Why did you come back?
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| Zara;s first Afrikaans' test: 20/20! |
I’ve forgotten how many times I have been asked this question. It is always asked in a
similar manner; somewhat curious, somewhat incredulous. I mean, who in their right mind
would come back to the chaos of South Africa; crime, massive road toll (1500 this festive
season), corruption, incompetence and insecurity. We have only been here for 5 weeks
but I find my initial bravado slightly dented; my “I really feel that I can make a difference
here” and “ we love South Africa” wearing a little thinner and ‘to be closer to family, friends,
great African lifestyle and an incredible work opportunity setting up Emergency Medicine
here” all being stretched to the max.
Then it is not surprising. In 4 weeks we have rented first in one house and now a second, bought, registered and insured 2 vehicles, installed Margot and Zara at a new school and grappled with a timetable that makes Paris Montparnasse look tame and debated the utility of learning Afrikaans, local French and lots more at their R60 000/year school; unpacked dozens of cartons shipped from New Zealand as well as others from France; visited numerous houses and tolerated agent’s rhetoric as we oscillate between purchasing or rental; battled on without internet relying on cell phone connections because the phone lines in our area have been stolen!
All this happening like a precipitous labour delivered unceremoniously from our comfortable little cottage and village in France.....
And then there is my work......today I submitted all my paperwork to the HR department for the second time because they lost the first lot and have failed to pay me; this is no small task and involves the completion of numerous forms, visits to the bank to get these forms stamped, managers to get more stamps and repetitive visits to HR to assess progress. On top of this, my application for the reimbursement of resettlement expenses has been turned down. That battle is in it’s infancy. When I arrived on the 2nd of January, they seemed to be expecting me, sort of! Oh, we thought that you were coming next week! I had no office, no internet and for the first few days no toilet! (that is why we get what is called a rural allowance!). I now share an office with my predecessor who is staying on (thankfully, to help with attendance at numerous committee meetings and copious admin). He has moved to a second desk to free up the HOD desk for me and we swing the phone cable and printers between our computers as there is only one.
Just getting into the hospital is a challenge and I am relieved to have my 4x4 to navigate generous potholes, mud and widespread construction. But, I mustn’t complain. A big part of this construction will be the new Emergency Department. (maybe next year!)
Things aren’t all bad though. The prospects in the ED are huge. I’ve started with the simple stuff first. Suction and Oxygen at all the bays, working monitors, A,B,C storage and generally tidying up. No we don’t call it “Casualty” anymore and yes, even “A&E” is out. It is now the Emergency Department where we see emergencies! This one is a little unusual in that it has been born out of the surgical department who, fantastically, realized that help was needed at the front door of the hospital. So it is really a trauma unit seeing primarily penetrating trauma with also plenty of MVA’s and PVA’s. Then, thanks to it’s surgical roots, the ED also covers the SOPD which includes the usual ED ‘minors’ which is run by ED medical officers with a couple of surgical interns down to help out. Then, in an attempt at medical equality, adjacent to the trauma unit are half a dozen medical emergency beds. Bizarrely, these are controlled and run by the physicians, but ED docs on hand next door if a real crisis occurs and someone needs a tube or resuscitation. The medical beds are
Then it is not surprising. In 4 weeks we have rented first in one house and now a second, bought, registered and insured 2 vehicles, installed Margot and Zara at a new school and grappled with a timetable that makes Paris Montparnasse look tame and debated the utility of learning Afrikaans, local French and lots more at their R60 000/year school; unpacked dozens of cartons shipped from New Zealand as well as others from France; visited numerous houses and tolerated agent’s rhetoric as we oscillate between purchasing or rental; battled on without internet relying on cell phone connections because the phone lines in our area have been stolen!
All this happening like a precipitous labour delivered unceremoniously from our comfortable little cottage and village in France.....
And then there is my work......today I submitted all my paperwork to the HR department for the second time because they lost the first lot and have failed to pay me; this is no small task and involves the completion of numerous forms, visits to the bank to get these forms stamped, managers to get more stamps and repetitive visits to HR to assess progress. On top of this, my application for the reimbursement of resettlement expenses has been turned down. That battle is in it’s infancy. When I arrived on the 2nd of January, they seemed to be expecting me, sort of! Oh, we thought that you were coming next week! I had no office, no internet and for the first few days no toilet! (that is why we get what is called a rural allowance!). I now share an office with my predecessor who is staying on (thankfully, to help with attendance at numerous committee meetings and copious admin). He has moved to a second desk to free up the HOD desk for me and we swing the phone cable and printers between our computers as there is only one.
Just getting into the hospital is a challenge and I am relieved to have my 4x4 to navigate generous potholes, mud and widespread construction. But, I mustn’t complain. A big part of this construction will be the new Emergency Department. (maybe next year!)
Things aren’t all bad though. The prospects in the ED are huge. I’ve started with the simple stuff first. Suction and Oxygen at all the bays, working monitors, A,B,C storage and generally tidying up. No we don’t call it “Casualty” anymore and yes, even “A&E” is out. It is now the Emergency Department where we see emergencies! This one is a little unusual in that it has been born out of the surgical department who, fantastically, realized that help was needed at the front door of the hospital. So it is really a trauma unit seeing primarily penetrating trauma with also plenty of MVA’s and PVA’s. Then, thanks to it’s surgical roots, the ED also covers the SOPD which includes the usual ED ‘minors’ which is run by ED medical officers with a couple of surgical interns down to help out. Then, in an attempt at medical equality, adjacent to the trauma unit are half a dozen medical emergency beds. Bizarrely, these are controlled and run by the physicians, but ED docs on hand next door if a real crisis occurs and someone needs a tube or resuscitation. The medical beds are
definitely second rate compared with the trauma ones....no wall suction nor oxygen,
inferior monitors, crowded, inferior stretchers etc. We are working hard at integrating the
units but with one ED consultant, one retired surgeon and a handful of registrars, we need
to bide our time and be patient. The ED sees no O&G, Paed(medical), Psych or minor
orthopaedics. These are all managed in their respective departments.
