Lots of thoughts

Rise up!

On Wednesday the 8^th, I visited the village of Mqatsheni , travelling up dusty winding roads leading toward the majestic mountains South Africa shares with Lesotho.   I was visiting the Khuphuka project, a rural community health and outreach organization run by the people of Mqatsheni, and started by Dharmagiri, the Buddhist hermitage nearby.   This past April I spent eight days with Sangha Seva and young people from the village turning over the reddish soil in families’ gardens, then weeding and planting a winter crop of cabbage, spinach, carrots and celery, to launch Khuphuka’s community gardening project.  Malnutrition due to lack of food security is common here because much of the working-age generation has been wiped out by the HIV and TB epidemic.   The gardening project is back to the land: digging, seed-sowing and watering the way toward better community nutrition.   Our shovel and chicken-wire-toting group from the UK and the US was warmly welcomed, and Mqatsheni quickly found a place all of our hearts.  Here are some then and now pictures:

Chris, Gugu and Julie planting in April

Skhumbuzo, Matt, Spire, cabbages and carrots this month.

Mqatsheni's valley in April

 September sunset behind the school in Mqatsheni

The word “khuphuka” means “rise up” in Zulu.   Khuphuka uses a holistic approach toward community health, training and employing villagers as community care workers who visit and assist neighbors who are unable to function due to chronic illness, trauma, or death of family members.  Khuphuka also trains and employs child health workers, does HIV counselling and testing, runs a mentoring group for teenage boys, women’s support groups, and offers community education.  Upon learning about the prolific training and outreach they’ve done over the past five months, anyone's spirits will rise up.   Check out the website: www.khuphuka.org.

After Mqatsheni, I joined Steven, the other new Centocow doctor, from Belgium (Flanders, for certain Walloonies who will wonder), at a three-day educational conference on HIV, TB and STI’s in Durban.  Steven is a peach in that he is kind, easy-going, helpful, and because his head is round and covered with blond fuzz.   He is already a great resource and friend.  He knows a lot more than I do about how to treat late stage HIV patients.  He’s finished a tropical medicine course and is heading toward subspecialty in infectious diseases.  He’s blazed a trail at the hospital, starting a couple weeks earlier than I did.   

At the conference in Durban, there was one person teaching us infectious disease management for rural South Africa, public health principles and practicalities for three days straight.  We were ~50 recently-arrived foreign doctors, South African doctors and South African research nurses.   She did an awesomely energetic, entertaining and intellectually rigorous job of it.   Her name is Dr. Dube.  She is originally from Zimbabwe, and is a professor at one of the medical schools in S.A..   She is an inspiration, about as quick-thinking as anyone I've ever met, and someone who demonstrates that it is possible to make a difference in the fight against HIV and TB in Africa. 

Durban was also great because of the scrumptious South African Indian food, the immaculate backpacker’s lodge, the beach with surfers bobbing out in the light blue waves, and the funky gay bar and restaurant, BBB, where, halfway through dinner, Steven and I realized what scene we were in (abundant cute guys, not a lot of women).

Ms. N-95

Work for me started five days ago, on the 15^th.  I was given responsibility for Ward 10, the men’s general ward, and Ward 9, the men’s TB ward.  My census has been about 20, which seems fine compared to the clinic doctors who see 40-60+ patients daily.  How to describe my first days of work?  Chaotic, poignant, sad, and humorous at times.   The patients are endearing, stoic, grateful and quite ill.   Of the eight patients per room, those who are alert enough get to know each other form a bit of a community at times.  It reminds me of Aleksander Solzhenitsyn's novel Cancer Ward. Some of the main types so far I’ve seen: burn patients, head trauma patients, TB +/- HIV patients, HIV patients that have brain damage from opportunistic CNS infections, HIV patients with GI problems, bedbound stroke patients.   The tight-fitting N-95 TB mask all day every day gives me groovy cheeks.

My interactions with the nurses and the expectations of me as the doctor are quite different from what I’ve experienced before.   I repeatedly find myself huffing with frustration when they don’t do what the nurses at Hitchcock automatically do, so I need to stop and have a reality check.   These nurses are coming from a far different background-- the culture, nursing education, way of communicating – all are different, and unfamiliar to me.  It is interesting to watch my mind jump to conclusions about them and shortly thereafter realize I’m incorrect – so human.   I have a lot to learn. 

My care of these 20 or so men has felt patchy so far.   There are moonlighters on call over the weekend and the ward doctors don’t round on the weekend, so for two days in a row no ward doctor sees the ward patients.  I went in and saw the sicker ones for three hours yesterday a.m., of which I’m glad, but when I look ahead to working week after week and doing overnight calls every week, I’ll almost surely take the weekends off like my colleagues here do in order to avoid burnout.   A lot of patients die in this hospital, and I'm already wondering if I could’ve saved one Wednesday night had I worked more.  Time for another reality check – I am just one person working in a low resource setting in the midst of a major public health crisis.  Poverty, disease and lack of education exist next door to privilege, comfort and abundant resources here.  In the 200 meter walk between my residence and the ward, I cross between parallel universes.

More pictures coming soon.