Shelle Schwamberger’s Blog

so many things…

I can’t believe that today is my last day at Mseleni Hospital.  I have had so many experiences and patients that I meant to write about, but time was limited and internet connection has been lousy this week.  Although I don’t fly home until Sunday, Charlotte and Tory are driving to Durban this weekend and leaving this afternoon so I will catch a ride with them.  I went on ward rounds as usual this morning, which are always entertaining and great learning experiences.  I also took some more pictures of the place, which I may or may not have time to upload today.  I helped out with a very sick child with pneumonia and admitted a man with a COPD exacerbation.  There are so many patients everyday, all with their own stories that I wish I had time to share.  Death is unfortunately so common here, but thankfully some stories have happy endings as well.  It is so gratifying to see a patient that has been sick for some time to improve and get up and walk out of the hospital!

One funny story today that I can’t pass up.  Ben was examining a young woman in OPD who was very thin, breathing with difficulty, and on IV fluids for dehydration - a picture I have become all too familiar with.  Ben and I were standing with a nurse and a translator by her bedside, and she asked the translator for some water to drink.  The translator handed her the STERILE WATER FOR IRRIGATION bottle that was sitting nearby on a tray and the woman promptly tipped it back and gulped from it!!  Ben and I just looked at each other in utter amazement with our mouths wide open as the translator then took the bottle back, replaced the cap, and put it back on the tray with the other medical supplies!!  What are you doing?  This is supposed to be STERILE water!  Yes, she said, sterile water is VERY clean for drinking.  Yes, but the tap water is here is also clean for drinking!  Now you’ve ruined the whole bottle as it is obviously no longer sterile.  I grabbed the bottle and wrote on it “DO NOT USE.  NOT STERILE.”  The translator just laughed and said, oh, sorry!  Unbelievable.  How many times does stuff like that happen and we never know?  A lady with a CD4 count of like 4 comes in with probable PCP pneumonia, TB, toxo, and who knows what else, and she puts all of her germs into our sterile water which we then use to irrigate some poor chap’s bushknife cut…

Anyway….

I am very sad to be leaving Mseleni.  There is a wonderful community of doctors, social workers, physiotherapists and occupational therapists here that I have really enjoyed getting to know and learn from and have fun with.  They are all doing such wonderful work here and making a lasting impact on this community.  I have toyed with the idea of skipping out on a residency and just coming back here to work right after graduation, but that’s probably not a good idea.  I need to get the best training as I can in order to be of the most benefit to patients here later.  Also, I have those silly student loans that someone is probably going to want me to pay back…

I’m really going to miss this place.  It makes me sad that I have had such an unforgettable experience here, yet I leave and life goes on without me exactly the same until 2 new medical students arrive on Tuesday to take my place…

rain

Well, I was just coming to the doctors’ office to spend some quality time blogging, when one of the doctors asked me if I could walk someone back to the Fredlunds’ house.  The man who was delivering nebulizers to our hospital today hit a goat and now his car is not running so he is stuck here for the night.  I asked someone, “Where does one take his car in Mseleni when he hits a goat?”  The reply was, “It’s best not to hit a goat.”  Fair enough.  Now it looks like the sky is about to open and I need to walk this guy to the “Mseleni Lodge” that is the Fredlunds’ house hopefully before the rains start.  I promise I’ll try to write more tomorrow!

Swimming with dolphins

On Sunday as we were eating breakfast, one of the guys that worked at the camp told us that several other guests wanted to go on an “ocean safari” but they needed a few more people to have a big enough group to go.  3 of us - Charlotte, Karen and I - jumped at the chance, especially because we aren’t divers like the rest of them.  Snorkeling we could handle.  So we sped off on a wet boat for what seemed like miles along the coast watching the white sand and green bushland roll by.  No condos, no high rises, no hotels, no people.  Finally, we reached the reef and all jumped out to snorkel.

The water was so clear and the visibility was excellent.  We all wandered around watching the brightly colored fish for about 15 minutes, until suddenly, I noticed that the rest of the group was getting back into the boat.  What was going on?  Is it over already?  Are we going somewhere else?  The boat driver (captain? sailor?) was beckoning us all back to the boat so I swam to the side and was pulled in.  There was a lot of excited Afrikaans being spoken by the other snorkelers.  Finally I got the story - a few of the guys had come upon a shark!  They said they thought it was sleeping, but it was right below us.  Ok, that’s enough information for me!  Off we go!  Snorkeling was fun but I was very happy to leave it behind if there were sharks!  So we sped off again in the boat and I figured the excursion was over until, suddenly, right beside the boat there were dolphins swimming!  Our guide asked if we wanted to swim with them…as we all were jumping out of the boat again.  Wow.  When we jumped into the water, the dolphins went down and we were looking down at them swimming along the bottom and spiraling upwards toward us.  They were beautiful.  It didn’t seem real.  The dolphins didn’t seem to fond of us being there so they didn’t take long to swim away.  All of us loaded up back into the boat again.  Luckily, on the way back, we came upon more dolphins and jumped out again.  This time, I was the last swimmer and everyone else was between me and the dolphins, until suddenly, the dolphins turned around to circle back by us which put nothing between me and them!  I looked one of the dolphins in the eyes from about 3 feet away!  It was absolutely incredible!

