Wednesday, December 10, 2008

Bulembu, Barberton and Breasts

I visited South Africa prematurely today. Not for pleasure but rather to take a 16 year old boy with a hand injury. He fell on his right hand whilst playing soccer last night. He was in a lot of pain and I suspected a fracture, so I applied a backslab and planned to take him to South Africa the next morning for x-rays. (We could have gone to a hospital in Swaziland but we knew we would have had to wait for at least 8 hours and if there was any pathology there are no orthopaedic surgeons to treat it).
We left for a place called Barberton which is about an hour away from Bulembu. The scenery was gorgeous and we were able to listen to an SA radio station which played music very similar to what I listen to in Australia. I think I have mentioned this previously, but I have really missed music whilst being here in Swaziland and any song that I recognize provides me with immense pleasure. I even sung along with John Farhnam (an Aussie icon) as we listened to “You’re the Voice”.
Anyway, back to the patient. We had x-rays done in Barberton and they were normal. I was still highly suspicious of a fracture of a bone called the scaphoid and the patient had developed numbness of his entire thumb which I was concerned about. I managed to get my hands on a list of orthopaedic surgeons in a nearby town called Nelspruit. I simply called one randomly, explained that I was an Aussie doctor working in rural Swaziland and asked him if he would mind providing me with a second opinion. I think he thought it was quite a novelty to have a random Aussie doctor call him and he agreed to see us whenever we arrived. Let me tell you, I got my first inclination of the culture shock that awaits me when I get home. Nelspruit could well be any suburb that I have visited in Australia. The houses were very similar, there were shopping malls and the medical facilities were even better than most private practices I have seen in Australia. It was all quite bizarre to be in Africa and yet feel like I was back home. The only difference I noticed was that all the houses had large concrete fences surrounding them and on top of these were barbed wire. Apparently this level of security is quite benign compared to what I will experience in Johannesburg.
We saw the orthopod and his office was immaculate with modern furnishings and expensive pieces of art work. Again, it crossed my mind that as an emergency physician I will never be able to have the beautiful office with plush waiting room and there is part of me that thinks I’m absolutely crazy choosing the specialty that I have…
Anyway, the orthopod agreed that it was likely to be a scaphoid fracture (these fractures often don’t appear on x-ray until about 10 days after the injury). We were instructed to then go somewhere else to go and get the plaster. We got to that place and were told that the patients medical insurance didn’t cover the plaster and that we had to go and get clearance for it at some other place. We couldn’t find this other place and by this stage I was getting concerned that we would not make the border gate that closed at 4pm. I certainly didn’t want to have to find a place to stay overnight. I made the decision that I was perfectly capable of applying a scaphoid plaster and we decided to come back to Bulembu and apply the plaster here. It’s funny, but I have become a little insecure in my abilities here. I was so incredibly challenged with my patients at Good Shepherd that I’ve started to forget that I actually can practice my “western skills” here as well. I guess what has also concerned me is that at Good Shepherd we did the absolute best we could with what little resources we had and this often fell short of what is considered “Western standards”. I got used to that and began to accept it. Now, I am treating wealthy, white South Africans and the standards and expectations have changed dramatically. I’m now going to great lengths to treat relatively benign complaints when for the past 5 months I have been desperately trying to treat incredibly serious, life-threatening conditions that I could do little about. The irony is, I think I got a lot more from the effort I made there (despite the results being tragically poor) compared to the efforts I am making here (with very successful results).
The border crossing was interesting. The South African side was all computerized and I was scrutinized more closely. The Swazi side consisted of hand writing my name in a big book and then being asked if I would like to purchase some craft work from some ladies loitering in the office. It was particularly endearing and I know that I will miss the old-fashioned, traditional ways here in Swaziland.
I applied a particularly good scaphoid plaster back in Bulembu and the patient walked away without even thanking me for the efforts I had gone to throughout the day…..

I was then able to go and spend the late afternoon with my special friends. We had a wonderful time as we watched a movie called “Madagascar”- a children’s film that I have not seen previously. The movie was hilarious and it was particularly special because I was never without a child in my lap. The orphans are in no way institutionalized, but they do seem to have a more pronounced concept of “sharing”. Without any discussion, they would each spend about 20 minutes curled up in my lap and then they would leave so that the next one would get special “cuddle time” with Aunty Mel. I treasured every moment. I made sure I gave each of them the same number of kisses and made sure I told them each that I loved them as they left my lap. I have bonded incredibly well with these children and I know I am in for one big heartache when I leave. There are about 50 orphans under the age of 4 and I spend nearly all my time with the 3-4 year olds. I thought I would just take a moment to describe each of them and hopefully when I can download photos, Courtney will be able to attach them to my blog.

Enoch is 3 and has been at Bulembu since he was born. He has the most incredible smile and he definitely knows how to use it! He “flirts” with me and he knows that this often gains him an extra cuddle and kiss compared to the others. Enoch is particularly talented with his ball skills and I know that if he is given the right opportunities, he could become an amazing sportsman when he grows up.

Dexter is almost 4. When I first met Dexter he was barely able to walk. He was incredibly sad and never smiled. In the time that I have known him, he has flourished. He is almost able to run and whilst his vocabulary is delayed compared to the others, he has progressed in leaps and bounds. He now has this drop-dead gorgeous smile and has become particularly affectionate towards me. I scoop him up and start kissing his ears whilst telling him “I’m going to eat your ears” which makes him giggle uncontrollably. He has now taken to coming up to me and saying “Aunty Mel, can you eat my ears?”

Alan is the oldest of the 5 and he will advance to the next level in the orphanage next year. He and I are not so close but he always informs me of any recent “news” like if he has had a fall, has a headache or has a sore ear. Kisses cure everything.

Lily is gorgeous and from the moment I met her I started telling her so. She now runs up to me every time she sees me and says “Aunty Mel- I’m gorgeous!” She has recently got glasses and a whole new world has opened up to her. She’s definitely a “girlie girl” and she loves showing me the contents of her handbag.

Doris is the youngest and the most recent addition to the group. She is incredibly affectionate and loves a cuddle with her Aunty Mel. During our cuddle times, she has discovered that I wear padded bras and she is completely fascinated by them. She’s often poking me and marveling at the fact that I appear to have foam permanently attached to my chest. I don’t have the heart to tell a little African girl that it’s probably not socially appropriate to be fascinated by my breasts.

Another day over and now only 4 sleeps until the family arrive.