So we figured out what the constant smell of burning things is…. It’s creosote. They are burning huge, vast quantities of creosote. Massive, black clouds rising up towards the heavens of noxious, hazardous creosote. Large oil drums burning…not with oil, but with a chemical now deemed to be toxic waste by Environment Canada. Why? …. Well, that’s anyone’s guess. Tragically, I think that because it is winter here, they are trying to stay warm ( even though it’s 23degrees here).
According to Wikipedia :
“Brief direct contact with large amounts of coal tar creosote may result in a rash or severe irritation of the skin, chemical burns of the surfaces of the eyes, convulsions and mental confusion, kidney or liver problems, unconsciousness, and even death. Longer direct skin contact with low levels of creosote mixtures or their vapors can result in increased light sensitivity, damage to the cornea, and skin damage. Longer exposure to creosote vapors can cause irritation of the respiratory tract.”
“Studies in animals have shown birth defects in the young of mothers exposed to high levels of creosote during pregnancy, but no similar studies have been performed on humans. Some animal studies indicate that creosotes may cross the placenta and reach the fetus. Because chemical components (PAHs, cresol, phenols) of coal tar creosote may be stored in body fat, they may be found in breast milk and could pass to nursing infants.”
So you will have to forgive us upon our return to Canada, should we be having persistent coughing fits, difficulty walking up stairs or spontaneous kidney failure. Or perhaps we will have some kind of unreported addiction to creosote fumes…
I think a chest x-ray may be in order upon our return.
We have been busy getting ready to wrap things up here. Our last visit to the New Hope Orphanage was a few days ago, and the place was inundated with foreigners all clambering to help. There were 45 visitors at the centre that day… more than the total number of orphans there (32).
However, I have found a group that is in more dire straights, and I think the money donated would be put to better use.
www.moya.co.sz
this is a group that does community work assisting orphaned children who are either in child-run homes or homes run by elderly relative ( read: soon to be child-run homes) with a more integrated approach, and – quite frankly – they seem to be in much greater need.
I will be transferring the funds from Canada – as it would involve passwords liked to my personal bank account and I do not trust the networks here ( Big Brother is always watching here)
Our eminent departure is tomorrow. Swaziland has been both wonderful and heart-breaking, eye-opening and terrifying… I can’t wait to get out of here, and I’m already thinking of our next trip back. Swaziland seems to induce this bipolar-nature in most foreigners that visit – the desire to leave and the drive to return. I have commented extensively on the medical system here and on the hospital itself, but perhaps I have not gone to great lengths to mention the people of Swaziland. They are caring, genuine, and wonderfully giving. They have made cakes for the 2 people in our group who had birthdays here. We have been invited over to their houses, and tonight we have been invited to a graduation celebration for the student nurses. And they have the most wonderful names : Fortunate, Precious, Joyful, Gladness, Lucky – original yet memorable. These are just some of the reasons why it is so heartbreaking to know that so many Swazis are HIV positive – such a wonderful culture filled with such good people, torn asunder and decimated by a plague.
We are off to take a few more deep breaths of creosote fumes before we leave – hopefully we can ingest enough to ward off any type of withdrawal symptoms for the next few days, and I’ve heard that ingested-creosote keeps ones hair nice and shiny!( I’ve heard it keeps EVERYTHING it comes in contact with nice and shiny… for decades !!)
Cheers
Us
Thursday, June 28, 2007
Sunday, June 24, 2007
Friday, June 22, 2007
1 week left in Swaziland
Only 1 week left in Swaziland. To say the time has flown by is a true understatement. No only do I not know where the time has gone, I’m not sure what I’ve done in that time.
I just found out yesterday, there are 3 CT scanners in all of Swaziland ( pop. 1.1million)... two of the 3 are in private clinics, but they're both broken... the third is at the Mbabane Central Hospital ( in the capital city), but they don't have the money to pay the x-ray guy to operate it, so it just sits idle...
