Septic Tanks, Singing and Sights...

It’s not always rosy out here at Mseleni. Last week our septic tank overflowed. A thick slimy offensive green sludge seeping slowly across the lawn. Added to this, a flush of the loo served only to circulate things, producing a faeculant float and some embarrasmant! Despite repeated calls to the hospital maintenance and a promise of repair, we are yet to see the “sewer sucker” and have placed part of the front lawn out of bounds! Then before that it was the washing machine. The spinner no longer works and this too is on some imaginary repair list. All laundry is now done next door in the Dietician’s machine. A few weeks before this it was the carpet. A strange smell prompted us to attempt to wash the carpets in our park home. This only served to stir up nasty and previously dormant odours and the pungent stench of urine dominated the house for some weeks. At some expense, Ilda got a carpet cleaner up from Empangeni, 2 hours away, but even this has failed to completely eradicate the house’s history. Then of course the air conditioner didn’t work but fortunately that is now not too serious as things have started to cool down a bit and we had a portable one which kept us sane. Then we had a burglar. A young, well known kleptomaniac from the community, who slipped into our home and helped himself to some DVD’s . Fortunately Ilda heard him and gave chase and our loss was minimal. He was caught by the hospital security at Ilda’s insistence but such is their incompetence, he was set free with little more than a scolding. And finally, in this paragraph of woes, our car broke down, which necessitated a 3 hour tow-truck ride to Empangeni for car and Ilda. She over-nighted there and then returned in a hire car the next day. Thank goodness that granny Rachel was with us to mind the girls and we had insurance to meet the bills.

Work continues unabated. The novelty of the ward work has worn a little thin and thankfully I will be spending more time in OPD/ED from this month and less on the wards. I think that I am to cover male surgical ward and then have two sessions in OPD rather than the mandatory one. There is so much to be done in OPD/ED that I look forward to being able to get my teeth into it. Oh to have enough gloves, soap, adequate suction and working oxygen sockets. The needs are basic but the challenges seem massive.

The pathology here is overwhelming in its enormity. Little is subtle and yet it is rare to have a clear cut diagnosis as diagnostics are limited and access to tertiary level tests and imaging almost impossible. I lose count of how many HIV + patients I have who are wasted, feverish, coughing and confused and to tease out which of the multitude of opportunistic infections they may have seems insurmountable. Why, in this high tech era, do we not have a simple test to diagnose TB and have to rely on patients coughing up sputum, which even then is only +ve in about 25% of PTB cases? Some of my patients are on no less than 15 different medications and 3 or 4 times per day painfully force handfuls of dry tablets down throats scorched with thrush into stomachs rebelling at even food, let alone tablets. They lie in bed sweating, pale and gaunt and gaze at us expectantly with orange sludge dribbling from their mouths hoping that today we can make them better. But the reality is that mostly we can’t and the grip of AIDS is so immense that we can only tinker before the grim reaper carries them away.

But it is not always this dire. There are frequently pleasant surprises and it is never dull. Like the Caesarian section in the middle of the night who, as my shiny scalpel peeled through skin and fat, the young expectant mum broke into song and the OR was filled with her exquisite chanting. And the weird and wonderful cases like the young woman at my rural clinic who couldn’t close her eyes and turned out to have bilateral 5^th and 7^th cranial nerve lesions and we await a CT scan to confirm (perhaps) pathology. Or the car crash I was called out to from my clinic, while grappling with what ARV’s to start for a 6 month pregnant mother with Hepatitis B and Syphilis who had previously defaulted on her treatment. The truck had rolled, narrowly missing our OT and had come to rest on its roof. After climbing through a thorn tree to get to the crushed cab, I was surprised to find it empty, only to hear that the occupants had done a runner! Their legs were intact.

And so it goes on. We continue to explore this beautiful land and revel in our w/e excursions to teeming game parks and golden warm beaches. Only last week we were again scuba diving, this time near Rock Tail Bay. The diving is spectacular and we were entertained by massive Potato Bass, Moray eels, Sting Rays and a Green Turtle.