Thursday, August 21, 2008

My first week at the Good Shepherd

I was wondering if I would ever be able to post an entry again. The electricity is continually shutting down and this computer is tempramental to the point that I could just throw it out the window, however, like everything in Swaziland, I am going to have to learn some patience- everything here works at a snails pace.
Like I expected, my first few days here have been nothing short of chaotic. I wish I was a better storyteller as the words I am about to write do not truly give a good depiction of what I have encountered.
On my first day, I saw all the male and female medical inpatients and it was enormously overwhelming. From my log book I have worked out that ~90% of the patients have AIDS and they are complicated with diseases that I have only read about. Lots of meningitis. TB is rampant. Have seen typhoid, lots of diarrhoea and AIDS related chest infections such as PCP. Many patients have horrendous oral/facial tumours that just eat away at their flesh. One lady has a perforated palate. We do not have any injectable morphine so my options for analgesia include paracetamol (acetaminophen), ibuprofen and panadeine. I cannot give my patient with the perforated palate any analgesia because she cannot swallow. She obviously can't eat so I expect her to die at any moment.
Yesterday I diagnosed a lady with leukaemia. I made a desperate attempt to transfer her to Mbabane (capital), I went to write a referral letter and the nurses informed me that she had just died. No warning, no acute deterioration- just died. A 30 year old female delivered her first baby, went for a shower and then just died. We will never know why.
The bed situation is a complicated affair. Men and women are separated and they can never mix. We ran out of male beds yesterday and I suggested that we put the men in the vacant female beds- I was met with a look of resounding horror from the nursing staff- it is not "Swazi" to mix the two. When I say that we ran out of male beds, I mean that every bed is occupied, the floor space between the beds is occupied and the area outside the administration offices is occupied. We don't have access block in the ED- if there are no beds, the family have to take the patient home (they are often dying) and return the next day to see if there are any beds available.
The Emergency department consists of 3 archaic trollies in a very small, crowded room. There is virtually no equipment. I do several lumbar punctures a day. I use a piece of cotten wool soaked with betadine and a spinal needle. No sterile gloves. No drapes. No local anaesthetic. For my non-medical friends, I can tell you that this is an extremely primitive and dangerous way of doing this procedure. I do it anyway as a great many patients have meningitis.
Gloves are in really short supply. We do have some gloves that resemble the plastic bags that you put your fruit and vegetables in at the grocery store. They are really big and flimsy. There are some rare latex gloves but they are used for particularly dangerous procedures. Sharps bins are in short supply and this concerns me given the enormous rate of HIV. No one could find one this morning and I was told to leave my spinal needle in a cardboard shoebox to be disposed of later. I have to say, it was the first time this week that I nearly lost it (and there have been plenty of opportunities this week where I could have lost my cool). I ended up taking the needle to men's ward and finding a bin there- an expedition that was frought with danger in itself.
At the moment I am looking after the female ward and then after my rounds, I go to outpatients where I see all the medical patients. I really enjoy looking after the women. I feel that they are at the bottom of the Swazi pecking order and I hope to bring them some dignity and compassion as I look after them. The other doctor who looks after Internal medicine goes on leave today and I now am the official doctor for this department. God help me and all the patients.
I have so much more to write, but I thought I would just start by describing some of the medical things I have encountered this week. I have so much to tell you about all the funny things I encounter outside of my medical work.
I cannot receive email here via my hotmail account. I have no idea why. If you would like to email me- send an email to Put my name as the subject heading and I will have an easier time accessing the messages.
I will try to post again on the weekend- if the electricity is on and the computer is working!!


Trent Y said...

I feel a bit guilty having enthusiasm for such terrible stories - but it does remind me why I like infectious diseases.

I'm curious though - do you have a lab to look at the CSFs? And does it change your management, or do you just give them antibiotics anyway?