Friday, October 31, 2008

Melanie's musings

Today was a huge day here at Good Shepherd. The “newly elected” (ie chosen by the King) Prime Minister and Health Minister came out to see the hard workers at one of their leading hospitals. The place was like a circus with people running around like lunatics trying to make the place look better than it actually is. Meanwhile, Chris and I spent our time hidden away in the hospital actually seeing patients. It seems ironic that as the only two staff members who aren’t paid to work here, we were the only ones who were working and not watching various speeches given by Ministers who didn’t actually step a foot in the actual hospital. I shouldn’t be so cynical- I know this happens with politicians everywhere in the world. However, I want to give you a “behind the scenes” insight as to what was actually happening behind all the pomp and ceremony.

I woke up early this morning. On Fridays I give the nurses a tutorial at 7am. I had a splitting headache and for a moment, it crossed my mind that I may have meningitis. I then reminded myself that I don’t have AIDS and despite the fact I have many cases of meningitis on the ward, it is uncommon to get the disease if you have an intact immune system.
I entered the ward and was nauseated by the smell of faecal material. One of my women, who has been with me well over a month, has shocking diarrhoea and the faecal material had leaked out of her incontinence pad and smeared every surface surrounding her. She has advanced AIDS and can barely roll over because she is so weak. Her family have abandoned her and I have no where to send her for her final stages of life. She will probably spend her last amount of time on earth lying perilously in her own excrement.
I then started my ward round, trying to ignore the stench of urine, vomit and faeces that lingered in the air. One of my first patients had been admitted overnight and I was reviewing her for the first time. She was 13 years of age and had been admitted with presumed meningitis. After reading her notes, I went to examine her. No pulse, no respirations and pupils fixed and dilated. Diagnosis: dead. Let me tell you, this has happened before and it’s not a pleasant way to start the day. She was 13, but already looked like she had advanced HIV. You may ask, “How does a 13 year old get HIV?” The sad answer is that many young girls are often sexually abused when they are little and by the time they reach adolescence, they have full-blown AIDS. I’m not sure how common it is here, but certainly in South Africa, there is a belief amongst a small group of people that having sex with a virgin will cure you of your HIV. This puts many young girls at risk and further perpetuates the cycle of HIV. We see a lot of young girls here who have been sexually abused. Thankfully, I have been shielded from having to actually care for them and for that I am grateful. It would destroy what little is left of my spirit.
I then had to see a twenty year old female with advanced HIV and a pneumonia called PCP. I thought I was succeeding in her management, but today she was confused, disoriented and having visual hallucinations. This happens quite frequently here and usually leaves me with a sinking feeling of impending doom. I wrote up some drugs for her and moved onto my next patient. Meanwhile, she falls out of bed trying to reach for something that doesn’t actually exist, and she starts crawling around on the cold cement floor. She was then sliding in between my feet, guided by her visual hallucination but also showing a look of shear horror and fear like she was possessed. I looked at my nurse and said “you better go and get some help”. I tried to comfort the patient and reassure her that she was safe. My nurse was taking an inordinate amount of time trying to find some help but she eventually returned with two of the male student nurses. With a difficulty that was painful to watch, they hoisted the patient back into bed and proceeded to tie her hands and feet to the railings using scraps of fabric. These are the physical restraints that are used here to deal with “difficult patients” and it really disturbs me to see these very frightened, sick people tied down. She started fighting against the restraints and I ended up ordering a drug to try and tranquilise her so that the nurses could manage her. There simply aren’t enough resources for nurses to do one to one nursing here and this was my only “safe” alternative for the patient. I dread to think what will happen to her over the weekend when I am not around. This is another dilemma I face- for two days I feel like I am “abandoning” my patients and there have been times where I have considered dropping in on a few occasions to check on them. I started doing this when I first arrived but I have restrained myself from doing so lately as I simply need to protect myself from burnout and have two days a week where I am not confronted by death and devastation.
I then went to outpatients, where I was the only doctor present. I started seeing copious amounts of patients, most of whom were co-infected with HIV and TB. Their management is incredibly difficult and I found my headache getting progressively worse. By lunchtime, I hit the wall and I went back to my flat and collapsed on my bed. I ended up falling asleep and I missed the afternoon in outpatients. I felt bad, but I was so exhausted and hopefully, now that the PM had left, the other doctors had returned to work.

So now I am at the beginning of a weekend and I hope it will be a pleasant one.

I am starting to get very nervous about the upcoming US election. Although I am not American, I do follow American politics closely and I am a huge fan of Barack Obama. In fact, I think I love him. This week, I even had a dream about him. It probably was influenced by the fact that I am reading his book “The Audacity of Hope” and the election is so near. We, as volunteers have been very concerned about how we are going to watch the election coverage. We lost our TV so we no longer have access to CNN. We were brainstorming all week and I finally got the courage to ask Dr Wahabi (gynaecologist from Ethiopia) if we could use his TV during the election. He happily obliged and we now have plans for Chris, myself, Susan and my Peace Corp friends to spend Wednesday morning (Tuesday evening American time) watching the election coverage. Kristin and Andrew have even volunteered to make pancakes so that we can make a party out of the occasion. However, let me warn you now, if Barack loses, I’m afraid there will be more tears……
Just so you can appreciate just how far reaching the results of the election are, the other day, I had one of the grounds men here at Good Shepherd approach me and ask if I could do him a favour. He wanted me to try and email Obama and let him know that the Swazi’s love him and they hope he isn’t taking the insults that McCain throws at him personally. I couldn’t help but smile. I had to inform him that although the internet was a powerful tool, I didn’t have Obama’s email address and I wasn’t sure how to contact him. The grounds man was most disappointed.

It was Chris’s birthday this week and we went all out to make it a special time for her. She had two parties. The first one was on Tuesday. I made minestrone and Kristin made a cake. Minestrone is my signature dish here in Swaziland. It is the only thing I can make that reliably turns out well enough for group consumption. Kristin’s signature dish is dahl and Chris’s dish is Cincinatti chilli which is chilli beef made with chocolate and cinnamon and served over spaghetti…….Julia makes her own bread and is just a magician at whipping up cakes that delight us all. Chris then had a second party on Thursday night where we invited all the doctors and their wives over for dessert. It was a nice occasion. Birthdays here are important. The average life expectancy here in Swaziland is 33 (yes, you read that right THIRTY THREE), so any birthday after that age is considered extra special. I hope Chris felt special because she certainly is the ray of sunshine here during the dark times in Swaziland.