Are we nearly there yet?

Sadly, I think the answer to that has to be no. I have a 11 hour stopover here in Johannesburg, and while I was very wary of going into the city by myself just for an explore, I was quite keen to go to the Apartheid Museum, which is meant to be excellent. Unfortunatly, somewhere in my research, I failed to discover that all museums in Jo'burg are closed on Monday. There didn't seem much point going into the city just to go to a shopping mall (the only alternative the tourist information lady suggested, once I said I'd already been to several game parks) so here I am, trying to entertain myself until I can at least check in for my next flight. Having got up at 5 to go to Manzini airport, I'm starting to flag a little in the absence of anything really to do.

The weekend was fun, but has also added to my tiredness right now as I don't think I got much sleep. We were camping, but didn't have any mats or proper sleeping bags, so the second night in particular (in Mantenga nature reserve) was very chilly indeed! Last night I had the usual problem of knowing I have to get up early, so stressing about this and completely failing to fall asleep. At some point I hope it catches up with me, ideally on the plane tonight!

Back in Blighty around 10:15 tomorrow, where at some point I will sort out pictures, write a final entry for this, etc etc.

Last words (maybe)

This will probably be my final entry before returning to England (and hopefully a bit longer than the last!) I am now one day away from completing my elective and, in a rather cliched way, can’t believe it’s gone so fast! This last two weeks I’ve been doing lots more clinical work, including delivering babies, suturing, assisting in theatre, doing procedures like lumbar punctures (with no local anaesthetic – eek!) and running clinics in outpatients! I’ve certainly learnt a lot, though how much of it will be relevant when I return to the UK remains to be seen – but it certainly makes me appreciate just what we have back there.

On Tuesday I went out with the Home Base Care team for the day – they are nurses who go out into the rural communities and provide nursing care, medications and food for people who are sick at home and unable to get to clinic. It was quite scary as I was suddenly expected to be the senior member of the team and decide management plans for patients on the basis of very little information, and prescribing from a very limited range of drugs. It was also very harrowing to see some very sick patients and not know how on earth they were going to get to hospital for the care they desperately needed. At least ARVs are free now; if they weren’t then I think the country would be fairly rapidly decimated. Even so, for some patients getting the few emalangeni required for the bus to Good Shepherd for their refills is a Herculean task.

Rachel and Lucy have now left, and we have two new students from Southampton called Laura and Catherine, so Tim is very happy he won’t be left on his own after this week! We’re still trying to plan our final weekend’s activities, but I’m sure we’ll come up with something fun – at the moment the “Cuddle Puddle” is high on the agenda (it’s a spa in the Ezulwini Valley). Tonight is our final braai and we will say goodbye to Joel and his wife Lynette who has been visiting this week, so things really are slowly winding down. I’ve got my car booked for 5:30 (eep!) Monday morning to take me to the airport, and then once I get to Jo’burg am planning to spend some of my 11 hour stopover going to the Apartheid Museum, which has been recommended to me. And then it’s just lots of flying and a fair amount of sitting around and I’ll be home! Assuming I can fit all my clothes and the large amount of dodgy souvenirs into my suitcase…

Bullet points

- I really hate internet this slow.
- I have been in theatre today, assisting with a C-section and doing a D&C almost by myself, which was minging.
- It's a very small world - bumped into Betsy at the weekend in Manzini, completely by accident (though easy to spot her as we were probably the only white people in the city)
- Tim says I have to mention him in here so he doesn't get upset.
- I'm running out of internet time. Joy.

