Monday, December 1, 2008

Swazi 1000

I got to bed late on the night of Thanksgiving and this combined with having to pack up my apartment, simply exhausted me, even before I got out of bed.
I was determined to make sure that all my patients on the ward were thoroughly sorted before I left and the ward round was long and complicated. By the end of the round, my nerves were frazzled and I was stressed out. I was drenched in sweat as the weather was unbearably hot and I was feeling the beginnings of a migraine coming along.
Thankfully, at midday, I was greeted by the delightful Heather and Andy Sullivan. They are the couple from Bulembu who care for the orphans aged 3-4 years of age. I have become quite close to them during my time in Swaziland and I was incredibly touched when they offered to make the 6 hour round trip to pick me up from GSH and take me back to Bulembu. The trip back to Bulembu was long, stifling hot and difficult as we made the treacherous climb up the mountain along an uneven dirt road. By the time we reached Bulembu, I knew I was in trouble. Ever since I can remember, I have suffered debilitating migraines that tend to manifest themselves at the most inopportune times. This was one of those times and unfortunately, I never made it to the “carols by candlelight” I was looking forward to because I was hurling my guts out whilst thinking that my head was going to explode. It was not pretty and it’s during times like this that I feel the most lonely.
I woke the next morning and felt much better. I looked around me and knew exactly why I felt better. I am being accommodated at the Lodge and my bedroom is simply delightful. Beautiful double wooden bed- with at least 100 thread count sheets. The polished wooden floors, the bath with claw feet and the features that take you back to a bygone era all make the experience incredibly comfortable and welcoming. The fact that I am being provided with three gorgeous meals a day and the staff know me well all contributes to me feeling like I have reached paradise. I am being treated like a first rate Swazi princess and I couldn’t be happier.
In case some of you have forgotten, I am here for “Swazi 1000”. This is a two week project in Bulembu where college students from South Africa have congregated to volunteer their time to restore buildings that will house orphans. I am incredibly privileged to be a part of this event as it is simply spectacular. The sheer enormity of this undertaking, the remarkably special people involved and the work that is being done- is overwhelming. This project is being co-ordinated with military precision and I am in awe of what is being accomplished.
I am here as the doctor who is available to deal with anything medical- emergency or otherwise that comes up during the two week exercise. I am accompanied by a young man named Neil. He is currently a student at Johannesburg University studying a degree in “emergency medicine”. Whilst this is not a medical degree, his knowledge is excellent and equivalent to what we term “Advanced care Paramedics” in Australia. He and I work really well together and already, only 3 days into the event, we have cared for numerous patients. Mostly lacerations, but some abdominal pain and cases of tonsillitis etc. We are amazingly equipped. Neil has brought defibrillators, intubation equipment, enough drugs and equipment that we should be able to cope with almost any emergency. I have more resources available to me than what I had at Good Shepherd Hospital!
