| Tom and I had an amazing two week holiday touring the coast-- from the Western Cape to KwaZulu-Natal to the Wild Coast with many stops in between. When Tom gets caught up at work (and episodes of 24)- he'll upload pictures from our trip thus far. As it always does, vacation has now ended and Tom had to return to work and Caelin this past Sunday. I'm slowly adapting to the next leg of my journey here and learning the ropes of this small orthopaedic hospital in rural South Africa.
Mthatha (Umtata) is the main city in the Transkei region and is located in the heart of “the wild coast” of South Africa. Throughout our trip, when we told locals where our final destination and my home for 5 weeks would be, we got confused stares, asked if we had been there before (with raised eyebrows), and warnings about how “different” it would be. In contrast, Nelson Mandela grew up 30 km from here in a town named Qunu and speaks about the rural beauty of this area, the rolling hills with small scattered villages and dramatic beaches. To give a bit of history, during the apartheid in an effort to further separation, the Transkei was declared a “homeland” with its own gov't and Umtata as the capital. However, there was no real infrastructure, industry, or way for the blacks to be a self-sufficient and self-sustaining gov't. At that time, it was known to be the most populated and poorest region in all of Africa. Today, it is like a 3rd world country existing within a developing one.
Tom and I flew into Durban and drove south to the wild coast. We saw a “welcome to the Wild Coast sign” and just beyond it, a roadblock with three men with machine guns flagging down cars. For reasons unknown to us, we were ushered through and over the next 20 kilometers, hit a few large potholes and dodged people, goats, and cows walking along the highway-- all further confirming we had indeed reached the Wild Coast of South Africa. The landscape was as described by Mandela; amazing rolling hills, deep valleys, thick green indigenous forests, all scattered with small huts. The rural people grow mostly corn, pumpkin and squash and have cows and goats—relying nearly entirely on the land. Tom and I stayed two nights in Mboyti, a resort within a small Pondo village without electricity or running water. The locals were amazing, welcoming us into their village and sharing their history and customs with us. We met a young boy on the beach who was wearing a brighly colored spiderman shirt. He was following us around, chatting in both English and Xhosa. We told him we were from America-- where spiderman is also from. He had not heard of the States and was unsure where the Pacific Ocean was located. However, he did say he believed we come from “that place” (where spiderman is from) since we “talk so funny and are hard to understand”.
Chris McConnachie, his wife Jennie, and their family moved to Umtata 22 years ago to provide much needed medical care for the people of the Transkei region. Dr. McConnachie is the director of the orthopaedic hospital and Jennie founded Itipini Community Project; a primary care clinic at a squatters camp built on a municipal dump outside the city. Trying to put into words what these amazing individuals have done is impossible. It is truly inspiring to be a part of the positive impact in this area and see the legacy they have created. Dr. McConnachie was initially the only orthopaedic physician for the 2 million people in the Transkei. You can imagine the impact he had treating club foot deformities, tuberculosis of the spine, ricket's deformities, and numerous fractures from trauma. Unfortunately, Dr. McConnachie was diagnosed with cancer just before I arrived and he and his family are in Durban. All are unsure of the near future-- but many are pulling together to see that these facilities continue to be here to serve this community.
The locals here are Xhosa and most speak their native language (an African “click” language which I suck at). The nurses (“sisters”) translate for us as most are from this region. However, the doctors and other volunteers come from all over the world-- making dinner conversations fascinating and OR conversations under a mask difficult to understand! There is a men's, women's, children's, and spinal team. I'm currently on the woman's team with attendings from Cuba, Italy, and a local physician. I'm living at a house on the hospital grounds with a physical therapist from Germany and another volunteer from NC—both who have been here for years and have been wonderful showing me the ropes, where to grab good grub and cold beer. My experience in one week has been incredible. Nothing arrives to the emergency room acutely...a shoulder dislocated a week ago, leg broken three days ago, gunshot wound from last week...this is more the norm. Sadly, Tb and HIV are too common and patients have complications of these diseases that I have only read about at this point in my short medical career.
I had my first call night tonight starting at 1600. At about 1605 I got my first call to the ED. A 33 year old in a MVC this morning with a pelvic fracture and neck strain...fairly typical story. As I was sitting there writing my admission note, an astute physical therapist came to let me know one of the kids in the high-care ward wasn't looking very good. I and my neighbor, a nurse practicioner from San Fransisco arrived to find this poor four year old girl who had surgery for Tb of the spine two days ago, in severe respiratory distress and starting to decompensate. We had no xray machine, no intubation equiptment, no ability to do more than take vitals and do a good physical exam. We quickly found her chest tube not functioning properly. By then, the sisters had found her xrays from this morning and yesterday, both showing increasing tracheal deviation from a hemothorax (blood had filled the chest cavity). We were able to straighten the tube and aprox 500cc of fluid came out of her little chest, but she was still unstable. David Olorutoba is the current acting director, an attending from Nigeria who is a gifted orthopod as well as anesthesiologist and medicine doc when needed. He immediately came from home to help us. He had keys to get us into the OR to find one of the few chest tubes kept here for emergencies such as this. With some serious improvising for tools, we were able to place another chest tube and the child is doing well. Adventures in understaffed underresourced medicine.
On a regular day, I'm in the clinic one day a week and the OR (“theater”) four days a week helping with some awesome procedures with very limited equipment. I'm also going to start seeing patients at Itipini when they are understaffed. We ran out of casting material and surgical drapes yesterday and the anesthesiologists were missing today. I'm told it's not uncommon to loose the power or water supply. Fortunately, the attendings are both great trouble-shooters and great teachers. The water here is brown, I have more bug bites than I can count, and I'm really starting to love it.
Thank you for all the emails as they've helped with the homesickness. I'm heading to Hogsback (the mountains) this weekend for some hiking with some of the other volunteers but hoping to be back online most weeknights while here. I'm hoping this finds you all enjoying time with family and friends. Best wishes to you all.
Love and Peace,
giana |
Tonight, Tom and I leave for South Africa. We'll arrive in Cape Town Saturday afternoon and are meeting up with Becky & Mark (newlyweds from my class who are doing dermatology rotations there). We're planning on exploring Robben Island, the Table Mountains, and of course--the wine region! 
April 2nd we're staying at the Addo Elephant Natl Park--- this is where we're staying in a treehouse. Think Swiss Family Davidson. On April 4 we're flying from Port Elizabeth to Durban and playing on the "wild coast" for the next week. On April 8th, Tom is driving me to Mthatha (Umtata) to Bedford Orthopaedic Hospital where I'll be staying until May 14th. 
Hope this finds you all well. 