Mbabane and Manzini

Again this is from a time-limited internet café but I'll try to update asmuch as I can. Last weekend Rachel, Lucy and I went to Mozambique which wasan adventure in many ways! First of all not being able to get a bus fromthe border to Maputo so ending up in a truck full of plastic chairs, thengetting stopped by the police multiple times on the way to the city(fortunately they didn't take money off us, which has happened to severalof our friends). The city itself is a huge sprawling mess - completelydifferent from anything in Swaziland! The centre is bustling with peopletrying to sell you things, and some very modern Western buildings but somevery run-down ones too. The suburbs get progressively less nice untilthey're basically shanty towns. Our hostel was good, if noisy, and rightnext to the beach, though it was a bit too cold for swimming!We spent Saturday on Catembe, strolling along the beach in search of arestaurant which was further away than anticipated! It was well worth it onarriving - I had the biggest prawn I have ever seen, along with some othervery yummy seafood. We went to the famous fish market in the evening,though it was much quieter than anticipated, and bought our fish then tookit to a restaurant to have it cooked! From there, we went to Coconuts nightclub, which was good fun, with nice cocktails although prices wereapproaching UK levels. This was a pretty late night so the next morning wasa bit of a wash out, but we found ourselves back to Swaziland bymid-afternoon in time for some catch-up sleep before a week of work.I've been doing Obs&Gynae stuff this week, both in outpatients and theatre- got to assist in a few C-sections which was cool, and even got to(attempt to) suture! Outpatients was fun; I was seeing my own patients butwe had one translator between 3 of us, which makes the Cambridge-Calgary model break down a bit! I've taken the day off today because one of thedoctors was going to a conference in Mbabane and has brought Joel and mealong to explore the city - though there's not much of it to see. Tomorrowwill probably be more baby-catching, followed by trying to write up some ofmy project before my supervisor leaves! I can't believe there's only 2 weeks to go now; time really has flown by out here. Now I'm just in theprocess of trying to get rid of as much stuff as possible so there's room in my suitcase for souvenirs etc

...As a brief add-on, as the last internet cafe I was in wouldn't let me post this, I'm now in Manzini, having spent lots (in Swazi terms) on gifts, souvenirs, Africa tat etc. Weather is good and we've just had KFC, so I'm very happy. Not sure I'll be able to bring any clothes home though!

I’m actually cheating this time and saving this entry as a Word document before I take it to somewhere with internet, just so I don’t have to worry about time constraints this time. I have quite a lot to report, but might not remember to fit it all in!

Work at the hospital is going well; I am not sure exactly how my report is going to work at the moment but I have done some useful interviews and seen a lot of interesting consultations as well as getting some handy on-the-spot teaching! Last week I went on two outreach clinics: one very quiet one in Sigcaweni (somewhere about an hour away in the middle of nowhere!) and a very busy one in Tikhuba (about half an hour up into the hills). It was interesting to see how they work out there with extremely basic facilities – Sigcaweni doesn’t even have running water! Tomorrow I’m hopefully going on one more outreach visit and then will take some time to write up what I’ve done so far, as my supervisor is going home next week.

Also at the hospital, I’ve started playing netball along with Rachel and Lucy (two other British elective students, from Sheffield) with the nurses after hospital finishes. The court is half size and not properly marked, and one of the hoops is somewhat bent, but it’s fun! I haven’t played since school, so I’m quite rusty, but so far nobody has objected.

Mlilwane at the weekend was great fun. It’s only a small park and has no big predators, but it’s in a beautiful location and the lack of predators means you can roam around pretty much as you please (just don’t annoy the hippos!) Still no giraffes though, I'm afraid fleur! The vast majority of people there were tourists from the US, UK and South Africa, often on long journeys over large tracts of Southern Africa – we get quite a few of them staying at Mabuda with us too! We actually ran into a couple who Lucy and Rachel had met during their travels round SA – it’s a very small world! The hostel (Sondzela’s backpackers) was nice – we liked our private rondavel – and a good chance to meet lots of fellow travelers. Dinner there was basic but edible, and we treated ourself to the buffet at the main camp restaurant on the other night, including impala stir-fry, which was fantastic. Having hired a car was a great bonus as it made us so much more independent and meant we didn’t have to pay to go on an organized game drive! Driving on the dirt roads around the park was a bit of an adventure but on the main roads it was fine for the most part – at least, we and the car were in one piece by the end! We went exploring part of the Ezulwini valley on Saturday afternoon and found our way to Swazi candles and various craft markets, as well as seeing House on Fire, a strange place with stunning architecture (it’s such an eclectic mix of styles I can’t even begin to describe it) which very occasionally holds massive club nights – sadly not when we were there. Naturally, I had to spend some of my money on souvenirs, which I hope will turn out to be at least vaguely useful for some people! There is still plenty of present shopping to go though; we’re planning a trip to the market in Manzini at some point to finish that off!

This weekend’s mission is to Maputo in Mozambique; we’re not quite sure how we’re going to get there yet but we’ll work something out. I’ll try not to get too sunburnt!

The week in brief

Only short, because I'm on a very tight time limit at this internet cafe. I'm in Mlilwane nature reserve, in the Ezulwini valley between Mbabane and Manzini. The landscape is beautiful here, and we managed to explore some of it yesterday on mountain bikes, making it up to Reilly's Rock hilltop lodge, a very exclusive resort which nonetheless allowed us in for a drink after our struggle up the hill! We didn't go on a formal game drive this time, just explored by ourselves in our car and on foot, but have seen all the big animals here (no big predators, so it's quite safe to wander around) and watched the hippos being fed. Also did some craft shopping at some local markets, which is always fun.

