The Durban July Races remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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Work becomes very difficult.

Shortages - Week 3 thurs remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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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.

Week Two remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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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

Week Three remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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

Theatre remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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Tea Time remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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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!!

Week 1 in the Hospital remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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Once they had worked out that I was English and started talking in English, an indepth discussion about the use of benzo sleeping pills over alcohol was conducted, with a clear gender divide showing itself, before Dinner was served at 1am(!).

Vood ya leak zech itching, oo szeb eff

I was asked,

What?

itching oo zeb eff

Not near me you don't thank you very much love, sounds painful. Anyway, a few moments after I asked for itching powder, a tray landed on my table with some goo and grey bits in it. It turned out that my well built Germanic hostess was trying to assertain my preference for chicken or beef. A quick check discovered that whilst the cabin crew could discern the difference, the cattle certainly couldn't (tastes like baby). It was at this point that I made mistake number two, clearly the language barrier was a two way thing. I could of sworn that I asked for a glass of white wine with my chicken, the bottle said wine (Germany 2005) the glass shape said not wine, and the taste buds said - a warm piss like flavour with sharp hints of vinegar with vinegary tendancies showing themselves delicately in a vinegar aftertaste.

Still, dinner slipped down like skin down sandpaper, before the pilot decided to guide us with laser precision into a variety of thunderstorms and turbulence. The chicken made a bid for an encore but was pacified by a stiff whiskey before Charlene popped 4 sleeping pills and the then started drewling on my shoulder.

J'burg didn't annouce itself, no really it didn't, we arrived on time, and in the right place according to the tv I watched as I ate my brocolli omelete (?!) (Africa looked pretty small compared to the plane on the screen) but J'burg was hiding in a huge fog. We had to circle for over an hour until the fog cleared enough for a landing (still couldn't see the ground until it jarred up into our undigested breakfast). This was all fine except for the fact that my connection was in 20 minutes, and no-one told me that I had to collect my bags, carry them across to the other terminal, check in, and then run to my gate (wouldn't have made it without Dennis my porter - R20 well spent). Only, the fog had of course delayed outbound flights too. So I arrived noisily infront of 200 people, sweating like an inappropriately dressed pig, to find a 2 hour delay on the board - all I needed now was a big sign above my head saying "foreigner".

Day Two remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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Window or aisle seat sir?

Window please.

Wrong answer, computer says no.

Aside for the fact that my beautiful window seat afforded me a great view of the rattling wing flaps, I was also oxed in by an outrageously arguementative German couple. This couple had clearly decided that now was as good a time as any to debate (in English) about lederhosen (it may have been about something else) and to practise there pronounciation of the word "fok" (more practise required I think).

Despite my best attempts, the glass window simply wouldn't yield to my plastic fork (although better progress was made with complimentary in flight snack - query sandwich?) and so my entertainment for the next hour limited itself to some monotonous head bashing, served up with a generous portion of eye ball gouging.

Fortunately, before I woke the old man in front of me with a slap-by-eyeball, Frankfurt made a timely intervention in order that it could present me with a hour of equally entertaining "Eye-spy Fashion disasters". White socks and sandals, 10 points, jeans-shorts, 50 points, wife beater and weird hair, 30+15 points, incredibly well presented, well co-ordinated, dashingly handsome Englishman (mirror), 30 points etc....

Day One remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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"No worries" I crowed, " show me the fo...."

"We don't have it yet sir, It hasn't been sent down from Central office yet."

Great, thank goodness I'm not leaving on Friday...

Added to which, I've lost my travel insurance certificate, and the network is down so I can't get another one. And they say things happen in 3s (I'm of a mind to insist on giving the plane a once over myself).

Nice

Money, a much overrated sidekick remains copyright of the author n1023860, a member of the travel community Travellerspoint.

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