On wednesday night Michael (surgical community service doc)invited me around for a braai (BBQ). On the way, we stopped and bought a new DVD player / 5.1 stereo system, so much fun was had getting it unpacked and set up.

Finally, on Friday night, Keshnee (one of the casualty officers) invited me to dinner in Dros, a franchise restaraunt, with about 10 of the docs from the hospital. Then I had a paniced packing session followed by not very much sleep and a 7 hour bus trip to johannesburg. My holiday has finally begun

Saturday was quite a bit busier – there had been a big football match earlier that evening, which when combined with your typical saturday night drinking meant we were quite busy. There were a number of muggings aswell, one of which ended up with a man with quite a deep stab wound in his ass, which I happily sutured closed…

Saturday wasn’t busy, but there wasa staedy stream of patients coming through Surgical Casualty which kept us busy until about 0530. I was getting ready to leave at about 6 when two strecher cases rolled in off an ambulance – one of them was a stab wound to the side of the neck, which looked like it might have gotten the apex of the lung. The main problem was thyat it wouldn’t stop bleeding – we had to get the surgeon on call to come and take a look – he ended up clamping and ligating 4 arterioles in the recovery room before the bleeding was under control.

As I was getting ready to go home, one of the Casualty doctors asked me if I’d be interested in going to a ‘Charismatic Church’ that morning (it was 8 on Sunday morning at this stage). I agreed, which might have been an indication of just how sleep deprived I was. I got home, into bed, and an our later, my phone went off. 30 minutes later we were sitting in a church which I thought could only exist in the world of Hollywood – there was a band and singers and a choir and karakoe style lyrics on a big projection screen, and the preachers definitely liked to preach. I can honestly say I’ve never experienced anything like that before, and while I may have had a problem with a lot of what was being preached (which was at odds with a lot of the catholic beliefs I’ve been exposed to over my school years), some of it was very relevant to the congregation, and you couldn’t fault the presentation.

I was planning to visit a DeBeer’s diamond mine today, but when I rang yesterday it turns out that the last mine in Kimberley ceased operations last August, so they are understandably not running tours any more.

Just a few more days in Kimberley, and then I start on my backpacking adventure – I’ll post up my itenerary in a few days once I’m sure it’ll all work.

I was in theatre on Tuesday night, and got to see a toe amputation (which was quick) and a below knee leg amputation (which was less quick).

All in all, the surgeons seem a lot more prepared to let me go and do things. I’m going to come in for the evenings / nights over the weekend and see what its like, apparantely it will be busy, so lots of suturing practice for me. Stabbings are a big problem here too, so I should get a chance to put in some chest drains

On the tourist front, I’m hoping to do an underground tour of the De Beers mine next week, and other than that, I think I’ve exhausted Kimberley’s tourist charms. I tried the McGregor museum, but it is much less interesting than the Lonely Planet would have you believe.

I’ll be back with more news after the weekend.

Well. As soon as it hit 5, the floodgates opened. By 9, the short stay ward was full and patients for observation were beginning to pile up in the medical recovery area. Then to make matters worse, we were visited by a sister who insisted that we had too many people waiting downstairs and that we should admit patients to the wards, where there were at least 20 beds available.

Liza, the intern on call, was unhappy with admitting patients who actually needed observation because they were unlikely to get it on the wards where the nurses are at their station, as oppossed to recovery, where all the nursing and medical staff are 2 metres from the patients. Then we had a visit from the CEO of the hospital, the head of the casualty department and the provincial minister for health (I have no idea why). The decision was to admit stable patients, even if they would normally be observed overnight and discharged the next morning.

The most pressing case we had was a case of severe lactic acidosis (arterial pH 7.1). We consulted with the ICU doc on call, but they were full and unable to free a bed, so we had to manage the patient in recovery
By 11 we had pretty much gotten the situation under control. The Medical Officer on call went home at that stage leaving Liza in charge. At about 2345 we left casualty for the on-call room.

