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!

Grandad Style!

Happy Birthday Roderick!

Cheers!

Grandad Style! Clic on the link

http://www.youtube.com/watch?v=9bZkp7q19f0

Birthday present: a Hubly Bubly

The WFRBS (World Famous Roderick Breakfast Special)

Why did you come back?

Why did you come back?

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

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. 

Allo! Vous avez du fil a retordre!

 Allo ! Vous avez du fil a retordre ?

Fil telephonique devant la grille

Detail du cable

Il est 1h30 du matin et les chiens aboient comme des malades dehors. Est-ce une coïncidence ; notre alarme ne fonctionne pas depuis que nous nous sommes couchés. A la 3eme vague d’aboiements, je prend mon téléphone et je contacte la compagnie de sécurité. Mon cœur bat a 100km/h et je suis près de la panique alors qu’a cote de moi Sandy essai de me convaincre  que ce n’est rien et que je doit dormir ! L’agent de sécurité arrive dans les 10 minutes qui suivent. Il vient inspecter la propriété. Un clic indique que son arme est chargée...je me retrouve plongée dans le film de James Bond. L’inspection ne mène à aucun indice suspect. Il repart, nous laissant dans le néant. J’arrive à retomber dans le sommeil, l’oreille attentive aux moindres bruits. Le matin, alors que nous approchons de la grille pour aller faire notre promenade matinale, nous découvrons un long fil  téléphonique gisant à même le sol en travers du chemin ! L’énigme se précise lorsque l’on découvre que la plupart des fils des 4 poteaux avoisinants ont aussi été coupés ! Le lendemain, lors d’un jogging matinale avec Aurélie, une copine française de passage, nous découvrons les épaves des fils plastic dépourvus du cuivre sur le bas-côté d’un chemin en bordure de forêt ! C’est d’autant plus aberrant que les fils venaient juste d’être remplacés car ayant aussi été volés il y a moins de 3 semaines !  Voici une situation plus que désespérée ! Pas la peine d’espérer d’avoir une ligne téléphonique/ADSL dans les prochains mois. La police a été prévenue...mais que faire ! C’est l’Afrique !!

Notre maison de location

Ça va maintenant faire une semaine que nous avons emménager dans une très belle  maison au toit de chaume à Blackridge, un quartier de Pietermaritzburg sans prétention. 

Je commence à respirer après un emménagement plus que stressant. Les déménageurs avec nos affaires de Nouvelle Zélande sont obligés d’attendre 2 heures, le temps que la propriétaire (qui emménage dans la ‘cottage’ située dans le même terrain) débarrasse ses affaires et fasse laver la maison. Je passe la plupart de la semaine a déballer les trésors oubliés que nous avions stocker dans notre garage à Lyttelton (Nouvelle Zélande), les affaires que Rachel (la maman de Sandy) nous a fait parvenir de Cape Town, nos affaires stocker à Pietermaritzburg après notre périple en Afrique et nos affaires venue de France Pour la première fois, nous nous retrouvons avec la majorité de nos biens !

Deballage de nos tresors de Nouvelle-Zelande: Mon kayak

Margot apres la course de natation du Midmar Mile

Pour les filles ça va très bien et l’école leur permet d’avoir une ‘constante’ dans leur vie.

Il me faut se soucier de sélectionner une école pour la High School pour Margot pour l’an prochain. Les inscriptions se font maintenant donc il y a un peu la pression. Pietermaritzburg semble etre la ville des ‘excellent High Schools of South Africa’. Les gens du Kenya, Zambia…envoie leur enfants dans ces écoles où leurs enfants sont mis en internat. Donc, je me suis donnée la semaine pour prospecter. La première école sur ma liste a été un choc : à peine ai-je passer la barrière que je vois des petites écolières habillées en mariées dans la cours de l’école primaire. Bizarre ! Puis côté High School, je vois les étudiantes habillées en uniformes similaires à ceux des bonnes sœurs couleur jaune canarie. A ce stade, j’ai envie de prendre mes jambes à mon cou et de courir. Avant d’arrivée dans le bureau, je passe à  côté de l’amphithéâtre dans lequel se déroule tout un cour d’éducation religieuse. J’apprend plus tard qu’il s’agit du passage de la 1ere communion. Pas la peine de vous dire que le prospectus d’inscription pour cette école ne sera même pas ouvert ! NEXT. Je continue mon enquête et je parviens à réduire ma liste à 2 écoles. A suivre !

Sandy commence à sonner la trompette dans son boulot. C’est le moment de passer a l’action et à l’équipe des urgences de s’organiser. Le pire c’est qu’il n’a toujours pas été payé...après 1 mois ½ !! Hier, il me raconte une anecdote des Urgences : le conducteur d’un rouleau compresseur a perdu le contrôle de son véhicule. Resultat, 1 mort et 3 blesses graves...fait divers qui sera sur la première page du journal local ‘The Natal Witness’ aujourd’hui !  Life Goes On !!

Hambagakle-Stay well !

Les chutes de Howick

Oscar Chalupski avec un novice Zulu: Duzi 2013 2eme chute d'eau

Jason (cascette orange): carnage a la 2eme chute du Duzi

6h du matin: Spectateurs du Duzi