A dear friend of mine, Zainab, has kindly shared with me her travel writings on a trip she took to South Africa as a 4th year Medical student. Zainab has since graduated and is working in the Emergency department of a busy Sydney hospital. I have compiled her four-part entries to cover two instalments. Enjoy part one, it is well worth the read.
CHAPTER ONE: Into the Wild
Last summer, three fellow 4th year medical students and myself, spent five crazy weeks in a rural hospital in Kwa-Zulu-Natal, South Africa.
The Emmaus Provincial Hospital was built a hundred years ago by Dutch missionaries and is situated in the rural, ethnically Zulu township (read: village slum) of Emmaus. Half an hours’ drive from anything Google maps is able to locate, with the shebeen (pub), and three tin shacks each selling mouldy bread and coca cola, the only services in town besides the hospital.
The HIV rate in the community is estimated to be at 60%, with Tuberculosis much the same. High unemployment, poverty, malnutrition, sexual abuse, and violence also plague the region. The five doctors at Emmaus Provincial Hospital served a population of 100,000 people.
The village lives in the seemingly Jurassic Drakensberg (Afrikaans: dragon) mountains. The most beautiful place on earth. Endless. Endless skies. Lush green mountains towering above on every side. Clear, warm, Summer days. Thunder, lightning shows, and torrential rain by night. (Aside: Also the region of the world with the highest incidence of lightening strike fatalities).
We arrived in Bergville. A township 30kms from Emmaus, with all the services you could desire- so long as you desired no more than SPAR groceries, KFC, and over-priced dodgy USBs. We were oriented to the region and met the important people in town. An elderly nun who’d arrived for a 3 month missionary visit. That visit began 30 years ago. “You’re not ready for this. I cried for days after I saw a child die”— Someone who had had something inside her broken, somewhere along her journey, I thought.
The others were three young Peace Corps workers also living in the region. They travelled everywhere either hitch-hiking or by public transport (read: mini buses operating external to the dimension of time, packed infectiously full of Tuberculosis patients).
It was dusk, dessert eaten, the orientation Braai (BBQ) ending, and time for us to head to our place residence for the next five weeks. As I drove our rental advertised-as-Toyota-but-actually-not-vehicle further into the countryside, I could feel the road worsen. “Watch out for pot holes and cattle”— the caution came clearly to my mind.
The sky grew darker, the night more enveloping, and we (foolishly) more bold in our recounting of macabre South African urban legends. Upon our arrival into Emmaus, you can imagine, we were a little bit on edge. We were to reside in roundavaals (Afrikaans: round mud hut with pointy straw roof), one hut for the boys and one for the girls. There were three girls, myself included, and our single male companion grew more nervous at the prospect of being left to sleep alone. We arrived at the village accommodation; several huts surrounded by flimsy metal gates and rusted barbed wire.
“Where’s the armed guard?”- I asked the Peace Corps worker staying in the compound.
“mmm…there isn’t one”, she replied. “But don’t worry”, she continued, “it’s only been broken into twice this year, and that was because the hut was unlocked, it’s the black mambas you need to watch out for”…
Following this series of events, it was established that it would be foolishness for us to sleep in separate huts; strength in numbers you see. So it was my three colleagues in one hut; myself in the other, much to their dismay. “I’m a Muslim woman and I need my privacy”, I insisted. I finally managed to pacify them with my assertion that being a black belt I’d been precisely trained for this sort of thing. I slept with a door alarm, a personal alarm, and a knife by my bed for the next 5 weeks.
I still haven’t decided whether I was too cautious, or not cautious enough. No one really knows the truth of the place. The white afrikaaners we’d meet at classy restaurants and country cafes thought we were crazy. The American Peace Corps workers thought we had nothing to worry about (we thought they were a little crazy). And the locals appreciated our staying in the community.
Personally, I felt quite safe by the end of it.
CHAPTER TWO: One Hundred Thousand People. Five Doctors.
“Thank God you’re here” was the common phrase that people welcomed us with.
Our apprehensive response was to wonder what exactly they were expecting of us. “We’re students…We’re here to learn…”
As circumstance would have it, we would turn out to be quite useful, and in the end we were surprised by our contribution.
I was allocated to the female ward. Visualise a hot stuffy hall with no curtains separating 45 beds. The ward, as its name suggests, provided inpatient care to any female regardless of condition. We had patients with cancer, miscarriage, tuberculosis, AIDS defining infections, diabetic amputees, domestic violence victims, suicidal overdoses— and the list continues.
Each morning about 20 blood collections, numerous cannulations, nasogastric tube insertions and catheter insertions were required—these tasks fell to the two of us assigned to the ward, and we performed them well. We were also taught and expected to perform higher skill level tasks such as lumbar punctures, something students (and junior doctors) in Australia NEVER do. The sheer volume of work made it necessary for us to help however we could.
The first time I had to draw blood from a HIV positive patient, I have to admit I was a bit nervous. I double gloved, wore goggles, and a mask. Yes. The local staff did laugh. The following week, I was down to a sensible, one pair of gloves and not quite as nervous any more.
The doctors were excellent. But they were tired, frustrated, and overworked.
We’ll need you on for Christmas evening.
“What happens over Christmas?”
“They drink and stab their family members”…
Pilates as the sun rises across the mountains. Water stops running. Sweaty and gross. Breakfast. Cereal with milk powder. Pungent, life giving coffee. Drive to hospital unshowered. Guards check our trunk for contraband or smuggled peoples; they insist on refusing to recognise us for our entire five week stay. Day begins. Day ends. Home. Nap time.
Water running again. Dinner: Just-add-water mince. Boots on. Backpacks stuffed with essentials: Gloves, alco wipes, alco hand gel, goggles, steth, torch, personal alarm, phone. Drive to hospital; showered. Questioned by guards as to our motives for visiting. Enter outpatients department, our regular five doctors have the night off, a locum (casual) is on duty, but nowhere to be found. The hall is full of trauma patients. Only minor lacerations. We breathe easy, collect a patient each and get on with suturing.
Mechanism of injury: assault via broken beer bottles, or bludgeoning by traditional Zulu fighting sticks seemed to be the two favourite. Rarely gunshot and stabbing wounds (Alhamdulillah). The violence seemed to be unplanned and impulsive, which led to people trying to kill each other with whatever they happened to be holding. Also— Guns are expensive, the area was remote, the people dirt poor. Can’t work out why we didn’t see more stabbings though…Luck perhaps.
By 3am I felt my compassion leaving me, and when the 20-something-year old guy whose lacerations I was suturing screamed and lifted off the bed as I injected local anaesthetic, I found myself roughly telling him that I had to do it…I may also vaguely remember pushing his head back onto the bed…
You worry about your safety, your competence, providing the best treatment possible with your level of training.
One of my colleagues obtained a splash injury that night. We were all terrified. She commenced Antiretrovirals, and the patient was found to be HIV negative. She was wearing goggles, but still was splashed in the eye…these things happen. You know they happen. And they scare you. And so you’re on edge. And so you find yourself treating patients brusquely…And then that scares you.
You can find the next and final instalment for Zainab’s story here. If you’d like to discuss this post, feel free to comment below.