Saturday, January 3, 2009

Goodbye Africa, Hello Australia

Our last day in Africa was a memorable one- for many different reasons.

We spent the day at the De Wildt Cheetah sancturay which is an internationally recognised sanctuary for breeding the endangered cheetah. We had a great time getting up close with the baby cheetahs and then going on safari to see cheetahs in their natural, albeit, controlled environment. At the end of our day, we were able to touch a cheetah and get a special photo opportunity which will inevitably end up "in the pool room". (sorry to my international readers, but this infamous aussie phrase from the movie "The Castle" aptly describes the significance of this photo).
We then made our way to Johanessburg airport and this is where the chaos began. The computer system was down and it took us over two hours to check in. Our plans to shower prior to boarding the plane were thawted as we literally had to run to the boarding gate. Mum, Rachel and Graeme had seats allocated together, but I was seated alone. This did not upset me much because by this stage, all our nerves were frayed and a few comments between my sister and I were blown out of proportion and I was more than happy to spend the 10 hours in solitary confinement....
First, there was the inevitable problems of seat allocations and double bookings which proved to be our iniial delay. Then there was a problem with getting the passenger manifest to Hong Kong and apparently a vital piece of paper had to be on board the plane before we could legally take off. The searing heat of Johanessburg started to take its toll and there was no air-conditioning. The temperature within the cabin rose dramatically and babies started screaming, pregnant women started to complain and the only resolution to the problem was to open the doors of the plane to allow fresh air in. In total, we spent nearly four hours waiting on the tarmac for this vital piece of paper. Again, instead of complaining along with everyone else- I sat and smiled about how typical this all was for Africa. I had two lovely girls sitting next to me and we laughed and shared our unique stories to pass time.
We at last left Africa and I was doing really well until I open my gift that was given to me from Kristin and Andrew (Peace Corp). You see, it was my 31st birthday and they had been so thoughtful as to give me a present to open whilst I was on the plane. The card they gave me was overwhelmingly kind and sincere and I started the inevitable crying. By this stage, I well and truly had run out of tissues, so Qantas serviettes had to suffice in mopping up the voluminous snott and tears that poured from my face. It didn't help when I listened to the Crowded House CD "Recurring Dreams" which reminded me of my Australian roots. I was a pathetic, lonely mess and I'm sure the sight was enough to frighten young children.
We eventually arrived in Sydney, having missed our connection to Brisbane. We had to wait 4 hours for another flight, but thankfully during this time, I was able to indulge in my first decent coffee in five months and my spirits rose.
We got into Brisbane at about 10pm- 21 hours after we first got on the plane at Jo'Burg. We were met by my delightful cousin Natalie who greeted me warmly with a gorgeous bunch of 12 long stemmed white roses. A beautiful way to celebrate my birthday which had passed without event. Her family had also bought me a spa package for my birthday and I eagerly await the opportunity where I am able to have some of the Swazi dirt scrubbed off my face and the tension eased from my aching muscles.
I didn't get to bed until 1am and it's now 5am and I am sitting here updating my blog. I think it's going to be a long day. I decided to get up as I was lying there ruminating about work which starts in a weeks time. I am starting a new job in a place I have never worked before and I am starting to feel anxious. The truth is, it has been six months since I have practiced modern medicine and I feel a little rusty. At the airport, my family were joking that in a months time, I'm going to be called into the Directors office and he's going to ask me why I've ordered so many HIV tests and why I have sent so many sputum samples to be tested for TB. I'm worried that a patient is going to be wheeled in and the first question I'm going to ask is "What's the CD4 count?" The past five months have immersed me in AIDS, TB and infectious diseases that we only read out here in Australia. My practice of medicine was so vastly different to what is done here and what is expected by my colleagues and the public. This morning I was smiling as I recounted some of the procedures I performed there that I simply would not do here in Australia. I frequently put needles into lumps and bumps that would normally be done under ultrasound guidance here in Australia. I often did procedures where I had to be creative- for instance- we didn't have chest drains, so instead we used urinary catheters to drain massive pleural effusions (collections of fluid around the lungs). I did almost 100 lumbar punctures whilst I was there. My medical colleagues would cringe if they knew the conditions I did this risky procedure under. The patient would lie on their sides. I would not have sterile drapes. My gloves were not sterile. I would have a cotton ball dipped in anti-septic solution which I would use to sterilise the skin. I would not use local anaesthetic. The patients, due to the conditions they lived in, would often be caked in dirt and despite my scrubbing, I would never get that dirt off before I inserted the spinal needle. I would then collect the spinal fluid in a basic blood collecting tube and the procedure, done at the bedside with no privacy curtain and in cramped conditions, would then be left to await the results which often took 1-2 days to receive. Thankfully, I was often able to differentiate the cause of meningitis (ie bacterial or fungal) by simply looking at the spinal fluid and assessing the pressure at which the fluid came out of the needle. With cryptococcal meningitis (fungal), the spinal fluid would be under such pressure that it would come spurting out of the needle and if the fluid was clear, I automatically made the diagnosis and commenced my patients on anti-fungals. I didn't need the laboratory to give me the diagnosis- my accuracy rate was almost 100%. This new diagnositic technique that I developed will be completely useless here. I also had no problem obtaining the spinal fluid. My patients were so thin and cachectic that I didn't need to feel between their spinous processes. I was able to see the correct space and just insert the needle. Australia is one of the fattest nations on earth and I'm now going to have to re-adjust myself to the challenges of performing procedures on obese people again.
I suspect I will have a few sleepless nights ahead of me before I start work in one weeks time. In the meantime, I will spend my days at the hairdressers in an attempt to rectify the disaster which is my hair. I will have my skin scrubbed and my toenails perfected. I'm back to my normal existence and somehow it doesn't seem right to look such a mess. I will keep the blog going for another week or so- this way I can describe the adjustment phase after what has been the challenge of a lifetime for me. I think I will miss the blog and the stories I was able to share with you. Somehow I don't think this will be the last story I tell. It will take a few years, but who knows, maybe my next blog will read "Stories from Sudan" of "Stories from the South Pole"....