June in South Africa

Life

This month we sadly said goodbye to one of our nurses and to our friend Ross. RIP.

I spent my first weekend of the month in East London, and did Kidd’s Beach Parkrun, followed by a big breakfast, and a lunchtime run to get all the mileage done and allow a relaxed rest of the weekend.

Then it was Comrades weekend, the ‘A’ goal of the year! I have written a separate blog on Comrades, but it was a fab weekend in general. I stayed with Sandra, her boyfriend Mark, and her mum in Pietermaritzburg Friday and Saturday night, with a couple of others joining us Saturday night too. I managed to fit in a parkrun at the awesomely named ‘Piggly Wiggly’, an amazing brunch, a pre race pasta dinner and a ridiculous shopping trip with the aim to find the most disgusting matching outfits to wear post race. Post race on Sunday, we stayed in Durban, we were all shattered and our appetites were failing us. Sandra stayed in the hotel for a soak in the bath and an early night and I went out for dinner with her mum and boyfriend, but couldn’t manage much of what I’d ordered at all. We made up for it Monday with a big breakfast followed by a bakery run to get plenty of goodies for the drive home.

On Friday, I attended Ross funeral in Mthatha cathedral in the morning, then a group of us had a braai in the evening and stayed over at Emma’s with the dogs. I pottered about in Mthatha Saturday, taking Daniel and Franco for a slow, hungover run, which was Franco’s second 13km and last long run for Knysna half marathon, and Daniel’s longest ever run by 1km, the last one being with me in January! I then met Emma, Sandra and Daniel for lunch and I was on call Sunday.

Tuesday night was our work quarterly doctors’ party, a bit of a last minute one so less meticulously planned, more casual and therefore more enjoyable. I was on call again Wednesday, and had Thursday afternoon off to snooze and finally start packing.

The following weekend I got down to East London and tried the new parkrun which had only been going just over a month. Karen and Dean went out in the evening but I stayed home with the teenagers and had a movie night. Sunday I raced the 8km rhino run and stuck around at the bar afterwards to chat with people from Oxford Striders, whose long runs I’d joined in with on the lead up to Comrades. I had an enforced shot of Jägermeister to celebrate my last run with them, while waiting for the prize giving to claim my trophy for second place. In the afternoon Sandra and Mark came over the Karen and Dean’s for a braai (the cheek of me inviting people to their house now I feel so at home!) and I ended up being convinced to stay over and drive back next day.

Tuesday night I was on call and so Wednesday afternoon I got my hair done with Joelle, before my final John Dory’s sushi wednesday with Emma, Daniel, Franco, and a brief appearance from Anthony. I gave away a pile of textbooks and kitchen/home stuff which felt rather liberating, but I had such a good evening and was so sad to say goodbye. A man at another table even sent us over a round of Jägermeisters, so my second shot of the stuff in a few days and probably my first two in the last decade!

I then had only two days left in work, but they were marred by the return of the clinical manager chairing the Thursday meeting, and then managing to unbelievably get sick with gastro on Thursday night and calling in sick on my last day! I therefore just did a round of farewells on the wards and was handed three bags of gifts by the maternity staff! early Friday allowing me to stop and start on the way to East London, and gave a clinical associate a lift down with me too.

Saturday morning I did my 10th and final parkrun at Sunrise on Sea, followed by breakfast at Murambi Roses cafe, complete with a beautiful cake made by Sandra’s mum. Such a lovely community, and the only parkrun community I’ve ever integrated into and been a part of, chatting at the end of the run each week, going for coffee, making friends (Karen for one!) and meeting the runners from there at parkruns all over the country while I was travelling.

And June was done, over in a whirlwind!

Work

In June, we rotated departments so i was in casualty/outpatients for my last month.

Work was work… the usual inappropriate health seeking behaviour from staff. One night I was on call in casualty but had to sleep at home as there was no bed linen in the on call room and it was freezing. I was woken at 6:30 by someone banging on my door just before my alarm to have breakfast and go back over and check on my patients in the observation bay before morning meeting. It was a staff member I recognised but didn’t really know who he was asking me to give ‘some treatment’ to his girlfriend with stomach pains. I said I would need to assess her and she should check into casualty where I would see her shortly. He asked how long and I said when I’ve eaten breakfast. He was very pushy and I had thought he had knocked on my door because he knew I was on call and the casualty staff had said I was in my house, but in retrospect I realised he was actually just being completely inappropriate, dragging me out of bed so she didn’t have to wait. Anyway, I dressed, ate and went over to casualty about 20 minutes later and she wasn’t even there so I looked around, and about to give up and go to the morning meeting he shouted she was coming now. She wasnt particularly unwell but needed to so a urine sample and pregnancy test and this took her quite some time so I went to the meeting and reviewed her afterwards. Not an emergency at all. Later that day, I had a porter book himself into casualty and skip the queue to consult about a ‘rash’ which was just some spots, not muscular acne or anything severe, literally just a few spots. I said this and that there was no treatment, and then saw him at pharmacy later trying to get something anyway. Then in the afternoon when casualty was busy, I was asked if genital warts needed to be seen in casualty or outpatients. Errrr, outpatients of course! Then later a staff member comes to ask me to please see her family member with ‘discharge’ in casualty ie. skip the outpatients queue. I said no as there were seriously ill patients waiting and it was all getting beyond ridiculous now.