Oh, and the x-ray unit at Mbabane is now broken ( 1 x-ray unit in the capital city hospital? ) so they are sending all of their x-ray requests to the hospital we are at, which is only an hour and a half away...
One of my patients made the front cover of the local newspaper. “Woman Bitten By Rabid Pig”. And yes, she was really bitten by a rabid pig. There is a serious outbreak of rabies in the cities right now, with quite a lot of people brought into E.R. with dog bites. But the “Rabid Pig Woman” takes the cake, by far. I’ve kept the newspaper article, because it is so outrageous, it’s worth reading again and again.
While I was purchasing the local rag for rabid-pig woman’s story (the Swazi Times is akin to a hybrid between the Vancouver Province and the National Enquirer… they purport it to be news, but how fact-laden is a story about a priest who prays for dead people and brings them back to life – something tells me the reports are not checking the facts quite as much as they should.)
Anyway, one of the other ‘semi-reputable’ papers featured a story about research recently carried out by the Swaziland government. Their new projections for life expectancy will drop to 30years old by 2010 – the vast majority of those dying being between the ages of 19-45 (the entire working populous)
Current forecasts are an estimated 110,000 orphans by 2015.
That’s 10% of the entire population of Swaziland.
On a brighter note, we were at an in-service on Friday, and changes are being made to the approach to counseling and testing of HIV ( aka. “The Virus”). Currently, all testing is done at a VCT ( voluntary counseling / testing ) centre. This seriously limits the number of people who can access the testing services, as the centres are primarily in large cities. The proposed changes will have many more testing centres throughout the country. The current set-up also means that people with opportunistic infections ( ie: TB or Kaposi’s Sarcoma) will come to the doctor / hospital with their complains, and when the physicians asks if they know their status, they indicate that they do not know whether or not they have HIV, nor do they wish to be tested – meaning the root cause of their ailments goes untreated, leaving the physicians to deal with the infections without treating the cause. The amendments will also mean that physicians can order an HIV test without the pre-counseling ( but still with consent), and counseling will follow only in the event of a positive result.
This will hopefully result in more people knowing their status.
Currently, only 18% of Swazi’s know their HIV status…. 82% have no idea if they’re carriers or not. Ironically, I was in the ART ( antiretroviral) clinic yesterday, and there was not a since patient all morning. Apparently, the CD4 count machine at RFM hospital is broken. This is the machine that tests for the viral-load in the blood. I was told it will be up and running by early next week… I’m keeping my fingers crossed.
And since it is winter here, the number of burn victims has increases substantially. Some are drunk and roll into the fire, others are very young and left at home by themselves…. The only reason I mention this is I was in surgery today helping with the debridement of a 6 years old girl’s severe burn. She has no parents and lives with her older brother, who was not home at the time. I will not elaborate any more, but writing about what I saw helps me deal with what I saw ( think of it as digital grief counseling )
One of our crew ( Dr. Karen from California ) went home yesterday to start her surgery residency in Cali.
The rest of us plod along, bouncing back and forth between Emergency, the O.R. theater, and the outpatients departments.
This weekend will involve the last major big-game park in Swaziland.
Next week is our final week here – then we will go our separate ways for a few weeks before heading back to Canada. Andrea is of to Tanzania to do a tour of one of the major parks in Africa. Ryan is heading back to South Africa to spend some time with family there. Jenn and I will be driving down the east coast to the tip of Africa, and flying out of Cape Town.
I’ve still got 3hr and 32 min of time here at the internet café – so I will try and update once more before we leave ( no promises )
Cheers
Andrea, Ryan, Jenn and Chris
I just found out yesterday, there are 3 CT scanners in all of Swaziland ( pop. 1.1million)... two of the 3 are in private clinics, but they're both broken... the third is at the Mbabane Central Hospital ( in the capital city), but they don't have the money to pay the x-ray guy to operate it, so it just sits idle...
Oh, and the x-ray unit at Mbabane is now broken ( 1 x-ray unit in the capital city hospital? ) so they are sending all of their x-ray requests to the hospital we are at, which is only an hour and a half away...
