Jul 2005

Following the choas of my second week, including falling asleep in theatre standing up at 6am (at the end of Friday night's on call) whilst helping in a laparotomy (full open abdomen operation) for a gunshot wound, week three was a slightly more sedate affair.

I was allocated a ward of my own (female gen surgery) in the hospital and became responsible for 4 or 5 ladies with a wide variety of problems. Mrs B has Diabetes (a common problem) due to obesity and has had to have both of her feet amputated because they died from lack of blood flow (a common problem when diabetes is not well controlled). She is awaiting a revision operation for her left leg stump so that a prosthesis can be fitted thus enabling her to walk again.

Mrs N is morbidly obese (also diabetic) - she was admitted in Friday evening with cellulitis (severe infection of skin and soft tissue) of her leg which needs immediate antibiotics into the blood (intravenous). At the moment she is doing well but her obesity means that she is not very mobile and so I think that, combined with the diabetes, her infection could be hard to shift and we will have to be careful that she does not lose her lower leg.

Miss J is an unfortunate case, she is 17, HIV positive and has had three previous operations. The first removed a cancerous womb, the second a cancerous nodule from the liver, and the third an entire lung which also had cancer. Problem is that the experts have no idea what type of cancer it is, and so we are waiting on Durban to find out how to treat her - the prognosis is not good, she is very thin and has no energy.

Miss H, also HIV positive, was admitted with a large abcess in her thigh, she had this drained and we are waiting for the lab to tell us which bacteria is responsible - mean while she is on a strong cover of anibiotics, the odds are that it is TB so we could start her on TB therapy, but this is a 6 month course and can be quite unpleasant to take.

One of the most important things I have learnt here is this. 4 things cause illness in Kwazulunatal:
1. HIV - about 40%
2. Diabetes - type II late onset related to obesity
3. TB - endemic in the population
4. Agression and violence

There is a basic rule of thumb. If they are fat, they have diabetes, if they are thin they have HIV/AIDS, if they are coughing or have abcesses it is TB and all other cases are Motor vehicle accidents or violence. This is obviously not true, but it is quite scarey just how often it is true. It is indeed possible to identify someone with aids just by looking (wasted muscles, no fat, skin lesions, no muscles in the temples) but quite impossible sometimes to identify HIV carriers and for this reason it is so important to be so very careful.

The irony is that these patients need medical assistance mch more than everyone else, but that medical assistance is so hard and expensive to provide because the medical team must first be safe, and Africa just does no have the money to fund this all.

Chao

Today the machine which reads blood results broke down so we have no Liver enzyme function readings,these are basic investigations for ill patients. The other day, the X-ray department ran out of processing chemicals so we had no X-rays until they re-stocked. Meanwhile the CT scanner can only do 15cm before it overheats. These are investigations that are taken for granted in the UK, the nearest referral centre from here is 2 hours away, and many of the patients are not stable enough to be transported (let alone the fact that it is logistically impossible to do this) so basic clinical skills are vital in assessing patients.

Work becomes very difficult.