Edendale Hospital Newsletter

Welcome to Edendale Hospital Dr Sandy Inglis! Have a look at the Edendale January newsletter in the link below:
http://www.kznhealth.gov.za/edendale/edendaily29.pdf

Mabibi and beyond.

Zara, bugologist of note.....

Ndumo Game Reserve......beware crocs, hippo, rhino etc!

With the Armstrong family 

Mabibi is a Tongan community nestled in the sandy vegetation between the fresh waters of Lake Sibaya and the rolling breakers of the Indian ocean.  They run what must be one of the most exquisite camps in Africa.  It comprises about a dozen private campsites tucked away in the thick coastal bush and perched on the edge of magnificent dunes and within earshot of crashing surf.  You are awoken at dawn by a sweet symphony of birdsong and golden sunrises provide magical light which filters through and plays on the fabric of your tent.  A short walk along sandy paths and a spiraling wooden staircase, entombed in thick green creepers and sail-like leaves, takes you down to a copper beach, dappled with the meticulous scratchings of ghost crabs and prints of timid antelope that have ventured from the security of the foliage.  Bold blue breakers crash incessantly onto the smooth sand and   further back, near the deep indigo water, dolphins cavort and cajole, careering down sleek, silver waves, cartwheeling and diving, euphoric and manic, in their beauty and liberty.

Camping Africa style at Mabibi.

Elegant Eland crossing pristine mountain
 stream in the Drakensberg

This is where we spent our first Easter holiday back in Africa.  Our routine was simple and repetitive; wake up to the above spectacle; run or walk on the beach basking in the morning light and sunrise; refresh in the warm seawater and risk the thundering shore-break; breakfast back at the camp with piles of fresh fruit; wage war with the vervet monkeys who attempt to steal everything; back to the beach armed with mask and fins; dive in an aquarium with Loggerhead turtle, octopi, electric ray shivering under sand, and gaze in awe at multitudes of fluorescent and colourful fish vying for food and attention; bask on beach; lazy lunch; read and snooze in warm afternoon sun; back to beach armed with kites, bats, balls; swim again in wild waves; shower; supper around fire; idle chatter; sleep....and start again.

That was our holiday!

Then back to reality.  My job is fantastic; no day is without action, drama, frustration, disbelief or joy.  We have had no telephones or internet for the last 2 weeks.  CT images had to be “whatsapped” to referral hospitals in Durban; communication relied on private cell phones and e-mail was non existent.  The telephone lines near the hospital had been stolen for their valuable copper.  Then, just to add to our woes, there were days with no water (so no operating theatre, no x-rays and no blood tests) and, repetitively, no electricity!  But these are woes that are tolerated and accepted without too much fuss and life, and work, continue, somehow adapted to the inconveniences; ok, do without that x-ray or blood test or that operation perhaps.  This week things are infinitely better and everything seems to be working.  There is construction and renovation everywhere and a creaking 50 year old hospital is getting a facelift in preparation for NHI, the new national health service, which promise to provide good health for all and minimise the massive health care inequality between the rich and poor.

Our Emergency Department is going from strength to strength. Morale is great and the team is growing and evolving.  EM is embryonic here but the excitement of a new project and the prospect of providing excellent emergency care is wonderful.  New equipment, new ideas and, next year, a new ED, make for a dynamic and determined department and I feel privileged to be a part of it.

Relaxing at Bannerman's Hut

On top of the Drakensberg in Lesotho, Mabibi Pass, 3000m

Margot and Zara have embraced and integrated into their new world like only children can;  every time we do this I am reminded of the fortitude and resilience of our children.  First it was Oz to NZ; then NZ to France, then back to NZ; then to home schooling in SA, then traveling in Africa, then back to France.....and now the full package of South African private schooling.  They attack it with a vigour and determination that provides ME with motivation for my work; to watch them playing hockey for the first time (and Margot making the 2nd team and Zara the U10 c’s), singing in the school choir at the easter concert; being part of the excitement of the school gala and heading off on school camps is both thrilling and wonderful and leaves us proud beyond belief.  Then Zara getting full marks for her Afrikaans tests (never seen the language before this year!) and saying how much she loves it!  Margot is exempt from Afrikaans having started in SA in grade 7 so is doing a bit of extra Maths and English in preparation for the entrance exams in 2 weeks time.  Ilda is keeping her busy with French sent from France.  This week it is auditions for the school play.

Swimming in a tarn, Drakensberg

Ilda, too, is resilient.  This week she, for the umteenth time, starts the arduous task of piling our belongings into boxes and preparing us for the next move.  We have committed ourselves to rentals for the time being, and this time head up the hill to the village of Hilton, which is conveniently close to the girls’ school and they can walk there in the mornings.  The house is thatched and in dense bush with magnificent views down the valley to Maritzburg.  Our next move will be determined by where the girls end up at school next year.