One of my patients made the front cover of the local newspaper. “Woman Bitten By Rabid Pig”. And yes, she was really bitten by a rabid pig. There is a serious outbreak of rabies in the cities right now, with quite a lot of people brought into E.R. with dog bites. But the “Rabid Pig Woman” takes the cake, by far. I’ve kept the newspaper article, because it is so outrageous, it’s worth reading again and again.
While I was purchasing the local rag for rabid-pig woman’s story (the Swazi Times is akin to a hybrid between the Vancouver Province and the National Enquirer… they purport it to be news, but how fact-laden is a story about a priest who prays for dead people and brings them back to life – something tells me the reports are not checking the facts quite as much as they should.)
Anyway, one of the other ‘semi-reputable’ papers featured a story about research recently carried out by the Swaziland government. Their new projections for life expectancy will drop to 30years old by 2010 – the vast majority of those dying being between the ages of 19-45 (the entire working populous)
Current forecasts are an estimated 110,000 orphans by 2015.
That’s 10% of the entire population of Swaziland.
On a brighter note, we were at an in-service on Friday, and changes are being made to the approach to counseling and testing of HIV ( aka. “The Virus”). Currently, all testing is done at a VCT ( voluntary counseling / testing ) centre. This seriously limits the number of people who can access the testing services, as the centres are primarily in large cities. The proposed changes will have many more testing centres throughout the country. The current set-up also means that people with opportunistic infections ( ie: TB or Kaposi’s Sarcoma) will come to the doctor / hospital with their complains, and when the physicians asks if they know their status, they indicate that they do not know whether or not they have HIV, nor do they wish to be tested – meaning the root cause of their ailments goes untreated, leaving the physicians to deal with the infections without treating the cause. The amendments will also mean that physicians can order an HIV test without the pre-counseling ( but still with consent), and counseling will follow only in the event of a positive result.
This will hopefully result in more people knowing their status.
Currently, only 18% of Swazi’s know their HIV status…. 82% have no idea if they’re carriers or not. Ironically, I was in the ART ( antiretroviral) clinic yesterday, and there was not a since patient all morning. Apparently, the CD4 count machine at RFM hospital is broken. This is the machine that tests for the viral-load in the blood. I was told it will be up and running by early next week… I’m keeping my fingers crossed.
And since it is winter here, the number of burn victims has increases substantially. Some are drunk and roll into the fire, others are very young and left at home by themselves…. The only reason I mention this is I was in surgery today helping with the debridement of a 6 years old girl’s severe burn. She has no parents and lives with her older brother, who was not home at the time. I will not elaborate any more, but writing about what I saw helps me deal with what I saw ( think of it as digital grief counseling )
One of our crew ( Dr. Karen from California ) went home yesterday to start her surgery residency in Cali.
The rest of us plod along, bouncing back and forth between Emergency, the O.R. theater, and the outpatients departments.
This weekend will involve the last major big-game park in Swaziland.
Next week is our final week here – then we will go our separate ways for a few weeks before heading back to Canada. Andrea is of to Tanzania to do a tour of one of the major parks in Africa. Ryan is heading back to South Africa to spend some time with family there. Jenn and I will be driving down the east coast to the tip of Africa, and flying out of Cape Town.
I’ve still got 3hr and 32 min of time here at the internet café – so I will try and update once more before we leave ( no promises )
Cheers
Andrea, Ryan, Jenn and Chris
Sunday, June 17, 2007
Vacation in St. Lucia
hello world
we have decided to take a few days off from the trauma centre, and we are currently in St. Luica, South Africa. A beautiful, safe town on the east coast of South Africa. The water is ~23 degrees, and the entire town is populated by vervit monkies. We have done a snorkeling day at Cape Vital ( about 40 min north of St. Lucia ), which is located inside the Cape Vital Game Reserve.