We managed to get a good 40 minutes rest (and at least 20 minutes sleep) before the first phone call. That kept us in A&E until about 0215. We got almost 2 hours sleep before heading back down to A&E at 4 for an acute exarcabation of asthma in severe respiratory distress. Back to bed for about 5, and up at 7 for a quick breakfast to prepare for the post intake round. Liza had to go do anaesthetics stuff so I was the only one who’d been there all night who would be there for the round.
This should have finished at about 10, there were only about 8 patients in recovery. Except, we had to go and see the 8 we’d admitted directly to the wards. I didn’t get out of the hospital until 12. As you can imagine, I was a bit tired. And, this was a quiet night – I’d gotten about 4 hours of sleep in total.

I’m going to do a weekday and a weekend call in Trauma over the next couple of weeks, I wonder how they’ll compare.

Shit

You should remember that this is a country with at ~30% HIV infection rate. The next couple of hours were a bit crazy, with both myself and the patient requiring a rapid HIV test. The patient had been tested previously and was negative, but you can’t be too careful. I was ‘counselled’ on the process, given a STAT dose of anti-retroviral therapy and then the waiting began. I knew my test would come back negative – HIV takes 3 months to show antibodies in the bloodstream, and even though they did a PCR and ELISA on my sample, there was no way it could come back positive following such a small inoculating dose.

The next few hours passed very very slowly. Then, I got the news. The patient was negative.

Relief.

A couple of hours later, my result came out, which was also negative. No need for a week of ARVs, nausea and vomiting, and luckily my first needlestick will prove non-fatal. That said, I’m never letting anyone else withdraw a stillette for me again – I don’t care if the cannula leaks all over the patient’s bed.

Obvioulsy I’ll need to do a repeat test in 3 months to make absolutely sure, but I seem to have dodged this particular bullet.

I did get to observe an ascitic tap on a man who’s abdomen was completely distended – there must have been 4 or 5 litres of fluid in there. His skin was stretched tight like a drumhead. I got to see and exmine some patients with DVTs as well as see some patients with meningism, and I saw another LP. I think they’ll expect me to do the next one, which is a little scary.

I think I’m going to do a night shift and one weekend day next week – the night shift will give me most of the following day off and the weekend shift will let me take a day off to do some touristy stuff – most of it is only open during the day.

Tonight I’m going to do the Kimberley Ghost Trail – It should be a fun way to spend an evening, and Kimberley isnt exactly known for its rollicking nightlife.

In other news, they’ve moved me to new accommodation – the new guesthouse is right beside the hospital, meaning all I have to do is roll out of bed and walk for 5 minutes to get to work in the morning.

The plane actually took off sometime after 8 o’clock, meaning I could have had an extra hour’s sleep. Oh well. The flight to Upington took about 1.5 hours across an almost completely empty semi-desert landscape. The planes are run by the South African Red Cross and are part of the Air Mercy Service which includes helicopter rescue and air ambulance services.
Once we landed, I decided to stick with the oncologist (this 2 weeks is meant to be medicine after all). I spend the day doing physical exams and seeing patients with all kinds of cancers, the ones I can remember are cervical, breast, prostate, lung (this one had invaded and was protruding through the chest wall)and lymphoma. Upington is an Afrikaans speaking area, and neither myself or the consultant speak any. Luckily, we had a fantastic nurse who translated for us.
The clinic was finished at about 1430 and I was planning to maybe go into Upington town for an hour bewfore catching my lift back to the airport. On my way out the door of the hospital, I ran into two orthopods from Kimberley who had just been told on the phone that the plane was on its way to Upington. This was a suprise to me because I’d been told that the plane wouldn’t be coming back until 1700 and to be at the airport at 1630.

1700 came and went and there was still no sign of the plane. The airport staff started to become concerned at us just hanging around – they were planning a rehearsal of their major incident plan that night. This gave us something amusing to watch until the plane finally arrived sometime around 1845. It would probably have been better if I’d understood anything they were saying, but unfortunately, it was all in Afrikaans. The rest of the Outreach team found it hilarious though…
I have some pictures from today, and will put them online when I have a chance.

I met the head of Internal Medicine, Dr. Hayat. He’s been very kind, and suggested I spend a bit of time in medical recovery (where patients go after getting through A&E) as well as on te general medical wards.

Today, I was in recovery / casualty. I took some histories, took blood, assisted with a chest drain insertion, and saw a Lumbar Puncture and pleural fluid drain. I’ve been told that I’ll be doing the next LP and chest tube.

Recovery seems to be run by the interns, and they are a lot more hands on than back home. I should get a lot of experience here, its going to be great.

More news soon