The Big Adventure to Kruger and updates

After 3 months of work and school we are taking a week long driving vacation to Kruger National Park. As usual everywhere we go, I fall in love with the location and consider making it my next employment destination.

The part of Kruger where we are headed is about a 10 hour drive from our home in Eshowe. We decided to take the slow scenic route to the park with overnight stops along the way. The first 2 nights we stayed near Piet Retief, a small town surrounded by vast stretches of farm land.  Our accomadation was a very nice working farm/ B&B, Dust to Dawn, that received a great review in a recent edition of the Sunday paper travel section. We saw lots of different farm animals and heard the uniform squeal of 7,500 pigs at 5am calling out for breakfast, but didn't get to see them.  For health reasons the pigs are not allowed visitors. The 5th generation German couple who own the farm are very hospitable. In particular we loved the home made German Bread and delicious home cooked meals as well as the elegantly decorated and comfortable rooms.

On Sunday we took a very long drive into Swaziland looking for a hike which we never found.  Although, we did enjoy driving thru the tiny villages and did take a short meander thru the fields despite the scary looking cows!  Swaziland has a very different feel from South Africa, there is no great disparity in wealth, where we drove it looked like everyone was equally impoverished.  We stopped at the Swaziland Candle and Craft Market to find busloads of Europeans and a few gifts for our friends at home. 

After a full day's drive north, we settled into our penultimate destination at Idle & Wild lodge in Hazeyview.  The climate here is definitely more tropical than what we are accostumed to.  For the first time in several weeks (months?) we enjoyed a day of heat and sunshine.  Fortunately, much of the day was spent on or in water: beginning, first with an early morning raft ride down the scenic Sabie river.  Beware of hippos and crocs!  After the big buildup, we only saw a solitary crocodile resting along the bank.    We then drove 40 Km, past the town of Sabie, for a short walk in the midday heat at Mac Mac pools, as highlighted in the Lonely Planet guide.    During the walk, we spotted some suggestive animal tracks that are presented here for possible identification.  The payoff for enduring such a vicious (albeit brief) walk was a plunge in the Mac Mac pool.  Shockingly not everyone participated, even though Lyn assured us there was no Schistosomiasis/ Bilharazia in the water.

After another long drive thru small towns and down dirt roads we arrived at Elephant Plains, an all inclusive luxurious game lodge overlooking a watering hole in Sabie Sands Private game reserve.   It was amazing and wonderful to be so close to these magnificent animals!  We went on 2  three hour game drives per day, at 5:30 am and 4pm and saw 4 of the big 5, all except the cheetah.  During the day we lounged by the pool watching and hearing animals and birds all around. 

The animals are accustomed to the Safari Jeep and allowed us to approach very near to them, almost within touching distance!  The young elephant in the photo had to come check us out, but backed away after a warning from the mother elephant.  It is rather scary to be in an open vehicle sitting next to a pride of lions.  One could have easily had us for a snack.    

Housing Update
We have moved out of the rundown dilapidated Hospital housing, would not recommend to anyone.  Brandon and I will be staying in the Eshowe Louries B&B run by our recently acquired friend Elsa.  She has several rooms in her house that she rents to short and long term guests.  There are many benifits to staying with Elsa, primarily she will be home at night to look after Brandon when I am on call in the hospital.  All meals and cleaning are included so I will be free in the evening to hang out with Brandon.  He is excited that the other boarder, Carl has a huge flat screen TV and an XBOX 360.   Mike will be home in the states planning our next great adventure in the Fall (or Spring), depending on where you live in the world!

Report From the Wards

It has been a long time since we posted our first blog from South Africa and much has happened since then. 

 First off, internet is very different, not readily available and expensive.  Wi - fi and Broadband are extremely limited/ unavailable even in bigger cities.   Internet access is obtained by connecting our laptop via a USB modem purchased from the cell phone company.  We buy a set amount of GB and when it runs out we no longer have internet access.  The first modem we purchased was a 75 MB and it ran out in about 45 minutes.  We have since purchased a 2GB modem and have avoided sites that use a lot of band width such as travel sights and face book.   My most prized possession is my iPhone.

