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!