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!