Saturday, November 22, 2008

One more week to go at Good Shepherd

It seems that despite only having one more week at Good Shepherd, I am going to be challenged right up until the very end.
It’s been a disastrous week in terms of what has been happening on my ward. Multiple deaths on a daily basis. On one day, I had 4 die within hours of each other and I was devastated. I started to question my ability and started wondering what I was doing wrong. In a moment of clarity, I was able to recognise that all these patients were incredibly sick with advanced AIDS and horrendous complications and no matter how much I fought for their lives, they were going to die anyway. It still doesn’t make it any easier.

I gave my nurses their last tutorial on Friday morning and I can’t help but feel that I am “abandoning them”. We have worked hard together and we have developed systems that have truly had a positive impact on patient care. I know that this will all inevitably fall apart once I leave as there will only be one physician to run both male wards/female wards and outpatients. An almost impossible task.

Julia returned to the USA on Thursday and we feel like we have lost a member of our family. She was one of the most incredible people I have ever had the privilege of meeting. At 23 years of age, she finished nursing school and came straight to Swaziland. An enormously courageous and selfless thing to do. She had been here for 12 months and during that time she integrated herself into the Swazi community by learning their language, immersing herself in their culture and dedicating herself to caring for the sick and destitute. She was also an incredible friend to me- her support and encouragement was invaluable. We shared many laughs and many tears and I feel a connection with her that will last a lifetime. I am so excited to see what her future holds as I know she is going to embark on more adventures that will lead to a truly extraordinary life.

By Friday, I was starting to feel completely depleted of any reserve to continue caring for my patients. I finished my ward round and then retreated to have a good cry. Thankfully, Susan informed me that she was going to Mbabane for a meeting and she asked me if I would like to join her. Being a volunteer, I have the freedom to say “I’m not coming to outpatients today”, so I happily accepted her invitation and we made our way into the capital city. We had a pleasant lunch and then made our way to one of the big hotels that was hosting a guest speaker from the USA. Her name was Dr Wafaa El-Sadr and she is the international director for ICAP (International Centre for AIDS care and treatment programmes). She is an infectious disease specialist who works at Harlem Hospital in New York under the auspices of Columbia University. She is an international expert on AIDS. She was giving a talk on AIDS and anti-retroviral treatment and she discussed the recent results of a huge international study called the SMART study. I listened to her in complete awe. It has been so long since I have been in an academic environment and I relished the opportunity to hear of her talking about disease, epidemiology, drug treatment and hopes for the future of AIDS. She must have noticed my enthusiasm for what she was saying because she came up to me after the talk and I introduced myself as an Australian doing my small part against AIDS here in Swaziland. She was very gracious and polite (and tried to convince me to give up emergency medicine and become involved in public health) and I found myself to be quite overwhelmed by being in her presence. I know this will sound absolutely ridiculous for some of you, but in medicine, there are some people who we consider “gurus” and I know she is one of them. I felt like I was in the company of a “super star”.
Susan and I felt re-invigorated that despite the hopelessness we see here, on an international scale, there is still a lot of passionate work being done to combat this disease.

By this stage it was about 7.30pm and we faced the dilemma of whether to drive back to Good Shepherd or stay in Mbabane for the night. We have been constantly advised not to drive in Swaziland at night as it is considered extremely dangerous. Despite the normal dangers of poor roads, the ever present cattle and goats that meander across the roads and the fact that no one here pays any attention to road rules or speed limits, we were also faced with poor visibility. However, I have not received any income since the beginning of July and my finances are starting to dwindle, so I was reluctant to stay in a hotel overnight. Susan was also keen to get home and she thought she was capable of safely navigating her way back to Good Shepherd. So we set out in the dark and I have to admit I was hyper-vigilant and nervous. Susan was extremely careful and as we made it closer to Siteki, I started to feel reassured that we would be OK. The reassurance did not last for long. We were within about 10 kilometres from home when a car recklessly came out in front of us and Susan had to suddenly slam the brakes and swerve off the road to avoid a collision. It was simply terrifying and we were physically and emotionally shaken. The rest of our trip was in silence as we both reflected on what could have occurred. There is no doubt in our minds that if Susan had not been so alert and her reflexes not so quick, we would have been in the midst of a disaster. There are no ambulance services here in Swaziland. The facilities here at Good Shepherd- if we had made it to a hospital alive- would have been inadequate to deal with severe trauma. We have run out of blood here, so if we needed a blood transfusion, we would not have had any blood available. I know these are all “ifs” but the reality is, we came close to tragedy that could have been avoided. I cannot imagine putting my parents through the agony of coming to Swaziland to collect my body and I am just so grateful that we escaped this event without us being hurt. I vow that for the remainder of my time here, I will not get into a vehicle at night. It’s just not worth the possible consequences.

I’ve decided to have a quite weekend and stay around at Good Shepherd. My tasks for this weekend are to write my Christmas cards and start packing some things up in preparation for my departure to Bulembu. I’m not exactly sure how I am getting to Bulembu, but at the moment it looks like I will be going on a truck that will be taking maize from Siteki to Bulembu. I’m just appreciative of any mode of transport. I will be coming back to Good Shepherd for a few days in December. I have offered to do ward rounds from the 22nd-25th of December whilst I am here with my family. It will give my family the opportunity to witness first hand the work I have been doing here and I know we are extremely short staffed during this time and my assistance will be appreciated.

It’s hard to believe my family will be here in 3 weeks. I know they are incredibly excited. Graeme (my step Dad) has had his bags packed for a month already and my mother is trying her best to get everything organised so that the various donations that she has received can be transferred here safely. She tells me that a number of you have been extraordinarily generous and I just cannot tell you how much I appreciate your generosity. Pleased be assured that you are truly making a worthwhile contribution and your donations will have an enormous impact.