 Hospital Stuff

As you know when I first arrived in South Africa I did a crash course in Obstetrics at a big Maternity Hospital in Empangeni, about 45 minutes North of Eshowe.  I primarily did c- sections and ward rounds as orientation to the hospital system.  I started work at Eshowe Hospital in July and worked less than 2 week before I was informed that my registration was incomplete and I should not work.  Days later the South African Health Counsel (HPCSA) went on strike and I waited for 3 weeks until the strike was over to finalize my paperwork.  By that time my shaky confidence in surgical obstetrics had waned.   I have now been back to work for an eventful 2 weeks and have had no terrible mishaps.  Will need to spend a lot more time working to really feel  comfortable in my “new profession”. 

I am in the Obstetrics and Gynecology department with three other doctors; two are community service doctors who have completed 1 year of internship, the other is a Congolese doctor who is a medical officer which means he’s had no specialty training.  I spend most days in clinic where I see patients for prenatal care and all problems female.  The only medical records are kept by the patients and they are very good about bringing them for their appointments.     We all take turns rounding on the wards (antenatal, postnatal and labor) and being on call for labor ward, emergencies and elective c-sections.

The concept of – See one, Do one, Teach one is definitely in effect here!!  Last week I examined a 40 yo HIV positive woman who presented in labor.  On exam  I found the baby was breech ( the head is up instead of down in the pelvis) and had a cord presentation (the umbilical cord was at the opening of the uterus which can then come out first and the baby will no longer have a blood supply).  I took her to the operating room for a c-section and both mom and baby are well.  Hypertension in pregnancy, pre-eclampsia, and eclampsia are very common in South Africa and often require c-section.  I also do D&C for pregnancy loss.  This week, I had a patient who came in 4 days after delivering a dead baby at home with sepsis and endometritis.  She is also doing well after D&C and antibiotics.

Vaginal deliveries are done by mid-wives; the doctor is only called if there is a problem.   Women are given no pain medications, all first time moms get a lateral episiotomy which is sutured with not very much local anesthetic.  I’ve seen nurses smack patients when they don’t follow instructions and push down on the abdomen if the mom is having a hard time pushing the baby out.   I can’t refrain from telling the nurses to stop!   

Fortunately for me, Eshowe hospital has had NO maternal deaths this year and the c-section rate is hovering around 20%.  GREAT statistics for this country.  The Maternity hospital in Empangeni, which gets all the very high risk patients,  has 2-3 maternal deaths a week, primarily from non pregnancy related medical causes and a c-section rate of about 50-60%.  HIV is the leading cause of death in this country!! 

I think it is odd and certainly not the US model of medicine that patients are cared for by doctors with so little experience in the specialty.  If a patient  doesn’t follow the usual course of a pregnancy or an illness there are few doctors or hospital facilities in this country up for the challenge and the outcome is often bad.  I’ve learned that the model of medicine in South Africa is that all doctors learn the basics of the core specialties – Medicine, Surgery, Obstetrics, Pediatrics and Anesthesia.  They are able to care for the majority of patients that present and some patients (a much higher proportion than in the US) die of preventable illness due to the country wide lack of a higher level of care.  The US has the opposite problem -- many specialists and super specialists and not enough primary care providers.  This is how I get to do Obstetrics without formal specialty training, as a c-section is considered a basic skill that interns master along with pediatrics, spinal and general anesthesia and basic surgery.  After working with an Ob in Seattle, I’ve done more vaginal deliveries and scrubbed into more c-sections than the community service doctor who is doing obstetrics with me.  I on the other hand don’t even have the basics of anesthesia, peds or surgery.   There is much to learn if I am going to fit in with the African model of medicine.   

 

Housing

Short synopsis is our housing situation is not good and we will be much happier when we find another place to live.  Not so easy in a small town with very few rentals and no furnished housing.  Rentals do not even come with a stove or a refrigerator.  We may move to Mtzuni, a small town nearby with more options and a beautiful beach and nature reserve.  It will be a much nice place to host guests. Will keep you posted.

