A Day in the Life of Dr Withington

Work… Where do I begin?

In a nutshell, this year has been a massive jump for me, but I now feel a lot more confident and relaxed in my role as a doctor. The team (especially the doctors I work with) here is amazing and the senior support and back-up is truly incredible.

At Zithulele, there are seven full-time and two part-time doctors. I am managing my own ward (currently paediatrics) – this takes up my mornings (and sometimes some of my afternoons as well) and in the afternoons I work in the outpatient’s department, which generally involves seeing really sick babies /adults. Overall an intense and amazing clinical experience! This is in stark contrast to last year, where being at tertiary hospital meant I felt more like a number than an individual and where nothing you do really feels appreciated.

Apart from the practical changes of going from an urban, tertiary hospital to a rural district hospital, one of the biggest differences for me has been how the cultural beliefs of all the patients here are completely imbedded into their lives! There are various examples of this:
• An 18 year old mother delivered a very premature baby weighing 1200g. The baby never went into respiratory distress and generally coped very well he didn’t need to be transferred to Mtata General Hospital (our referral hospital that is a two drive away hours away on a very bumpy road that could cause more damage to his brain). Six weeks down the line, after I had invested significant time and energy into the baby and whose mother had been incredible supportive during the whole process, the mother’s older sister and two of her cousins waltzed into the ward, picked the baby up and starting walking out of the ward with the baby! I immediately stopped what I was doing and asked for an explanation – it turned out they had been sent by the baby’s grandmother to fetch the baby to go to a traditional healer to have the birthmark at the back of his neck (which was about the size of my baby nail) removed! This process involves tacking a scalpel blade and literally making 3 cm incisions down the entire length of the back in parallel lines – a totally unsafe and sometime life-threatening process!
• If a child or baby gets diarrhoea, a lot of mothers give them “plate medicine” – a medicine concocted by a Sangoma made up of a combination of vile and dangerous ingredients (Jik to name one!). We get so upset with parents who have done this because more often than not the baby has been treated with the “plate medicine” first and then only once the baby is now doubly sick (from the diarrhoea and now the “plate medicine”) do they come to the hospital. The belief or practice of traditional medicine is so great that even when the child is admitted to the ward and being treated with “our western medicine”, some mothers continue to give the baby the “plate Medicine”. A glass coke bottle was recently found on a ward round in paediatrics with “traditional meds” inside it and a small sample of the toxic matter was put on a glass slide and put under the microscope – it contained various types of algae, and multiple bacteria!

Apart from some of the maddening experiences stemming from cultural beliefs, there have also been some maddening experiences stemming from practical incompetence! One Friday evening I was called out at 23h30 because an oxygen cylinder in the paediatric ward had run out and there were no porters on duty. The implication was that I had to get out of bed, drive to the hospital, and solve the problem rather than one of the on-duty nurses sort it out!? After having asked various wards and not been in luck I managed to locate a brand new cylinder that we could use. (That’s like finding gold!) These cylinders are massive (basically my height and weight!) so I had to drag Tom out of bed with me so help me move it around. Having got it to the right ward, the next challenge was to loosen the gauge in order to be able to fit the tube – this required a spanner which no one knew anything about – cue Tom to head back to our house to get the toolbox. He came back, but now of the spanners in our toolbox fitted, so we restarted our search for the elusive spanner that is specifically used for loosening the gauges! All this time the baby who needed the oxygen was getting more and more hypoxic due to a lack of oxygen! Eventually the spanner was found, the gauge loosened, tube fitted and the baby got the oxygen, albeit 60 minutes later. A bit more organisation, and this whole process would not have taken more than five minutes!

Leading on from this point, resources here are quite an issue, mainly because the central depot that supplies all the various rural hospitals in the area seems to be either very poorly stocked itself or are totally useless (usually a combination of both). We have had a period of close on a week where there has been no oxygen at all in the hospital (whilst this is shocking, our neighboring hospital, Madwaleni, has currently not had oxygen for 12 days!)! Not having oxygen is awful, especially when, for example, you are called to a rescus where you have nothing to give a patient that is gasping with a very low oxygen saturation, or resuscitating a baby on room air that has been delivered flat (not breathing) after doing a Caesar. Antibiotics are also very often out of stock and we have to chop and change from one to the next depending what is available and until it runs out or until the next stock arrive!