The work, as you must imagine, is dramatic, challenging and exciting. Monday morning handover had my jaw hanging wide open. We combine with the trauma surgeons for a round up of the week-end drama and I lost count of the number of stab chests, stab abdomens, gunshot back, belly; laparotomies, bowel resections, chest drains and resuscitations. There was the chap who had been stabbed in the neck and over his heart; he was pale and shocked and the dilemna was where to go first...open his chest or his neck? So the surgeon went in half way splitting the ribcage at about the 3rd space, squeezing down to the heart and nicking the pericardium to confirm that all was ok there and then looking upwards to see a hosing subclavian vein. Then a cut above the clavicle, divide it, stretch each end back and voila. access to the hole and the jobs done...oh and he is doing well on the ward. Then there was the child with massive burns from a house fire, tubed in ED, resuscitated but all too late. And the 27yo male shambocked to a pulp in a “community justice” and demises from renal failure and metabolic meltdown. 90 minutes of handover provides a window into a violent society where guns and knives rein and drunken tiffs are solved with a bullet or blade.
Then Tuesday morning starts in ED fast and frantic; no warning; no call from emergency services, just desperate parents bearing battered babies; a road grader has lost control and flattened a primitive shack; a child is dead and another’s life hinges; he has a degloved scalp and a fractured tibia and we sooth him with opiates. He is sutured and plastered and with his younger bruised sibling, comforted by his mother. The distraught father of the dead child receives first aide for his injuries.
As I turn around I am confronted by our next trauma; a 30 yo male with multiple stab wounds following a disagreement with the brother of his girlfriend. His intestines hang in a pink mangled coil on the bed, squeezed like pasta, out of a wound below and to the right of his umbilicus; my colleague expertly feeds them back into his abdomen staving off the inevitable shock; another wound in his left axilla hisses air and blood and a life saving drain is placed into his chest cavity. He is pale, cold and his consciousness dwindling. We intubate him, secure his airway. call for life saving blood and are running to theatre. Trauma surgeons wheel him in, open his belly and repair wounds. He does well and is sent to the ward to recover.
It’s not all work and no play though. We have had some great outings up to the massive local lake where next week we will take part in a mile swim with 30 000 other competitors. We have been up into the foothills of the magnificent Drakensberg in search of peace and trout and I have taken part in a 16 km hilly running event and a superb 42km mt bike race with lots of rolling single track. In 10 days time we return to our beloved northern Zululand to see old friends and immerse ourselves in the tranquility of the game parks.
South Africa is bitter sweet. I’m sure that our decision is right for now but I think we need to gaze at those elephant again to feel truly happy to be back here.
The work, as you must imagine, is dramatic, challenging and exciting. Monday morning handover had my jaw hanging wide open. We combine with the trauma surgeons for a round up of the week-end drama and I lost count of the number of stab chests, stab abdomens, gunshot back, belly; laparotomies, bowel resections, chest drains and resuscitations. There was the chap who had been stabbed in the neck and over his heart; he was pale and shocked and the dilemna was where to go first...open his chest or his neck? So the surgeon went in half way splitting the ribcage at about the 3rd space, squeezing down to the heart and nicking the pericardium to confirm that all was ok there and then looking upwards to see a hosing subclavian vein. Then a cut above the clavicle, divide it, stretch each end back and voila. access to the hole and the jobs done...oh and he is doing well on the ward. Then there was the child with massive burns from a house fire, tubed in ED, resuscitated but all too late. And the 27yo male shambocked to a pulp in a “community justice” and demises from renal failure and metabolic meltdown. 90 minutes of handover provides a window into a violent society where guns and knives rein and drunken tiffs are solved with a bullet or blade.
Then Tuesday morning starts in ED fast and frantic; no warning; no call from emergency services, just desperate parents bearing battered babies; a road grader has lost control and flattened a primitive shack; a child is dead and another’s life hinges; he has a degloved scalp and a fractured tibia and we sooth him with opiates. He is sutured and plastered and with his younger bruised sibling, comforted by his mother. The distraught father of the dead child receives first aide for his injuries.
As I turn around I am confronted by our next trauma; a 30 yo male with multiple stab wounds following a disagreement with the brother of his girlfriend. His intestines hang in a pink mangled coil on the bed, squeezed like pasta, out of a wound below and to the right of his umbilicus; my colleague expertly feeds them back into his abdomen staving off the inevitable shock; another wound in his left axilla hisses air and blood and a life saving drain is placed into his chest cavity. He is pale, cold and his consciousness dwindling. We intubate him, secure his airway. call for life saving blood and are running to theatre. Trauma surgeons wheel him in, open his belly and repair wounds. He does well and is sent to the ward to recover.
It’s not all work and no play though. We have had some great outings up to the massive local lake where next week we will take part in a mile swim with 30 000 other competitors. We have been up into the foothills of the magnificent Drakensberg in search of peace and trout and I have taken part in a 16 km hilly running event and a superb 42km mt bike race with lots of rolling single track. In 10 days time we return to our beloved northern Zululand to see old friends and immerse ourselves in the tranquility of the game parks.
South Africa is bitter sweet. I’m sure that our decision is right for now but I think we need to gaze at those elephant again to feel truly happy to be back here.
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