And so slowly, we bed in into this crazy world of South Africa.  It’s not easy but it is certainly rich, challenging and hugely rewarding.  Every morning, when I drive to work, there are always a number of local Zulu folk thumbing a lift to work; they squash up into my Land Rover, grappling with seat-belts and chattering excitedly and always proffer their grubby five rands.  This, makes me smile!

Electric spider perhaps?

Plastic on the Beach

Plastic on the Beach

For our holidays we went to the beach

To a place so perfect, almost out of reach

Nestled in the bush amongst the dunes

We listened to birds singing their tunes

And monkeys came to have some fun

Looking for nuts, perhaps a bun.

Then the sun came out and we went down to the waves

Onto the beach, then rocks and caves.

Sparkling water, warm and bright

Sliding up the beach so slight.

Golden sand in my hand

Near to paradise in this land.

Then, something that made me sick

All along the beach, scattered plastic.

Combs and slops and ropes and tops,

Drums and tubes and lids and lubes,

Red and white and green and blue,

And other there a broken shoe.

Bits from all around the globe 

Have gathered here on this beach

Carried here out of reach...

But to the turtle they are foe

For down their throat they will go

Causing slow and painful death, 

Squeezing out every last breath.

So the clean must begin in a tic

Lets get rid of ALL Beach plastic.

Sandy Inglis April 2013

Giants Castle. Drakensberg, KZN

Texte a venir...patience!

Spot Baguette!

Oribi Ridge Shelter, Giants Castle, Drakensberg

Le meilleur restaurant du monde!

Levee de soleil sur Giants Castle, Drakensberg

Brochette de chaussures

Les Inglis apres la marche matinale

Levee de soleil sur les Drakensbergs

La mer de nuage sur Natal Midland

Zara Zulu

Roche ocre des Drakensbergs

On the way to work...and back home

Emergency Medicine South African (Gangman) Style!    

Cows on the road outside our house!

Morning rush house traffic in Uplands Road

Only 2 months have past in this, the wild west of Emergency Medicine, and yet the drama, the excitement, the frustration and the chaos make it feel like we have been here for years. I am employed here as the Head of Department for Emergency Medicine, plucked from the comfort of Australasian Emergency Medicine (EM) to come to this province of Kwa-Zulu Natal to make some sense of EM here. It is ironic that in this country where trauma kills more people than cancer and where 1200 died on the roads over last Christmas, EM, as a specialty is so undeveloped. I am one of only four EM physicians in this province and the only one in this town, serving a population of over one million. Other parts of the country are relatively flush though and nearly 100 EM physicians exist throughout the country. Academic EM abounds and Reg training is active, but we have a long way to go. “Casualties” are everywhere and, even here, I am at pains to explain to ED and in-patient colleagues alike, that casualty is dead and even ‘A&E’ is a dated term, but old habits die hard. Let me take you through some of what I went through to get here...... 

Parking at work under fat dripping pipes from the canteen!

Despite being South African, holding a South African MB.ChB and being on the HPCSA (SA medical council) general register, as well as being a registered specialist in NZ, Australia and UK, my initial application to register as a specialist was declined; “lack of proof of training and specialist qualification’! What followed was a painful and drawn out exchange and a final review which successfully got me on the specialist register. Then my interview was the next hurdle. A telephonic interview to me in London; date change 3 times and then time changed twice; then the teleconference didn’t work, then it did; then I heard nothing for weeks (or was it months?). Then a colleague in the hospital managed to find and film my contract in the HR department and e-mail me the pics so I knew that I had a job! Then, despite calling the HR staff and requesting my contract it was never sent and on arrival I discovered that my original contract, signed by the highest authority, was in fact lost!
I arrived to start work on the 2nd January 2013; I was vaguely expected and on presentation to HR a few sheets of paper were thrust into my anxious hands to fill in. These were bank forms to ensure I got paid and overtime forms. On numerous later visits to HR to check progress further forms were issued in a torturous drip-feed fashion revealing departmental dysfunction beyond belief. Then, as if this wasn’t bad enough, on discovering that I had not been paid for January by mid February, I returned to HR to discover that HR had lost all of my paperwork and had to start the entire process again. Then to top it all, my ‘resettlement’ payment (outlined in my contract) to get me and my family and possessions to South Africa, was rejected by the hospital ‘cash-flow’ committee.
Then to work. My predecessor was still firmly entrenched in his (my) office as his was yet to be built. Thanks to this, we were obliged to share office, telephone and move internet cable from one computer to the other to check e-mail etc. We did the same for the printer. Parking for the HOD was hit and miss and if I didn’t arrive well before 07.30 to claim my spot under the kitchens, where pipes drip old cooking oil and dirty dishwater onto your car, then I was traipsing around the campus through mud and debris to see where I could squeeze in. 

