

Below: Zara with various bugs and creepy crawlies!