The St. Lucia wetlands is a UNESCO world herratige site, because it encompases 5 distinct ecosystems located within 230,000 hectares. The town is situated next to the largest estuary system in Africa, where the inidian ocean feeds miles of wetlands. The wetlands are populated by aligators and hippos, which one can view simply whilst sitting at a water-side pub drinking cheap beer and writing post-cards. We have done a Hippo tour ( on a boat up the estuary ), and i now understand why the hippo is the most dangerous animal in Africa ( more people are killed by hippos than any other animal in africa) - the tour guide was telling us of hippos protecting their young against crocodiles, and actually killing the crocs. They then passed around a hippo-tooth, which was about 2 feet long and weighed no less than 15lbs.... 1 Tooth !! the largest tooth size for a hippo was measured to be just over 1 metre long. And apparently, they're fast ... real fast.
Alas... no elephants bathing in the estuary.
We are resting and recharging at the worlds most beautiful B&B, and the food here is outstanding. It is literally a mansion, and we have the entire place to ourselves. A very startk contrast to the single hard boiled egg and single slice of bread allote us at RFM Hospital.
This morning we all awoke at ~5:30am and went down to the beach to enjoy a sun rise over the Indian Ocean. It was yet another one of those sureal expereinces. The orb of the sun was a fuschia / fire-engine red with a halo of bright oranage. Our picutres will do it no justice.
There are many, many different types of birds here, sending Andrea into a bird-watching frenzy. If you have never seen someone is an ornithology-induced-craze, it is a sight to behold. She wanted me to mention that we saw a Turaco ( ? Livingston's Turaco? ), and you must all now wikipedia this bird. I am writing this blog whilst sitting at the breakfast table (they have semi-high speed interent here) and we are watching monkies and horn-bill birds in the palm trees.
i have made efforts to upload images here, but it appears Africa is not That advanced yet...
we return to the Swaziand tomorrow.
HAPPY FATHER'S DAY to all Dads everywhere.
i'm going for more REAL coffee now.... ( not the powdered rubbish that i have become accustomed to )
cheers
Jenn, Andrea, Ryan, Marianne, Linda and Chris
we have decided to take a few days off from the trauma centre, and we are currently in St. Luica, South Africa. A beautiful, safe town on the east coast of South Africa. The water is ~23 degrees, and the entire town is populated by vervit monkies. We have done a snorkeling day at Cape Vital ( about 40 min north of St. Lucia ), which is located inside the Cape Vital Game Reserve.
The St. Lucia wetlands is a UNESCO world herratige site, because it encompases 5 distinct ecosystems located within 230,000 hectares. The town is situated next to the largest estuary system in Africa, where the inidian ocean feeds miles of wetlands. The wetlands are populated by aligators and hippos, which one can view simply whilst sitting at a water-side pub drinking cheap beer and writing post-cards. We have done a Hippo tour ( on a boat up the estuary ), and i now understand why the hippo is the most dangerous animal in Africa ( more people are killed by hippos than any other animal in africa) - the tour guide was telling us of hippos protecting their young against crocodiles, and actually killing the crocs. They then passed around a hippo-tooth, which was about 2 feet long and weighed no less than 15lbs.... 1 Tooth !! the largest tooth size for a hippo was measured to be just over 1 metre long. And apparently, they're fast ... real fast.
Alas... no elephants bathing in the estuary.
We are resting and recharging at the worlds most beautiful B&B, and the food here is outstanding. It is literally a mansion, and we have the entire place to ourselves. A very startk contrast to the single hard boiled egg and single slice of bread allote us at RFM Hospital.
This morning we all awoke at ~5:30am and went down to the beach to enjoy a sun rise over the Indian Ocean. It was yet another one of those sureal expereinces. The orb of the sun was a fuschia / fire-engine red with a halo of bright oranage. Our picutres will do it no justice.
There are many, many different types of birds here, sending Andrea into a bird-watching frenzy. If you have never seen someone is an ornithology-induced-craze, it is a sight to behold. She wanted me to mention that we saw a Turaco ( ? Livingston's Turaco? ), and you must all now wikipedia this bird. I am writing this blog whilst sitting at the breakfast table (they have semi-high speed interent here) and we are watching monkies and horn-bill birds in the palm trees.
i have made efforts to upload images here, but it appears Africa is not That advanced yet...
we return to the Swaziand tomorrow.