Thankfully, these resources have already proved invaluable to us. Yesterday at 1pm I was called by Neil who told me that he had a 20 year old patient with chest pain and shortness of breath. I have to admit, I didn’t rush to this case. The night before I had some students come to my room and tell me that a young girl was seriously ill and it was an emergency- I jumped out of the bath, threw some clothes on and ran over to our temporary “hospital” only to find a young girl with some intestinal cramping. I took the opportunity to define what should be considered an “emergency”. When I was called to a 20 year old with chest pain, I didn’t think there was much to rush for. When I got there, my opinion changed immediately. The patient looked dreadful- the pulse was racing, the patient had laboured breathing and was drenched with sweat and in severe pain. The patient also weighed about 150kg (~300lbs) and suddenly I knew that I had to consider that this young patient may have a cardiac condition. Thanks to the amazing equipment Neil brought along, we were able to get a 3 lead ECG and I didn’t like what I saw. He was having dynamic changes to his ST segments and I started to worry that although unlikely, this patient maybe having cardiac ischaemia. My emergency training has provided me with many skills and diagnostic abilities, but I have to admit, over the years, I have developed this “gut instinct” that tells me when something is going wrong. I made the decision that we couldn’t keep the patient here in Bulembu and that we needed him evacuated to South Africa. The people here were simply AMAZING and thanks to Neil’s knowledge of the South African medical system and modes of transport, we were able to organise a speedy evacuation process. What occurred next simply could not be scripted. Somehow, with the assistance of fellow volunteers, we were able to lift the patient onto a dining table which we used as our “stretcher”. We then carried the patient out to our awaiting “ambulance” which was the back of someone’s ute. Just as we left the building, the heaven’s opened and it began to bucket down with torrential rain. I was drenched, but completely unfazed. We had an IV line, we had already given aspirin and 18mg of morphine as well as an anti-emetic in case the patient got nauseous. We had a defibrillator and I felt that Neil and I could cope with any eventuality. (although I was a little nervous about having to use the defibrillator- we were absolutely soaked and the thought of using an electrical current gave me pause). In fact, I was so unperturbed that at one stage I thought to myself “My gosh, these South African men are just gorgeous, I wish I was 10 years younger” (now that’s disturbing, but remember I have been through 5 months of a complete man drought) With the three of us cramped in the back of the ute, we drove to the South African border. We were met by some Advanced care paramedics (again, ruggedly handsome) and we safely transferred the patient into their care. Although the diagnosis is still uncertain, we heard today that the patient is doing well.
We haven’t had quite that level of excitement since, but Neil and I have spent the rest of our time at the abandoned hospital here. Our challenge over the next 2 weeks is to try and sort the place out. It was abandoned suddenly and there is a lot of equipment and resources that can be used elsewhere. The project is enormous and I doubt we will get through it in time. The problem is, the hospital received an enormous amount of international donations and most of it is completely inappropriate for the medical care we are able to provide here in Swaziland. Incredibly sophisticated pieces of equipment- hundreds of central venous lines, instruments for incredibly complex surgical procedures and even catheters for angiograms and other invasive diagnostic procedures. I know all of this was donated with generosity and kindness, but honestly, here in Swaziland, with our basic provision of health care, all of this is redundant. We have had to dump hundreds of thousands of dollars of resources simply because we cannot use them here. It breaks my heart. That being said, we have been able to salvage a lot of resources that will be invaluable to the Good Shepherd, so not all is lost. A lot of the equipment is from America and is 110 voltz. Here in Swaziland, we have 240 voltz, but some of the equipment may be able to be converted although it will be at great expense. When we have sorted out the resources, we plan to set up an emergency room here at Bulembu and then we will write protocols and train the nurses here to provide simple emergency care. This is a huge undertaking and perhaps overly ambitious for a two week project.
Not all of my time is spent working. I have been able to spend time with my beloved orphans. The babies are cute, but I prefer to spend my time with the 5 children aged 3-4 years. They have got to know me during my visits to Bulembu and we have established a close relationship. I spend hours playing with them, being the recipient of many cuddles and kisses and generally having the time of my life. I am completely and utterly in love with these children. I know my heart is going to be broken when I leave. This afternoon, I spent 3 hours with them. I sang nursery rhymes to them, helped them name Australian and African animals and helped them with colouring in. I don’t think I have felt this happy and this content for a very long time. They are beautifully behaved children and each take turns for their special “cuddle time” with their Aunty Melanie. I am never without a child in my lap or in my arms. I am absolutely delighted that their favourite show on TV is “Hi-5”. This is an Australian production and thanks to my many years as a babysitter I am very familiar with all the songs. We danced and sang and I delighted in the fact that no matter where you are in the world, all children are generally the same. We are all humanity. We all want to be loved, we all want to be able to express ourselves and we all want the freedom to do so.
I truly feel like the luckiest girl in the world to have this experience. Whilst I do feel bad about abandoning Good Shepherd early (and I know they are upset with me), I feel like I can truly enjoy the rest of my time here in Swaziland. I have temporarily escaped the devastation and for that, I am truly grateful.