The hospital continues much as ever, getting quite crowded with elective students now but so far no big clashes! I also went back to Hlane to visit the South Africans who stayed with us at Mabuda last week; they were very welcoming and the food was great, though the evening worship session was rather uncomfortable as I didn't know any of the songs.

That's all I have time for now; more later in the week, I hope.

This is Africa

“TIA” seems to be a common saying around here, especially amongst the South Africans who have been passing through Mabuda Farm this week. It’s a slightly derogatory statement coming from them, usually referring to when something doesn’t work properly or takes much longer than it would elsewhere. There have been numerous examples of this happening in the last week; notably the fact I’m writing this in an internet café in town rather than at the hospital, because the communal computer has finally died – it was overloaded with viruses and didn’t cope when someone finally ran a clean-up on it! Other things include the sporadic powercuts occurring most evenings – last night meaning I had to do my washing by candlelight – not to mention the fact I’m handwashing at all! I’m afraid some of my clothes will never be quite the same again. Oh, and a guy just came up to me in the street to tell me about how he was the black Jesus and was looking for a girlfriend. Just about managed to resist that opportunity!

My version of TIA is a slightly happier one. Yes, there are problems with many things, but the same is true of the UK – just different things. Although I may have just turned down the new Messiah, and walking down the street is a challenge against all the people trying to sell me things, in general all the attention is friendly and falls a long way short of anything intimidating. I went out to one of the outreach clinics today, well off the beaten track, which was an adventure having to compete with cows for roadspace, but some truly spectacular scenery. The staff there were all very friendly and had some interesting ideas and thoughts for my project.

We've got two more medical students now, both girls from Sheffield Uni. We're hopefully going to go to Mlilwane reserve this weekend for some hiking/exploring, and might drop in at some of the many craft shops in the area for some souvenir shopping. I shall have to practise my haggling skills! At Mabuda, we've had lots of guests passing through - South African school holidays have just started so lots of people are on their way to Mozambique for surfing/diving etc. Nice to have some varied company, and lots of interesting experiences to share. I didn't do much last weekend, just relaxed around the farm, and went to church with Joel and the family who own Mabuda on Sunday. It was an interesting experience - technically a "mixed" church but led by an American priest, and generally not my style but worth the visit. We went into town to watch the football final on Sunday night, which wasn't as exciting as we'd hoped, but I'm sure you all know that by now!

Time is running out, so I'd better get going. I will try to update this before the weekend but it depends on how hectic things get...

Week 1 summary continued

To continue where I left off yesterday…

I have also been spending a few afternoons in outpatients, which is certainly a bit different from the UK! There are two consulting desks per room, but only one examining couch (with somewhat inadequate curtains). There is also only one translator between two doctors, making communication even more difficult than it already was. Most of the patients only have very little English, so I am never sure exactly how much they understand my questions if not translated, and also how whether they are answering honestly or saying what they think we want to hear! I have learned a few words of SiSwati, but nowhere near enough to be able to consult in it – but it’s still nice to make an effort.

Communication issues aside, medicine in general is very different. Investigations are expensive, so a lot of conditions are treated empirically without definitive diagnosis. Antibiotics really are handed out like sweeties here – the UK can’t even begin to compare! We are trying to work out why they don’t have MRSA here, but for some reason it doesn’t seem to be a problem, which is good as they don’t have any vancomycin.

Away from the hospital, I have been settling in nicely. Mabuda Farm really is lovely, and we have been sampling the various citrus fruits from the garden – I’d never seen a grapefruit tree before! There are some other people around from the UK, some of whom are staying at Mabuda and others at the hospital, so I’m nowhere near as alone as I feared I might be. Last weekend we hired a car and went to Hlane game reserve; formerly the royal hunting grounds and now a very nice compact reserve (making spotting animals much more likely!)

We arrived in the early afternoon and by coincidence they were holding their annual traditional dance competition, which was an unexpected extra treat! Joel (another elective student) and I then went on a sunset game drive while the others went to the airport to pick up another guest. I was somewhat apprehensive as a large group of Americans got in behind us, moaning about how difficult it was to climb into the truck, how they couldn’t see anything with the sides down etc, but after that they were reasonably civilised! The drive lasted about 2 ½ hours and we saw lions, elephants, rhino, hippos, lots of impala and a couple of warthogs. By the time we got back to camp it was almost dark, and Joel and I set about making a fire for the others when they returned. We got it going quite nicely (with the help of a bit of paper but not much else!) and kept it like that while we waited…and waited…turns out they’d had a puncture on the way back and so were delayed, but made it safely in the end. We had a braai (barbecue) with all the traditional stuff plus pap (a South African maize meal dish) and various exciting bits of meat, finishing with the obligatory chocolate bananas and marshmallows.

