Kirk’s Blog

Final Entry

 We have made the journey safely home and work has started already for me.  Thank you to those who have read this blog and those that have been praying for us.  I am very greatful for the opportunity we had to go to South Africa.  It was an incredible experience for me personally, professionally, and spiritually.  The trip was sweetened by the company of my wife and son who were able to take part in the adventure as well.  Here is a list of some of the things I will miss:

1. The short walk to work in the warm African sun

2. Coming home to eat lunch daily with my wife and son

3. The fellowship of the other missionaries

4. Sitting down to a nice warm cup of delicious Rooibus tea and delicious conversation

5. Not having a pager to carry around

6. Getting to wear shorts and sandals to work  

7. Ouma biscuits

8 Orange Fanta

9. Our German neighbors

10. New and exciting experiences

11. A language with clicks

Durban

 The “Golden Mile” of Durban.  On the far right you can see one of the soccer stadiums that has been constructed for the 2010 World Cup.  It looks like a great place to watch a game.

Turtle

 Ben with a giant turtle.

Ushaka

 On our way back home we were able to stop to enjoy a day in Durban.  We stayed at a nice hotel on the Golden mile and went to Ushaka’s Marine World.  It was fun being a tourist.

OB

 The maternity ward.

Hospital

 A courtyard inside the hospital.

Hospital

 The main entrance to the hospital.

Weekend On-call

It was my turn to be on call this weekend. We rotate the hospital duties for Friday, Saturday, and Sunday. We also split up the rounding on the wards a just focus on those that need to be seen. Both Saturday and Sunday I probably quickly rounded on 30-40 patients in a few hours and as far as I know they are all still alive.

I was pleasantly suprised with the amount of sleep I was able to get. A night on call at home does not guarentee any sleep and I had at least 4 hours of uninterrupted sleep each night.    Last night I was covering the emergency room.  I was called from our evening church service because an 8-year old had been hit by a car, which is not suprising given how many children I have seen wondering around on the streets.  In general the kid looked pretty well, but her upper arm was clearly injured and deformed.  I could not quite tell by exam if the arm had a displaced fracture or a dislocated shoulder.  We called the X-ray technician on call to come in to the hospital, but they did not answer their phone and neither did the back-up technician.  So unfortunately this poor kid had to sleep in the ER infested with mosquitos waiting for an X-ray in the morning.  The x-ray confirmed my suspicion of a displaced fracture the following morning.

One other interesting phenomenon is the frequency of power outages.  The lights in the whole town (including the hospital) go off for a few random seconds most nights.  On windy days the lights go off very frequently, every few minutes.  Lisa and I have decided that the power is generated by a guy riding a bicycle.  Every now and then he gets tired and has to switch with another rider.  When he switches the power goes out (randomly).  Now anyone that has ever ridden a bike knows that it is much more difficult on windy days so they have to switch bike riders much more frequently leading to the increased power outages.  I cannot verify that this theory is true but it makes sense.  Last night as I was stitching a facial laceration by a guys eye and the lights kept going out I could have used a stronger bike rider.

Thoughts on Food

As I may have mentioned previously our cooking facilities are more than adequate but still somewhat rudimentary.  We were pleased to discover that all of our basic food supplies (even baby supplies) could be found about 15 km south of us in Mbazwana.  Last weekend when we traveled to Hluhluwe one of the highlites was shopping at the even nicer grocery store they had in town.  They also had a beautiful gas station that would be beautiful even by US standards.  I know I have found myself eating a little more sweets than usual because sometimes I actually do wanta a Fanta Fanta, and the orange Fanta here is delicious. 

Since our meals had become a little repetitive and predictable we decided to take a risk and eat at the hospital cafeteria for lunch.  We had heard that this was an option and a native South African recommended it.  I was a somewhat leary of the recommendation however when she began explaining how delicious Vegemite is, but we took the risk and were pleasantly suprised.  For less than 5 dollars combined Lisa and I were able to get a heaping plate full of rice or phuthu, a vegetable, some meat, and a glass of juice.  It was nice to have some variety in the meat since the only meat Lisa has trusted enough to buy was bacon.  The hospital lunch really was delicious and a few days later there is no diarrhea.  What could be better?  In total that is 3+ weeks in Africa and no traveler’s diarrhea in our family.  What a great suprise!  

HIV and TB

I have not spoken much about these 2 diseases thus far but they are major problems in this part of South Africa.  I am not sure of the exact figures, but about 30-40% of the adult population in Mseleni has HIV.  There is great access to ARVs (antiretrovirals) here.  When it is determined that ARVs should be initiated the majority are started on a 3 drug regimine called regimen 1a (d4T, 3TC, EFV) with monitoring of their CD4 counts and viral loads.  If this regimen is not effective and the patient has been compliant with instructions they will be switched to a different 3 drug regimen called regimen 2.  These are the drugs available to the patients and this systematic approach is put in place because of the lack of resources for resistence testing. 

Prevention is obviously a very important factor when discussing HIV.  Each patient that is tested undergoes pre-test and post-test counseling about the risk factors for disease transmision.  I have been working on the maternity ward and about 50 of the 150 total deliveries done here each month are to HIV positive mothers.  The mothers are given either ARVs or AZT depending on their CD4 count and the infants are also treated and tested.  The mothers are still encouraged to breastfeed for the first 6 months here because the risk of deadly gastroenteritis from improperly fed non-breastfed babies is so high.  

10% of those newly diagnosed with HIV will be found to have Tuberculosis within the next year.  There are about 75 new cases of TB diagnosed each month at Mseleni hospital or the surrounding clinics.  TB is a very interesting disease that can have a very latent, indolent disease course or can be very active and aggressive especially in the face of immunosuppression.  Also, TB can affect nearly any structure in the body.  In just my few short weeks here I have seen TB meningitis, TB of the spine, a tuberculous knee effusion, and of course lots of pulmonary TB.  It is also a difficult disease to treat requiring at least 6 months of a 4 medication regimen.  There is developing resistence to the medications and there is plenty of MDR (multidrug resistent) TB in Mseleni. 

TB or HIV is a consideration for nearly all of the patients I have seen in the outpatient department since these 2 diseases can affect the body in so many different ways.  Nearly every patient gets asked about CLOWNS (Cough, Loss Of Weight, Night Sweats), the hallmark symptoms of TB.  On average there are about 1.5 in hospital deaths per day and the majority are HIV or TB related.  It is amazing to see the ages at which patients die, many in there 20s and 30s.