The bottom line is there is certainly a lot to keep you depressed around here. Fortunately, if you keep your eyes and ears open, there are also loads of positive stories.

I have put myself in charge of the responsibility of “Good News for the Week” (very much in the mould of the FNB-sponsored Good News SA). After having an especially emotion- and energy-sapping week, I realised the importance of focussing the good news. Every fortnight or so, I go around to everyone in the hospital and ask for good news snippets , type them out and put the posters up around the hospital. Good news for the week a couple of months back went as follows:
• There are currently enough wheelchairs in the hospital.
• The Therapy Department found a lot more Velcro, which was running low.
• (Velcro is essential in splints as well as cushions and other adaptive equipment.)
• OPD has been FAR more manageable this week!
• The Therapy Department had a great wheelchair basketball session with 45 inpatients! These will now happen bimonthly as a therapeutic sport.
• The security budget for the next financial year is more than double the previous one!
• The Minister of Health met with Dr Karl Le Roux (One of the 2 senior doctors at ZLE) meeting doctors who are working on the ground level in rural health!! Definitely a first!
It may seem fairly random if you not directly involved, but hopefully by focussing on the positives it can keep us all in the right frame of mind!

That’s a glimpse into what I’ve been up to at work. I’m looking forward to adding stories as the year progress to hopefully complete the picture and illustrate what a fascinating, frustrating but brilliant year is has been!

A New Leaf

After numerous empty promises of resurrecting our blog, yesterday I decided that enough is enough, and really will try to post at least one entry a week.

So here goes!

Quite a bit has happened since our last post. I’m not going to try to rehash everything that has happened over four months in one blog entry (I will rather incorporate bits of news in posts of the coming weeks).

Watch this space!

Easing Back Into Blogging

Given that its been nearly two months since we last updated our blog, we thought we’d ease you back into it. No insightful comments or thought-provoking articles. Just some gentle banter about our local beach (which might tempt some of you who haven’t visited us, to swing on by).

Zithulele is situated four kilometres from the most incredible beach –Lubanzi. You can either run down (which takes about 25 minutes) or drive down on a shocking road (also taking about 25 minutes), even by Transkei standards! But the effort to get there is totally worth it!





Our neighbour, Roger, owns an Eskimo, which Tom has really been enjoying.



One evening on the beach after work.



Some of the clan after a swim.


Learning Xhosa on the beach

On Saturday we and the whole Zithulele crew headed off to Rhini location, to the wedding of Ebye, a German Doctor, to Alicia a local Xhosa-speaking woman from the area. Ebye (pronounced “I-ba”) came out here to the Transkei 4 years ago initially as a volunteer at Zithulele. He then transferred to Madwaleni hospital where he spent 2 ½ to 3 years working until he decided to branch out and work at two of the peripheral clinics. We don’t know him particularly well but like all traditional African weddings everyone from the area is invited! It really was an amazing experience!

The wedding was set to start at 9am however not even German efficiency could overcome African inertia! There had been pamphlets advertising the wedding on many doors in and around the hospital and ARV clinics however the only instructions were a very vague location and no time just the date…! Anyway so we set out around 10am getting to the area-ish by 10:45. Luckily in the distance up on a hill we could see a fairly large white marquee with a gathering crowd. Hoping it was the right wedding and not another wedding or possibly even a funeral we parked our car and headed up in the direction of the marquee. After being warmly welcomed in by Alicia’s brother (whom we had never met before); meeting the father of the bride; helping him do his tie; witnessing the local nursing sisters from the Ngcwumguba clinic ululating and dancing up the hill as they arrived; playing follow the leader with all the little children also waiting around - we were no closer to the start of the wedding! At around 12:30 we were assured the wedding would be starting in 10 minutes time.





Anyway, when it did kick off it was a really awesome –everyone stood as Eybe with his parents and 2 best men from Germany walked up the hill into the marquee. Then we got a very vibey dance from the groomsmen and bridesmaids from Alicia’s side dancing up the hill, with African Kwito-type beats –definitely beat any mundane entrance we’ve always been exposed to! Then finally the bride, in a beautiful white traditional wedding dress.