Strikes

I have heard about the strikes in South Africa.  Last year the nursing staff went on strike and there was no one left to take care of the patients in the hospitals or clinics.  The HPCSA went on strike last month delaying my registration.  This past week the municipal workers went on strike, vandalized the water pipes so the town including the hospital had NO hot water and very low cold water pressure, enough to drink but not enough to flush the toilet.  They also dumped garbage all over the main street of the town.  Apparently this is strike season.  It seems fairly usual for the government to offer a 6-8% raise when the workers are asking for 18-20% and havoc ensues until the median is reached.    

Getting Sorted in South Africa

We are still in the process of settling into our new home, our new country, but at least a semblance of routine is in sight.  Brandon began 7^th grade, midstream, this week at the Convent school, and so far loves his new school.  Being a foreigner, he is the center of interest to all his classmates.  Furthermore, there is a heavy emphasis on sports, in which the kids get to run around barefoot, which plays to his interest and makes his parents very happy.

After commencing work immediately upon arrival, Lyn has been on sabbatical from Eshowe Hospital the past ten days until her credentialing status is finalized (the irony is that the bureaucratic screw up occurred on the US side of the transaction).  This should be completed any day, but is now being delayed by a strike in South Africa.   Lyn is VERY eager to work.  And maybe get a paycheck.

This unexpected cessation in work has given us the opportunity to tackle other essential activities (opening a bank account, purchasing a car, securing health insurance) which takes a great deal of time, energy, and patience here --won’t bore you with the details, suffice it to say that we have heard the phrase, “Well this is Africa”, used many times in the past two weeks.  It has also provided an opportunity to explore the region.  Eshowe itself is a fairly small town, though it appears loaded with children, based on the number of schools, and funeral parlors.  The hospital, school and markets are all within walking distance (as is just about everything in town) which makes it a nice change from our life in Seattle, where just about every activity necessitated a drive. 

Fortunately, Eshowe is not very far from more interesting places.  We have already taken three trips to Durban, which is a modern city equipped with all the stores, services and conveniences you would find in any large city in the US or Europe.  It also has a fantastic long stretch of beach with great surfing waves.  Both Brandon and Mike are eager to learn how to surf, while Lyn is more focused on the sharks that reside in the water.   While in Durban, we have made many trips to Gateway mall which is billed as the largest mall in the Southern Hemisphere.    It is staggering in size, shops and the number of people walking about and contains a massive rock climbing wall and wave surfing pool, which is a favorite of Brandon’s. 

We have also made a couple of forays to nearby game parks.  Hluhluwe-Umfolozi is about 90 minutes from our house (if you don’t get lost) and is an amazing place to visit.  On Tuesday, while Brandon was at school, we snuck up for a visit and were rewarded with some amazing sights:   a herd of about 20 elephants crossing the road in front of us and disappearing into the bush; an adult and child rhino eating grass and eyeing us with cautious, timid expressions as if we might charge them (JFC, the adult was HUGE!).  We have also seen giraffe, wildebeests, warthogs, zebras, an assortment of deer and Impalas, and monkeys (mostly in town, as well as in our backyard hanging out in the avocado trees).  No lions or cheetahs as yet.

Why the move

I have had my heart set on working in a developing country since well before medical school.  That dream sat on the back burner for many reasons, until about two years ago when I met a wonderful retired couple at Northwest Hospital who were applying for the Peace Corps.  That encounter rekindled my interest in looking for an opportunity to work in a developing country.   Brandon was in middle school and Mike was unhappy with his job.  It was about time to pursue the direction I had intended for myself.   Serendipitously, a nurse I work with directed  me to PATH, a local nonprofit organization.  PATH works to "create sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health".  Although they did not have a job for me, they introduced me to Therese Hanson who works with Africa Health Placement.  She has been invaluable in helping me find a job in Eshowe, South Africa.  Great web site if you are interested in learning more - http://www.ahp.org.za/. 

Now the day has come!  I have wrapped up my job, my home and my life in Seattle, and am leaving for South Africa June 14, 2011.  Mike and Brandon will join me July 1st.  (Just in time for our 1 year wedding anniversary July 2nd).