Day 5
I thought I should update you a little on my current location and vocation.
Final exams finished last monday and with any luck I beleive I have passed them! (This belief is based on the fact that I have not recieved an email from the university stating that I have failed! and I felt good enough about the exams just sat, all seven of them.
After exams on monday we all celebrated the end of an era, four years of medical school been and gone, strangers now friends, Perth once foreign now home.
I promptly went home and packed everything i own in boxes and suitcases. Home, no longer home.
Tuesday was spent on a sail boat around Rottnest Island and Wednesday was spent feeling completely overwhelmed as I moved all of my belongings and packed to come to Southern Africa - a trip plannned for well over a year but not really someothing I had thought about enough, or had time to get excited about.
Pre hospital D3
As I sit here now I still cant get used to the idea that we (myself and two other students from Uni) are currently living in a Kingdom. see wiki for more info
From the farm, which is a kilometer from Siteki and just over an hours drive from Manzini (where our little plan flew us into from Joburg) we could be anywhere in the world. The farm is an old homestead which looks like a hunters lodge crfossed with an old plantation house and an african castle, if such things existed (which I guess in a Kingdom they do!). It has high wood plad ceilings and guiant busts of African game lining the room. A painting of the previous King who wonce visted here, adorns the doorway and is a reminder that we are indeed in Swaziland.
The reminder at home is needed, largely as we have been 'rained in'. Being the educated nearly doctors that we are, you would think we would know better. But none of us actually checked the weather forcast for Siteki. We assumed, wrongly, that Swazi being a similar latitude to Perth would have the same or similar climate to home. Clearly as it continues to drizzle outside this is not the case. We are all thankful for our last minute decision to pack jeans and a jumper. Both of which are being used daily as the mist/rain fills the magnificent valley that our thatched cottage overlooks, as we are pearched on the top of a moutain, largely in the clouds.
Most mornings we have had 100m visability as the mist obscures the lust green valley, patch-worked with different crops, groves of trees and the rooves of the catholic mission hospital just visable under the eucalypts distant on the opposing mountain edge. According to our hosts this is simply 2km away, to our unfamiliar eyes it appears further away and the idea of the muddy trail limits our enthusiasm to walk to the hospital daily.
So far, and I write this before visiting the hospital. Swaziland has not sent me into massive culture shock. English or at least greetings are common place and our town Siteki has choice of supermarkets stocked with regular food items, around the same as Australian prices, but not always the same as Australian tastes! I do however, recognise that this is a shop for the rich of Siteki, it is still far beyond what I had imagined would await me here. The women wear close to western clothing; some dressed in mid length skirts and others still wearing jeans and pants. Indeed I feel I will be dressed more conservatively than some of my patients.
I guess, to be honest with myself and you, I expected the immence poverty and isolation I discovered in my time in NIger in 2006. A time that feels both a million miles away and just the other day all at once. I am still awaiting a challenge here - although no doubt the introduction to the hospital will provide this.
Day two of the hospital (D5)
Yesterday we were introduced to the 'muddy' version of the hospital, or so the doctor in charge of our elective called it. The hospital is much larger than any of us expected and is a hub of activity. People wander around the grounds and women line the corridors of the labour ward with fesh new lives on the breast, recieveing education about how to look after these new lives, as we make our way to the doctors morning meeting. The small room on the second level of the hospital is filled with doctors from all over the continent of Africa, indeed from around the world adorned in white coats. We walk in and sit. No one greets us, no one is speaking to one another other, it was an odd dynamic. By the end of the meeting we have learnt of the death of an abandoned new born baby, who appeared to develop DIC secondary to hypothermia? and we are begining to understand that the country faces two major health problems, TB and HIV.
The hospital is made up of a series of corridors with wards off set to either side. These corridors and wards are attached by corrigated iron sheeting overhead. The wards are seperated into mens and womens departments and then further divided into health needs. There's men's/women's surgical and medical and seperate 'isolated' TB wards, where the doors are wide open and it appears people may come and go, even though we are not quite sure thats the point, at least it's a start. The emergency department is a small room, with two trolleys and a curtained off area that we are informed is for suturing. The department has two entrances after the 10 meter walk from one door to the next, you open out to the waiting area for outpaitent clinics. Close your eyes and imagine a large waiting room with wooden benches, like church pews without the backs. Now imagine these filled with people, brightly dressed, some with babies, small children and blankets (as I mentioned before, its a little cold here at the moment). In the corner are the health workers who see the patients first and divide them into their need: surgical, medical, women's health. They are given a number and they wait for their number to be called and to be seen by the appropriate doctor.
The privacy we take as 'our right' in medical consultations, simply doesnt exist here, well...not to the same degree. The small rooms off to the side of the waiting room hold two doctors, each seeing patients at the same time. Add to this dynamic some or all of the following: family members, work bosses, a translator (who may translate for you, or simply converse with the patient and forget to fill you in), a security officer by the door, administration women who wander in and out of the consultation and then two very eager medical students, looking rather out of place and feeling a little out of place in their newly aquired 'white lab coats' as doctors wear these to be identified. Not so secretly we are excited that our lab coats have finally come in useful for something.
The hospital has more resources than we thought it might. There are XRay facilities and some contrast and barium tests, as well as a well equipt lab able to perform MC&S and TB staining. There is no CT scanner in the country, therefore one must have astute clinical skills and creativity at times to solve a diagnostic challenge. Examination also seems to be limited here if an XRay can be done, it is, and maybe without clinical exam, it seems we in the West are not the only people begining to rely on medical technology instead of history and examination, however, limited that technology may be.
The eye clinic and the paediatric ward are seperate to the main hospital and slightly down a hill. We found it highly ironic that the eye clinic is down the bottom of a hill, only accessable by several windy paths with a few stairs and tight bends. The irony however, was lost on some. We spent some time yesterday in eye surgery and whilst there seems to be a lot of supplies here, they are kept less stringently than in an Australian hospital. The hospital appears clean, there are always women mopping and the smell of the dinning room fills the hospital mixed into the sweet smell of hospital disinfectant. The theatre yesterday was crowded but clean. Whilst most ophthalmology operations are conducted under local anaesthetic, the theatre still had an anaesthetic trolley, albeit a little dusty, from lack of use, and a wipe down. We assisted in theatre yesterday conducting a bilateral, double tarsal fracture. and by we assisted, I am refering to the holding of a book which outlined step by step how to conduct a 'double tarsal fracture' operation, much like the images you would find on an ikea instruction set. The operator is highly skilled but simply hadnt performed this operation before. The operation though was a success and because of it, this woman's sight will be restored, and you cant really argue with that. There were two scrub nurses, although management of sharps left a little to be desired, and as pointed out by one of my fellow students one nurses sole duty appeared to be controlling the music selection for the operation. Moments like these I love Africa.
Today we have seperated a little as one of the students has gone to Manzini to help with the eye clinic there, and the other two of us are hopeful to go on some home visits. We arent sure what to expect, only that it should aid us in our understanding of this country and it's people and that Swazi's live in homesteads, not in villages, so isolation is a big problem.
Will be in touch again sometime as the internet access here wills.
much love to you all who are interested, and who are tuned in to this adventure,
Amy
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