We then spent a night at Oribi Gorge, a nature reserve on the Mzimkhulu river which sits perched on the lip of an enormous forested canyon. They offer several extreme sports including the world's highest (possibly only?) canyon jump - I couldn't just walk away from that. It was a bungee jump next to a waterfall - you jump from the lip of the gorge over the falls and plunge down towards the river before they winch you up through the falls. In short, it was terrifying. But there's something quite special about hanging next to a huge waterfall just above the forest canopy, hearing the sounds of the forest and feeling you're the only person there, suspended in midair. After that we had a fantastic 3 nights at the Umngazi River Bungalows and Spa - what a beautiful place.
The thatched bungalows are on the river mouth, surrounded by fantastic gardens and looking out over a perfect golden beach. We had all-you-can-eat breakfasts, 3-course dinners and lunches every day, a sunset cruise on the river watching African fish eagles dive for their supper, a canoe trip through a Mangrove swamp, and a massage overlooking the ocean. It's hard to believe this luxury is just a few miles from Isilimela!Life at the hospital has continued much as usual. It's been getting busier and busier in the run-up to Christmas as the Transkei diaspora return from their homes all over South Africa and further afield to spend the holidays with their families. It's noticeable that for most of my time here we've always had more female inpatients than male; however, now the reverse is true as all the men who work in the big cities return home for the festive season, bringing their TB, HIV and proclivity for stabbing each other to share with the already downtrodden inhabitants of our little corner of Pondoland.
My own medical learning curve has been as steep as ever! I've now performed three Caesarean sections, thankfully always with the support of one of my more experienced colleagues. The second one is particularly memorable for taking place in the evening during an especially violent thunderstorm. Our electricity supply is quite fragile and in electrical storms it often cuts our, which of course it did mid-operation. So for a few (mercifully brief) moments we were actually operating by the light of a mobile phone! I also was able to travel to Port Elizabeth for two weeks of Anaesthetic training where I stayed with a fantastic consultant anaesthetist and his wife who have been incredibly supportive to us out here at Isilimela. It was a real eye-opener to work in a tertiary referral hospital in South Africa with consultants and highly-trained nurses and intensive care facilities, etc etc. But depressing too in that they were also plagued with lack of supplies - they ran out of laryngeal masks and several inhaled anaesthetic agents while I was there - as well as victims of the mind-numbing bureaucracy and appalling management which seems to be the curse of the health service in South Africa. I'm much more comfortable with the basics of anaesthesia since returning from the course and have managed three general anaesthetics since coming back which have all gone very well.
It was also great to be in a proper city for a change. Mthatha, our nearest city, is only barely worth the designation. It's a horrible, sprawling, catastrophe of a city - if you have a mental image of ugly, decrepit, rubbish-strewn cities in the developing world, Mthatha is the archetype. There are no traffic rules other than might is right, there are no pavements, no entertainment facilities or restaurants worth mentioning, and its main purpose for us is that it houses the nearest bank capable of performing any useful services, if of course you have the requisite forms signed in triplicate and your passport, proof of residence and preferably a signed letter of authorisation from the president of the republic, although they are prepared to waive this requirement if you stand in line for most of a day and accept some minor scowling and exasperated sighing at your clearly unreasonable demand to have access to your money. However it is one of those eyesores which you can, in spite of yourself, grow to love. I particularly love the newspaper billboards with their ridiculous headlines. A selection: "THE MYSTERY OF THE GIRL - AND THE COW!!" or "MORE RAIN - BUT NOT HERE!", or my all time favourite, "NGO SAYS, SHOW US THE MONEY, BIKER BABE!". Unfortunately I've never actually come across the newspapers themselves but the billboards always crack me up.
Port Elizabeth, on the other hand, is a nice city with beautiful beaches right in the centre of town, theatres, museums, restaurants, coffee shops, and most interesting to me, an array of motorcycle dealerships. It's called the Friendly City, and is known for its low crime rate (in South African terms). Certainly I felt pretty safe nipping around in my rental car and took advantage of having access to civilisation, stocking up on books, camping gear, nice food, etc. At the weekend my host lent me a tent and I took off to Addo Elephant National Park which most certainly lives up to its name.
I have never seen so many elephants - unbelievable. There were also wildebeest, lions, kudu, eland, haartebeest, jackals, ostriches, zebra and innumerable other animals and birds. From there I drove to Tsitsikamma National Park which is really the start of the Garden Route to Cape Town. It's a rugged coastline with steep mountains and deep, dark river canyons. Also very beautiful but unfortunately my experience was significantly hampered by severely bad weather on the second day there.Also unfortunate was the lack of suitable motorbikes for purchase in PE, despite significant time and effort on my part spent searching. They were all too expensive, too old, or too unsuitable for the rigours of dirt roads in the Transkei. So, regretfully, I booked another bus, this time to Durban where I'd seen a bike on the Auto Trader. The bus was an experience in itself - they take economy class to another level.