HAPPY FATHER'S DAY to all Dads everywhere.
i'm going for more REAL coffee now.... ( not the powdered rubbish that i have become accustomed to )
cheers
Jenn, Andrea, Ryan, Marianne, Linda and Chris
Tuesday, June 12, 2007
Surgery and Cake
life here is one big, continuous surreal experience
we observed the surgery of a boy with severe paraphimosis ( near gangrenous )
( if you don't know what is is, google it.... NOTE: you will never, ever get this word in Pictionary )
then... we had some birthday cake...
yesterday was Marieann's ( now correctly spelled) birthday. there is no Siswati version of the song "happy birthday to you", so i can not regale you with wonderful stories of learning to sing happy birthday in a foreign language.
I inserted a foley catheter yesterday. And today, inserted a pleural drain tube into a patient with ARVD and TB... in fact, everyone in the room had ARVD ( read: HIV ) and TB. Yesterday, the autoclave broke down ( the device that sterilizes the surgical equipment and scrubs for the operating theater), ... and today, there was no water.
Sunday involved the Swaziland cultural village, that had a small traditional story session incorporated with dance.It was painfully obvious how sick one of the dancers was, and it appeared that she had TB as she kept suppressing coughs throughout the show. Then, we had a picnic by a waterfall.
It was so wonderful to see some traditional Swazi culture, and yet so tragic to realize that the culture is being wiped out indiscriminately, with little hope of salvage in the near future.
we are taking a long weekend and driving down to St. Lucia in South Africa. This is the resort area that is famous for its snorkeling and diving. It will merely add to the daily contrast of excess and poverty that surrounds us.
i still haven't figured out if we are saving anyone, or simply being TB-Tourists in a 3rd world country...
i'll let you know as soon as i've figured it out
we observed the surgery of a boy with severe paraphimosis ( near gangrenous )
( if you don't know what is is, google it.... NOTE: you will never, ever get this word in Pictionary )
then... we had some birthday cake...
yesterday was Marieann's ( now correctly spelled) birthday. there is no Siswati version of the song "happy birthday to you", so i can not regale you with wonderful stories of learning to sing happy birthday in a foreign language.
I inserted a foley catheter yesterday. And today, inserted a pleural drain tube into a patient with ARVD and TB... in fact, everyone in the room had ARVD ( read: HIV ) and TB. Yesterday, the autoclave broke down ( the device that sterilizes the surgical equipment and scrubs for the operating theater), ... and today, there was no water.
Sunday involved the Swaziland cultural village, that had a small traditional story session incorporated with dance.It was painfully obvious how sick one of the dancers was, and it appeared that she had TB as she kept suppressing coughs throughout the show. Then, we had a picnic by a waterfall.
It was so wonderful to see some traditional Swazi culture, and yet so tragic to realize that the culture is being wiped out indiscriminately, with little hope of salvage in the near future.
we are taking a long weekend and driving down to St. Lucia in South Africa. This is the resort area that is famous for its snorkeling and diving. It will merely add to the daily contrast of excess and poverty that surrounds us.
i still haven't figured out if we are saving anyone, or simply being TB-Tourists in a 3rd world country...
i'll let you know as soon as i've figured it out
Thursday, June 7, 2007
It's Not Called AIDS Here
The previous post was kind of rushed at the end. I was attempting to write the challenging part of our trip – and then contrast it with the great parts of our trip so far. Alas – as the evening approached, I had to sign off rather quickly.
Unfortunately, we are not able to walk around the town after dark. The area that the hospital is located ( hence, the area we are living in ) is considered “not safe” after dark. So we must be in the compound, finding various ways to amuse ourselves.
The endurance of the people here continue to astound me. People walking on broken bones. Small incisions with no local anaesthesia. Ryan and I were trying to figure out if the pain threshold of the Swazi people is actually higher than that of a north American.
