Jun 2005

It seems that this week has been neverending, I worked 76 hours including two on calls. It really leaves you drained but the medical experience is huge.

Highlights included my first operation ever - obviously very simple and highly supervised, but nevertheless, everyone has to start somewhere.

This is me about to perform my first operation whilst on call on riday night of week two. I am cleaning the thigh of a man who has a TB abcess.

Once the pus is drained, Drainage of Abcess (warning, this is not a video for the feint at heart) you have to remove all of the infected tissue with your finger...

..and then wash out the hole with antiseptic. To finish you place drains in the wound and bandage the leg.

This chap was stabbed in the elbow and his brachial artery was cut. This supplies the two wrist arteries and the hand so needs to be mended! The Artery is first disected away from the surrounding tissue before the two ends are joined with tiny stitches - a blood clot destroying drug is passed into the vessel to stop it from blocking.

This man was shot through the abdomen by a 7.62m sniper rifle. You can see the entry hole on his right side and the bullet shock wave has pulled 20cm of Colon through a 5cm exit hole in the muscle wall. He was very lucky as the bullet only grazed his liver. 2cm higher would have killed him. He was patched up and the hole in the Colon was stitched.

This man was shot by a low velocity 9mm pistol. You can see that the bullet is lodged in his upper left abdomen (top right of picture). This slower bullet caused more damage as it had stayed in the body. This means that all of its energy has been dissipated inside the body.

These lovely ladies are our lifeline to the patients. They translate our consultations with the locals and organise all of the tests and treatments. 3 consultations take place in each of these small rooms at one time - good for confidentiality!

This man turned up with a massive abdomen. He had a pseudocyst in the abdomen which is labelled above. We drained over 7 litre of fluid. Unfortunately this is part of end stage cancer so although we have made him more comfortable and he will leave hospital - his future is not very bright.

Sunday and a day off, we went 2 hours north to St Lucia and Cape Vidal on the coast where we snorkled and saw many shoals of fish including stingray.

This picture was taken after we had just performed a total mastectomy with axilliary clearance, the patient is still on the table.

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!!