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!