Spot the fat dripping!

4X4 track home...yes this is real!

With all the admin in order (I did get paid in late February!) its off to the ED. EM here is in its infancy. It has been born out of the surgical department and as such is very surgical with nothing like an ECG or nebuliser in site. The ED is essentially a trauma unit seeing an incredible volume of spectacular trauma; as much penetrating as blunt. Pedestrian MVA’s are prolific, knife wounds to every zone of the neck, belly, back, scalp and chest and

bullets everywhere else. Trauma here is not sanitized or packaged on shiny yellow spinal boards with bright orange head-blocks; vehicles are unsafe; children sit unrestrained in front seats; seatbelt use is rare and airbags just don’t exist. There is no warning and trauma arrives brutal and bloody, in arms, dragged in, out of backseats, deformed limbs, battered brains, spilling guts. Burns are horrific and are mostly hot water in kids but electrical and lightening burns are common and, worse of all, are the explosive fire burns and the revenge acid burns where palliation is the only option. The trauma support in the hospital is excellent with world class trauma surgeons who balk at nothing. We work well with them. The surgical side is more challenging. Thanks to its surgical origins, the ED has inherited the so called “SOPD” and together with it, a sort of hotchpotch triage where everything that is not medical, comes. Medical (or triage) officers wade through everything from sprained ankles to 3-week-old abscesses to goiters to lipomas to foreign bodies, directing traffic, signing forms, booking clinics, taking bloods, phoning in-patient teams. It is a monster that the ED needs to shed fast but the surgeons are way ahead of us and plan only a name change for this inconvenient collection that impinges on time in theatre.
Adjacent to our 6 trauma beds are 8 medical resuscitation beds. These have been provided to be part of this token casualty (sorry ED) and, although staffed by ED nurses, are administered and run by the physicians with ED coming in to help with resuscitations, ACLS and ventilating patients, as there is no piped oxygen or suction on that side. The pathology here is beyond belief with HIV, TB, renal failure, very sick DKA’s, sepsis, CVA’s, seizures, CCF, all sorts of toxicology, etc, etc etc. We would love to look after this part of the department but with SOPD around our necks and limited staff, that option is on hold.
I am the only Emergency Medicine consultant in the department. I have my predecessor who is a retired surgeon who has made amazing progress thus far. He is also a wizard with hospital admin and committees. Otherwise, we have 4 medical officers, 3 registrars (and 2 out on rotation), 2 community service (post intern) docs and 3 interns. It is a small team to run a busy ED (and triage and SOPD) and we have changed the roster from the original 28hour shift (8am to midday the next day) to a 12 hour shift, a day off post call and a late start the next day. A classic ED roster is impossible with the numbers I have.
Mind-boggling, as head of Department, is the enormous administrative burden and interminable meetings; strategic planning, leadership discussions, committees for everything from resusc to disaster to quality to adverse events....core standards, MANCO, HOD’s, and every other acronym you can imagine. It is a battle to stay in touch with the coalface but twice daily ward rounds in ED provide ample clinical exposure and a Monday ‘on the floor’ keeps the stethoscope swinging. The academic programme is impressive with ED CME meetings, radiology, ICU round, Reg teaching, M&M and more. Opportunities for research abound.
The biggest challenge now is to transform this trauma unit/SOPD into a fully fledged ED. I envisage a transition involving a move away from SOPD, embracing medical emergencies and then defining ourselves as a critical care ED seeing only Code (triage) reds. (triage 1&2). The Oz/NZ model will not work here. We would sink in a week! Focus on the reds; do it well and then review. We are working on core business for ED for the province; getting it right will be make or break.
You don’t come back to work in SA for the money. Not only is getting paid a battle but I just realised that my 3 week locum in Oz last year paid one third of my annual salary here this year. Put it this way; I could resign my post here and work as a volunteer, do 3x3week

locums in Oz and I would be earning about the same amount. One bonus here is a 13th cheque on your birthday month but then there is no CME allowance, no company car, no communications package and only 22 days leave per year. Luckily the cost of living is minimally cheaper! 