We are sharing a flat at the hospital with 3 others. Dr. Karen from
The twins that were delivered by c-section the other day are in the maternity ward. Mary-Ann was in the ward, and went over to say hello to the woman and her new twin girls. The Swazi woman is HIV positive. The Swazi woman asked Mary-Ann if she wanted to name the two girls, which she humbly did. The Swazi woman then asked Mary-Ann if she wanted one of the twins. To take home.
What level of destitution must exist for a new mother to offer up one of her new born girls?
There is a clinic adjacent to the main hospital for VCT ( Voluntary Counselling and Testing … of HIV ) and an ARV clinic ( AntiRetroViral ). The stigma of AIDS is so great here that the term AIDS is not acceptable. Instead of AIDS, a person has ARVD (AntiRetroViral Disease). Testing is not mandatory, and most people do not want to be tested. It is easier to live without the knowledge than it is to face the stigma of being HIV positive. Fortunately, for those who are tested and found to be positive within the city, there is a network of help available. For those out in the rural communities, it is not so easy.
Our group was scheduled to go to a rural community clinic this morning. A small community about 1 hr from the hospital. We were literally climbing into the van when we were informed that the trip was cancelled as there was no doctor to accompany the team there. This means that the people who were expecting a mobile medical team to come to their community today will have to wait another month before a trip is made to their clinic.
Jenn and Andrea learned to suture with dental floss this morning.
Ryan is doing history taking and diagnosis in medical outpatients already.
And I am helping the surgical team with imaging. An inpatient from an MVA with a head injury was complaining of abdominal pain – so I suggested he get an ultrasound ( I’d suggest a CT… but that ain’t gonna happen here). His belly was full of fluid and his spleen was not in good shape. 2 hrs later, the guy is on the surgery table, with what looked live 18 litres of blood sucked out of his belly and a fragmented spleen removed. It was awesome to be able to follow the guy from the ward to imaging to surgery and back to the ward all in a few hours.
Every day here poses new challenges. And we are venting to each other on a daily basis… trying to comprehend what we are seeing and experiencing. How it is that we can see the things we see, and come back to our flat to listen to our mp3 players and drink our purified bottled water knowing that we will eventually get on airplanes and return to our homes where things are clean and efficient and if we are really, truly helping the Swazi people.
I’d like to think we are. And I’d like to think that we can leave just a little bit of knowledge behind that will help others when we’re gone.
Andrea, Ryan, Jenn & Chris
Monday, June 4, 2007
Swailand / RFM
Ok… So… internet is painfully slow.
Where to begin ? Lufthansa was not only nice enough to take our excess baggage, they also bumped us ( yes… all 3 of us ) up to business class for the flight to
The flight from
A small layover in
The entire expedition was almost brought to a grinding halt at
The hospital is shocking.
The hospital has no hot water. No defibrillator. No dialysis machine. Virtually no saline. No CT, No MRI, ultrasound has No Doppler. Everything is broken, and what isn’t broken is filthy. It’s like a bad episode of M.A.S.H. – only in real life. I will send off pictures of the hospital as soon as I can find a place to upload. It is certainly is an awesome challenge. Ironically, we have found the Swazi version of fitness world only 3 blocks away!! And they have Showers ! albeit, Cold Showers ! ( what ? you thought there was hot water at the gym ? )
We just found out today,
We have been to the orphanage. And it’s the type of place that wants to make you rejoice and cry at the same time. The kids are amazing. The sense of community is unbelievable, and they were literally hanging off of us only 5min after meeting us. I would write to share their stories, but if you know me at all, you know I would turn it into a book and then the nice internet people here could retire in the
Sunday involved a big game park. Now, if you’ve never been to a big game park in
Last night – a helped on a leg amputation… I can’t even begin to describe what I saw.
Today was boring.
I only stood in surgery and saw a c-section of undiagnosed twins, a hernia repair, a breast lesion biopsy, a circumcision.
It is getting dark – so I must sign off so we can bail now.
Gotta run
Andrea, Ryan, Chris & Jenn
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