The ceremony went on for quite some time with very broken snippets of someone translating 2 or 3 sentences in English and an awesome MC who had a constant impulse to check the mic every time it was handed over to someone new rushing forward going testing testing, 1,2,3 and singing a few songs unaccompanied or which he accompanied himself with back up beats whenever he felt the time was right…! Ebye obviously was referred to many times throughout the service mentioned on most occasions as “elbow” and once or twice as Ibo… -fairly amusing!




Anyway, it was a real privilege to be able to be a part of such a special event which was taken very seriously by both respective parties and where we were made to feel so welcome! The generosity shown by Alicia’s family was really overwhelming and something we were really pleased to witness!!

Homestay

Homestay

On Friday evening we had the privilege of spending the night at the Siyephu’s – fifth generation Xhosa farmers. We arrived after a somewhat precarious drive in the rain, which had made a portion of clay road particularly slippery, at our accommodation for the evening. Tata Siyephu is actually a staff member at the hospital (in charge of the water supply – a very important role!) was there to meet us with his extended family. He doesn’t speak a word of English but with lots of “molo’s”, “unjani’s”, handshaking, smiles and nods, we were welcomed into his home. There is a separate hut especially for the “guests” where we could make ourselves at home and relax.


It was an amazing experience to see first-hand how a working homestead is run. At dusk Tata Siyephu gave a gentle cry and the sheep, slowly at first, started making their way towards the kraal, each counted in turn on entry into the kraal. Tata Siyephu owns 64 sheep! There is also a kraal for the cows, which were also brought back in the evening. In the morning around 06h30 each sheep is counted one by one as they are lead out of the enclosure to go and graze again for the next day.



One thing that struck us about our experience is that, whilst novel to us, rural farming such as this typifies Africa more than any other scene – it is the absolute norm. Forget civil wars and famine (yes, there are lots of them) and lush jungles, exotic wildlife and open plains (there are lots of them too) – if there is one scene that encapsulates Africa more than any other it is this. People quietly going about their lives trying to survive…

For supper we were served traditional samp and beans with a very basic tomato sauce. The next day we had an awesome little fry-up on our Cadac cooker for brekkie and then left pretty shortly thereafter to get home, get dressed and go to the next adventure – a local Xhosa wedding with a slight twist…

News from the TK

Our apologies for not being better at posting entries on our blog. We guess that it boils down to getting into a routine - something which seems to be quite difficult to do here in the TK!

Since our last post we have no crazy stories to share; instead we find ourselves settling in more and finding ourselves far busier than we ever thought possible!

Jo’s work has been crazy. No post-calls and only six full time doctors serving a 140 bed hospital mean that she works 07h30 to 17h30 every day. Chuck in, on average, one to two calls a week, and there unfortunately is not much free time (and the free time that she does get is usually spent getting some R&R).

Whilst chilling at our home is great, the hospital can be claustrophobic so it is great to be able to get out. Last weekend we spent a weekend at a cottage at Hole-in-the-Wall, which was nothing short of incredible. Most of the photos have been posted on our Facebook profiles, but we have included a few below.









Warm water, no traffic, safe, rural, green and lush – give us the Wild Coast over the Cape Peninsula any day!

The Vegetable Garden

As mentioned in our previous post, we have started a veggie garden. Before we talk about this, we thought it might be make sense for to post a picture of our house.



We are the unit on the left. Each unit has two bedrooms, a bathroom and a kitchen that opens onto a lounge – it is very spacious and we are very happy here (especially considering the accommodation nightmares that some of our colleagues have had to ensure – more of which will be discussed in a later post).

Just to the left of the tyre in the picture above is an area that previous doctors fenced off to create a vegetable garden. We have been allocated some space, and inherited the patch below.



After much work by Tom (Jo was conspicuously absent during the manual labour needed to get the patch in shape) as evidenced in the picture below…



… we created a compost heap and planted fennel, basil, potatoes, tomatoes, mixed lettuce, carrots, baby cabbage and leeks. Whether all or any of these will succeed in our garden remains to be seen – on one hand, we are cautiously optimistic given that the land here is so fertile but other the other, refuse to get our hopes up given that we are absolute novices at this game. Either way, watch this space!