hbThere are five seats to a row instead of the usual four and I mostly had to sit in the foetal position to avoid either fracturing my kneecaps through repeated collision with the seat in front with every judder of the spluttering engine, or losing circulation to my legs from wedging them underneath the seat in front. Thirteen hours of this - complete with screaming toddlers, ladies of improbable girth in the adjacent seats, interesting aromas, and no on-board toilet (possibly, but not definitely, a causal factor in the disturbances in the olfactory landscape). This is Africa, baby. Anyway I got to Durban thanks to a little help from some friends, and purchased the aformentioned motorbike which now has pride of place in my living room. It's so nice to have some independence - not to have to rely on my colleagues (or much worse, the notoriously unreliable hospital transport) to get anywhere. Every time I take it out, I love it a little bit more. The locals also love it - if you want attention, drive a motorbike through an African village. There seems to be something innate to the African Y chromosome which makes you love bikes - the boys yell, run and caper wildly behind me, the young men make cool hand signals, the older men stare or try to flag me down for a lift. One girl even yelled at me to try and give me her phone number! Not sure if she wanted a date or just a taxi service.My maiden voyage was getting the bike back from Durban which was a 7 hour trip. We broke it up by staying just outside Port Edward in a nature reserve on the Mtamvuna river. There are so many arrestingly beautiful corners to this country, often when you least expect them. The owners of the lodge where we stayed suggested we borrow their canoes and head down the river the next morning. If you've seen Blood Diamond - this is the river where they filmed it, I'm reliably informed. It's a swathe of green between sandstone cliffs with fish eagles in the trees and weaver birds in the reeds. There's also a lot of flying fish, who kept jumping out of the river when we paddled through - amusingly once just as I got a call on my cellphone from Gemma and a fish jumped right at me, only missing my face due to a fortuitously positioned canoe paddle!
Back at the hospital then life feels pretty settled. I suppose as you grow more used to something, certain things which were just different at the beginning, and therefore new and exciting, begin to bother you as you realise that they could and perhaps should be changed. A few of my efforts in this direction have borne some fruit - I wrote letters to the National Health Laboratory Service and to Department of Health bigwigs complaining about the poor service we were receiving and have since had a couple of meetings with them, resulting in the fact that we all (doctors) now have Blackberry mobile phones which link into the Lab's results software. Plus we've seen a real improvement in turn around times for essential tests. I've seen some
improvement as well from the nurses who've attended the training sessions I've organised for them, particularly in shock and fluid resuscitation - I get unaccountably gleeful every time a nurse tells me, 'we noticed this is shock, doctor, so we put up some fluids.' It just didn't happen a few months ago. However there are still a lot of frustrations about which I am powerless to do anything. For instance, last week a private GP transferred me a patient who was paralysed on one side of her body and had a coma score of nine (which is well on the way to being in a coma). He'd had her at his clinic for four days and now decided to transfer her to me, suggesting a diagnosis of Bell's palsy. For the non-medical, Bell's palsy is a short-term paralysis of one side of the face only which certainly doesn't cause you to lose consciousness; while any medical student could probably have identified this patient as a stroke. This is a routine occurrence from the private doctors in this area who seem to be entirely unregulated, and extract huge amounts of money from our impoverished population. Shameful. The ambulance service also seem to be operating in a different universe, refusing to transport patients who are at death's door but then bringing patients in the middle of the night who are suffering from 'painful neck veins'. It's infuriating, and there is no apparent recourse - no one to complain to, no superior to call. And the patients here are so unaware of their own abandonment by the bodies which should be providing essential services to them, or so apathetic in the face of it, that they are unable to complain themselves, as they should, and loudly. We are trying to pick our battles - and be encouraged by every small victory.
This brings me finally to Christmas. It's been strange celebrating in 30-degree heat when Europe seems to be in a deep freeze. It was especially jarring to see fake snow in shop windows in PE, with Christmas trees and Santa chortling, while people walk about in shorts and vests outside and the sun is splitting the heavens. Back at Isilimela we had a lovely day - I made a Christmas pudding and put it on to steam while we went to the beach and caught some waves - perfect temperature. On the
way back, the dog was so tired (and probably dehydrated) he couldn't keep up with the bike so my colleague Bregje had to pick him up and wedge him between us on the motorbike, which caused much hilarity. Shame we didn't have a camera. The Christmas pudding was so good I almost wept. There's nothing like it. I was even quite glad that no-one else likes it that much - more for me. We also made a Pavlova as a Kiwi friend has come to spend Christmas with us and apparently it's traditional in NZ. So good times were had by all! My housemate and colleague Annelieke, had her parents coming to stay, who arrived yesterday so we saved Christmas dinner (roast beef with roasted sweet potato and butternut mash) for last night along with opening presents. Santa's elves in Mthatha seem to have a fairly limited repertoire so there was a strong personal hygiene theme in Santa's offerings this year! Today is the only public holiday in the festive season here - the others fall on weekends and don't get rolled over to the weekdays; I feel slightly cheated. But I've had a great day - we walked to a local waterfall and went swimming in the plunge pool.
Perfect. I'm on call over new year's weekend - a 72-hour on call when I expect to sleep very little. Port St Johns is one of the famous destinations in South Africa for new year's eve and there'll be a lot of drink and drug fuelled revelling, which in these parts translates into a lot of stabbings and haemopneumothoraces for me. So spare me a thought as you sing Auld Lang Syne this weekend, I'll probably be groggily hacking at someone's intercostal muscles trying to get a tube between their ribs at 2am local time. I'll be thinking of you all, friends and family in scattered arts and parts, and thankful for all you have contributed and continue to enrich my life with. Sorry it's taken so long for me to update this blog, reply to messages and emails, or respond to Skype requests - combination of increased workload and shocking internet connectivity for the last month or so. But here's to a better 2011 - grace and peace to you all for the coming year, and looking forward to seeing many of you when I come back in February or August.
No comments:
Post a Comment