The way home via Albany road: the 4x4 way

Outside the hospital life is definitely different. South Africans live on the edge. Angst is everywhere; dogs bark incessantly; you run watching your back; we sleep barred, bolted and alarmed. Our telephone lines have been stolen twice, valued for their miles of expensive copper and armed response is the norm. Many live closeted in gated communities, secure behind high voltage electric wire and security guards. They live comfortable and immune from the drama that is South Africa.
Beyond all this is the joy of being in South Africa. Society here is not pampered, not protected, not predictable, like in NZ or Oz. The thrill of being part of a slightly unstable social experiment; rules are vague. The beaches are golden and isolated, ruffled only by the prints of a giant Leatherback turtle coming up to lay her precious load of eggs; rugged game parks harbour stalking lion, gangly giraffe and massive rhino in their lush green bush and majestic vultures soar silently high above the dramatic Drakensberg. Eland graze quietly on sweet pastures nestled below the krantzes of these massive mountains.
One feels, acutely, the joy of being alive here. Nothing is taken for granted. The rich scent of African earth after a vicious electric storm; the deep choral voices of Zulu men singing; the sight of Inguni cattle, with their marble-like colouring, drifting down our street like apparitions. We feel privileged to be a part of it..... 

Baguette on her morning run over looking the city of Maritzburg

Mseleni: Le retour

Lever de soleil de la maison

Caisse a outils et Landy (Landrover)

On nous avait bien prevenu lors de l’achat de notre 4x4 Landrover Discovery II Td5: 

• Buy a Landy = buy a large toolbox! 

Traduction pour les non anglophones: 

• Achetez une Landy = acheter une grande caisse a outils!

Nous partons ce long week-end pour notre ancien territoire dans le Zululand: Mseleni. La 4x4 est remplie de palmes, tubas, equipements de plage car nous allons aussi passer deux jours dans le site magique de Rocktail Beach Camp le long de la cote de Isimangaliso qui n’est accessible qu’en 4x4.

Nous avons 6 heures de route et apres a peine une heure d’autoroute, dans la banlieu de Durban...la Landy devient toute molle de l’arriere et ce met a rebondir a la moindre petite bosse sur la route. Des voyants rouges s’allument. Le manuel d’utilisation nous indique que se system de syspension pneumatique est mort. Le diagnostique est confirme par le garage a Durban. Retour a Pietermaritzburg pour deposer le Landy au garage et transferer les affaires dans notre la voiture #2: la VW Touran. Nous ne serons pas a Mseleni ce soir ou nous sommes attendus par la famille Viljoin et autres amis pour une diner-bring-a-plate.  

Nous nous arretons chez un ami a Mtunzini Jeremy Steere pour passer la nuit avant de repartir tot le lendemain.

La route de Mseleni apres Hluhluwe a ete refaite et est impeccable, avec l’ajout d’une multitude de ralentisseurs et de zone de parking special taxis. Il y a meme un chemin pietonnier en ciment en retrait de la route au niveau des communautes pour les pietons et velos! Nous n’avons pas ce lux a Pietermaritzburg.

Margot et Zara sont supers contentes de retrouver leurs amis Wentzel, Analou, Uju et Lize avec qui elles ont partage 1 annee de leur vie a Mseleni... et quelle annee!

Je retrouve Gerda qui me montre sa “classe”. Elle continue l’ecole a distance avec ses 4 enfants. Je l’envie.

Nous passons la journee a la plage de Lala Nek pres de Rocktail ou nous retrouvons la famille Armstrong. La mer est chaude mais un peu agitee ce qui rend la visibilite passable pour voir les petits poissons tropicaux.

C’est le debut de la saison de l’eclosion des oeufs de tortue. Nous tentons notre chance pour voir ce phenomene un soir de demi-lune mais sans succes. Le lendemain, je decouvre des traces de bebes tortues sur la place juste en face de Rocktail Beach Camp!

Nous nous arretons sur le chemin du retour a Hilltop Research Center dans la reserve de HluHluwe/Emphelozi pour se reconnecter avec les animaux sauvages d’Afrique. C’est l’ete et l’herbe est tres haute ce qui rend l’observation d’animaux difficile. Nous spottons des rhinos blancs, des girrafes, crocodiles et hippos...mais pas d’elephants.

Ah, L’Afrique!

La Grande Zulu Hut!

Margot a baleine. Lala Neck

Reunion d'enfants a Lala Neck: Famille Armstrong, Viljeon et Inglis

Lisa montrant une espece de scarabe attrape par Adrian

Zara et un shongololo

Lala Neck

Route vers Lala Neck, Isimangaliso coastal forest

Thorn tree

Marche de nuit le long de la plage a la recherche de bebes tortues

Margot a Rocktail Beach Camp

Detail d'un tronc d'arbre, Isimangaliso coastal forest.

Bug sur une plume de pintade

Petit dejeuner dans la reserve de Hluhluwe Game Reserve

Rhino blanc a Hluhluwe

Spot le crocodile!

Anybody there!