Week 1 in the Hospital

So, 7:30am start on the Monday morning for a meeting about mortality and morbidity issues within the Theatre department and whether these were avoidable. Mostly no, it appears that late presentation plus meddling by the witch doctor cause serious unnecessary problems. 8:30 and straight into Theatre to scrub and assist in sorting out a young girl who was hit by a car and had severe polytrauma.

Bang! what a start to my elective attachment, a significant proportion of the patients here are carriers of HIV (many of them either don't, or refuse to know about it too).You have to be careful when dealing with them, but not much more than usual common sense is required.

Tuesdays is a list day in Theatre with our firm running two theatres. Cases varied from abdominal stab wounds to colostomy patients. General surgery really does mean it here. There are only two different distinctions, General and Orthopaedic, at Ngwelezane hospital but this caters for a massive variety of patients. Today I assisted in theatre again.

The Hospital itself is quite a culture shock from the UK, it is Herring bone in structure, with the main corridors open to the air with tin coverings. The Wards house 50+ patients each (there are 10 main wards) and are run by a skeleton staff of nurses. There is no resident Medical officer on the surgical wards but daily rounds are done and they are available by phone.

Diabetes also seems to be a big issue in Natal (type II - acquired) with obesity very common (in the non HIV positive population) and public health education is poor. Subsiquently, several of the patients that we saw at the outpatients clinic were recovering from, or needing limb amputation. In the UK this is a rare and stigmatised thing, but the sheer number of amputees on the wards are proof of the inadequate primary and preventative care available. Clinic is run from two open roof rooms which provide little privacy - especially when up to 3 Doctors are working in each room.

Literaly anything can turn up and I found myself working with my own patients and interpreter (Zulu is the indigenous language in the area) with the advice of other doctors if required. I am permitted to request investigations and prescribe basic medications (antibiotics and pain killers for exaple) as this frees up the other doctors. I am obviously supervised but have far more independance and responsibilty than a med student could dream of in UK.

Wednesday night found us waving good bye to two British Doctors who had been working at Ngwelezane for the past year, it also worked as quite a convienient 'hello' for me (see picture) and much good cheer was raised (and drunk) by all. Luckily, Thursday was Youth Day in South Africa and a public holiday and I had opted out of 'on-call' (a wise choice considering my state the next day).I therefore spent Thursday in Mtunzini, a small town where most of the other Doctors live, chilling out and sorting myself out. Youth day also matched with the Comrade's marathon, a 90km run from Petermaritzburg to Durban. some 12000 idiots took part in 25 degree heat - crazy fools!!

Clinics again on Friday - but new referrals this time - as well as emergency cover in theatre (for the continuous trickle of Stabbings) and I assisted in two laporotomies for these and a skin graft on a poor chap who had lost both his feet following electrocution by a power main with 40% burns. Back in clinic I found myself dealing with paediatrics (all part of the package) and a boy with Acute urinary retention and suspected Down's Syndrome and a possible Septic Arthritis of the hip in a little girl. They were both handed on to higher bods (I confess to having very little clue initially with the girl - much help required).

Finally the end of the first week, I have a feeling that by the time I have found my feet it will be time to fly home but I have learny more here in one week than I would in a term back home. My anatomy is shocking - much study required I think but the nature of the hospital is that there is so much Medicine mixed in too. The language barrier is a big issue, fortunately all medical speak is in English but some of the nurses are not so hot in this and there level of knowledge is way below that of their UK counterparts. A surprising number of non SA doctors work here but those who do speak a lot in Africaans so that all passes me by except for 'sharp!' which is slang for 'nice one' and 'Lakka' which means good. This week has been both of those!!