It was a beautiful evening; the stars were spectacular, it wasn’t too cold and we could hear all the noises of the animals in the background. The lions did sound rather too close for comfort but we were reassured that they were stuck behind several layers of fence. The main danger was a stray ostrich who proved to be a major tripping hazard when wandering in the dark! We camped out for the night and in the morning went on a self-drive game drive, which was more of an adventure for the poor car than for us! 4x4 definitely recommended for this sort of thing. All in all though, a wonderful weekend and a real feeling of “this is Africa!”

Back to work this week on my project, fitting some clinical in around the side and trying to work out if it’s possible to unlock my phone in this country…

1 week in...

So, I’ve survived one week and no major traumas yet! I meant to update this on Friday but had to rush back to the farm as some backpackers had arrived and I had the key to the lodge. Then we were away all weekend so I’ve only just got back to a computer.

The first week went well; I’ve got some much clearer ideas about where I’m going with my mini-project. I’ve spent a few mornings in the PMTCT clinic and the main things that strike me are how busy it is, and yet how patient the patients are, plus how incredibly hard it is to maintain a decent follow-up system without sufficient computer facilities or staff skills/time to use them. The staff are very dedicated to what they do in each consultation, but there is no system to ensure that patients come back when they need to collect CD4 count results, talk about starting on ART, pick up their AZT (zidovudine) refills etc. As a result, around 50% of HIV +ve women who deliver in the hospital have not been taking the correct therapy. I’m trying to look at why this is (both numerically and more qualitatively by interviewing patients and staff) to see if there’s anything can be done to improve thingsboth ante- and postnatally.

The computer is being very unco-operative this morning, so I will be coming back later to try and complete this week's update including our weekend trip to Hlane...

First impressions

Well, I’ve made it in one piece and am starting to get the hang of things. The internet is painfully slow (and expensive) here so I am not sure how well this is going to go in the long term.

Anyway, the journey was as expected; long-haul flights are never fun, although the little propeller plane over to Manzini was quite exciting! The hostel I’m staying at, Mabuda Farm, is really lovely – it’s a family run place, and is still a working farm (with roosters waking up at about 5am each day!) The main house is an amazing sandstone building in old Colonial style, with the heads of various antelope on the wall. I’m staying in the backpackers lodge which is a more traditional Rondavel – a round hut with thatched roof. It’s very cute and really quite comfortable. There are a couple of other British elective students here with me but apart from that we have the lodge to ourselves. The whole area is very pretty, with lots of exotic flowers even at this time of year, and rolling hills stretching off into the distance. Sadly though, pictures will have to wait till I get home.

The hospital is about 2 miles away, which in the current weather is quite a pleasant walk – I would hate to do it in the height of summer (it’s currently midwinter here, but still around 20 degrees most days). Apparently it’s one of the best in Swaziland, but it’s still worlds apart from the UK. On the whole, however, it’s a nice place – crowded and very busy, but clean and all the staff are friendly. I’ve only really just started my clinical work here – in the PMTCT (Prevention of Mother-to-child Transmission) clinic and a bit of gynae theatre too. I'm still trying to create some structure for my actual project but everyone here seems quite keen to help out, which is great!

More to follow later in the week, I hope.

Off we go

I thought this would be the easiest way to keep in touch with everyone and let you know what I'm up to. For those of you unclear on the details, I'm going to the Good Shepherd Hospital in Siteki, in the East of Swaziland, for my elective. This has all been arranged at the last minute after my original plans (for somewhere considerably more developed!) fell through, but fortunately thanks to the work of my ex-DoS, I've found this amazing opportunity instead.

I'm not really sure what to expect yet, never having been to Africa before, or worked in a hospital like this, but I'm very excited! I don't know how much internet access I'm going to have but I will try to keep this as up-to-date as I can. Sadly I'm still a bit of a techno-dinosaur and only have an old-fashioned camera, so pictures will probably have to wait till I get back!

Oh, and for the several of you who were unaware, Swaziland (where I am going now) is NOT the same place as Switzerland (where I went in my gap year!) Look at a map!