We were all giddy the whole way back.  I never expected that a spontaneous ocean safari would involve such close dolphin encounters.  Adrenaline was surging through my body and I couldn’t stop smiling.

Mozambique

This weekend 7 of us took a getaway to the beautiful Mozambique coast.  We had to leave at 4:00p.m. from work in order to reach the South Africa-Mozambique border before it closed at 5:00.  We cruised at high speeds along the nice paved road and pulled up to a big gate that a guard was putting a padlock on at 4:58.  Luckily, Tory, a South African girl in our car, speaks fluent Zulu and managed to convince the guard to let us through with lots of begging and sweet innocent smiling.  As soon as he finally relented and agreed to open the gate and allow us to pass, Tory added one last request.  We have another car full of friends that should be right behind us.  If you could just wait for them as well…  He frowned and did not want to keep the border open for any longer.  He was ready to quit work and go home for the night.  More Zulu conversation followed, which delayed enough time for our friends to drive up behind us, so thankfully we all made it across.  Whew.  But that was only the beginning of the adventure as the paved road ended at the border.  We switched the cars into 4 wheel drive and bounded off into the roads of sand and bush, still without about an hour to go to the beach.  Dusk was rapidly approaching and a lightening storm was entertaining us from a distance, but as neither of our drivers had much experience with their 4×4 off road driving skills, we were all getting nervous.  There was NOTHING around - no people, no small huts or villages, no farms.  Only rolling hills, grass, bush, and sand for as far as we could see.  We continued down the road at high speed (to avoid getting stuck in the sand) and all screamed as suddenly right in front of us was a burned-out Land Rover.  I got out and took some pictures, but the rest of them were more concerned with backing up and finding an alternate route through the bush to get around it.  It was facing us and completely blocking the one lane “road” that we were on.  We had another little scare as our tires began to spin, but with a few driver changes and luck, we managed to get ourselves out and around the obstacle. 

Arriving at the grounds where we were staying, finally, we stopped at the gate to check into our rooms.  The man in reception said that we had booked ground tents but because of the rain they are probably leaking so we should stay in the deck tents instead.  He also gave us a map that he said was wrong and tried to explain the correct way to our tents and told us to ignore the map.  Why give us the map at all you may ask?  Yeah, me too.  But anyway, the tents were on a raised wooden platform with a big roof over the deck so we were camping but would stay dry.  We put down our stuff and headed to the kitchen to cook and eat.  Someone came and told us to check out the bar, so of course I obeyed.  Up some stairs there was a wooden deck with a wooden bar looking out over the most gorgeous ocean view and untouched coastline that I have ever seen.  I was so happy that I decided to celebrate with the local Mozambique beer - Manika. 

We had a lot of fun that night cooking, eating and drinking at the bar listening to the ocean every time there was a break in the reggae music.  It was so nice to be on a relaxing vacation.  At one point in the evening, conversation inevitably drifted to work until Charlotte said, “There will be NO work talk this weekend!  I don’t want to hear the word ‘creatinine’ out of anybody’s mouth!”  Good call.  We all needed a vacation. 

hippos

orphan playing doctor

Hospital courtyard

suturing

walkie talkies

Not much is wasted here in the way of food.  ALL parts of the chickens are sold and eaten.  In some places, the chicken head and feet are bagged together and sold as “walkie talkies”!!

E tick

At Mseleni, the code for “HIV positive” in all of the charts is the letter “E” with a check mark following it.  The South Africans and Brits call check marks “ticks” so they describe HIV patients as “E tick.” No one seems to know why they use this particular code.  I can understand the need for patient privacy, but in some ways I feel that we have gone overboard.  We write every other diagnosis in the chart and use the proper names for them when discussing them.  I feel that by being afraid to say HIV just adds to the stigma of having the disease.  HIV is still the only test in South Africa that you cannot order for diagnostic reasons in the hospital without first having patient counseling and consent for testing.  (I believe that goes for the U.S. as well?) Again, I am very glad that there is patient counseling and a consent process, but we don’t go through that process with any other diagnoses - even the terminal ones.  I don’t know, it’s just an interesting situation to me… I’d love to hear your comments.