Outpatients was a strain for me. My interpreters were variable and the patients were skewed towards the poor historian end of the spectrum, often answering questions with completely off topic and irrelevant statements and giving chronologically impossible stories. They also like to pile on more and more symptoms as if they think it will make them sound more sick and more likely to be taken seriously. Whereas I always start off taking people seriously, and a cluster of symptoms is more likely to signify a common cold whereas a single symptom of headache and ear pain more likely to be something else. Also “whole body pains”, “waistache”, and “cramps” are common, almost ubiquitous, but for me difficult to fit into a differential diagnosis.

Late coming and absence continued to be an issue. In one meeting on a day we were particularly short staffed, it was noted none of those present were South African, and all those absent were. The CEO and clinical manager were asked to attend the meeting the next day and everyone was summoned, reminding them of the compulsory morning meetings. Attendance the next day was slightly better but I heard someone who had arrived 35 minutes late announcing “I was early this morning”. I also noted that certain people who are always late (if they come at all) and often leave early, yet always write 8-16:30 in the register, will always make sure they write 17:00 or 17:30 if they ever leave late, and will send a whatsapp to the whole team to point out when it’s busy and they’ve left late.

In one meeting, the patients’ written complaints were read out and most stated that doctors come late and leave early. Yup…

Remember I mentioned a sessional doctor who only does on call shifts at the hospital, who is clinically very ropey, tends to make her 16:30-08:00 shift more like 18:00-06:30, and recently I had to do a caesarean 90 mins before my shift started because she had gone already? I text her at the time to point this out and she showed zero insight or remorse. Well, this week I was working in casualty and one day it was very busy. The orthopaedic trained nurse was away so I did all the plastering, as well as two uterine evacuations for retained products of conception. At the end of my shift at 16:30, there were two patients waiting to be seen but I was still on the phone making referrals. I briefly checked the reasons for attendance for the two waiting and their vital signs, then having determined them stable but in need of a full work up, decided to allow the on call doctor to deal with them and instead I went to review and either admit or discharge the patients in the observation bay and also the downreferrals who had returned from the tertiary hospital, completely clearing the observation bay for her. I left at 17:10, 40 mins late and she still hasn’t arrived. At 17:30, I was about to go for food with Ishe when I received a text from an unknown number (new phone) asking why I had left patients unattended to in casualty. I explained the above and that I was still on site if there was an emergency since the on call doctor was late, but decided to go and check what was going on. I then realised it was her that sent the message. She was demanding to know why I hadn’t seen these two patients, citing their arrival times as before the end of my shift and shouting at me in casualty in front of the patients and nurses. No-one stuck up for me and I gestured to the nurse to corroborate, explaining I’d been doing procedures, not just left early, and that if anyone was ‘unattended’ it was because she was late. She shouted I should speak to her not anyone else. I held my hands up, recognising you can’t reason with unreasonable people and told her if she’s not happy to take it up with the boss because everyone knows what she’s like and what I’m like. Total whackjob (to be polite). I’m not comfortable with leaving no doctor in casualty, and am used to a formal handover, but it doesn’t happen here and I can’t always come early and stay late to cover for everyone else’s shortcomings.

During my last on call, in the middle of the night, a patient came to maternity, who I assessed and determined needed to be seen at the tertiary hospital as am emergency. The on call doctor there queried the recent management of the patient and I said it was not my management and agreed with him, but I was just seeing the patient for the first time. He proceeded to lecture me on pre-eclampsia (I had that well drilled into me by Dr Newbold years ago and know it well), and even when I kept saying “I know, but…” he continued. I ended up saying something along the lines of “well it’s my last shift here so it won’t change my management or referrals to you anyway” and he said I could take my learning home with me. I said I hoped not and would rather forget the poor practice I’d learned here. It was rude, and of course not all practice is poor, but it’s not meeting the guidelines we follow at home. And come on, a lecture at 2am? When the mistake wasn’t mine and I agreed with him, and he’s not my senior? So patronising.

There were some issues going on with security and friction between them and certain doctors this month. Searches of cars were ramped up on entering and leaving the hospital and one doctor in particular seemed to be targeted. He probably wound them up and vice versa. Anyway, during his on call the night before the party, his house was robbed. His house only, the middle of a terrace of eight, and while he was on call and on site while others were away all week. And his house was in the doctors quarters with metal burglar bars, while mine is outside the security barrier with single glazed doors and windows and no security bars. He was in maternity doing a caesarean with his car parked there and clearly visible by the security stationed at the hospital entrance. Not at all suspicious… and rather unnerving. I was glad to be leaving.

At my penultimate morning meeting, the clinical manager returned from his extended period of sick and unpaid leave and we had a déja vû meeting which was almost identical to the one on my first day back in September. About signing the register and coming on time and where would the register be kept. A year on and still no change. He then talked about the policy of seeing patients in outpatients before going to the wards and started talking about people not adhering to the policy and how a nurse had gone and spoken to the CEO while he was present to ask for a doctor to be released to go to the ward, “not naming names”. I had to interject. He smirked and said “I wasn’t naming names”, and I said he can name me, because in saying that he’s implying guilt, whereas I did the right thing in leaving outpatients to attend *an emergency* on my ward when called and that I’m a trained medical professional and am not going to await permission to do so and allow a patient to die. Apparently I was being ’emotional’. I think perhaps a bit of emotion would allow compassion, clinical consideration and logical reason as opposed to the blanket ‘tackle OPD because it’s the face of the hospital’ just to look good, when by definition inpatients are generally sicker and more clinically in need. What had happened was I was called by my ward sister about a patient struggling to breathe and had gone there, only to be called by outpatients to explain myself as to where I’d dared to go. It’s not like I’m shirking (though plenty are), and I will work hard wherever I’m needed but being constantly pulled in multiple directions and treated like I’m workshy or a child while already covering multiple clinicians ‘off sick’, or on leave, or who ‘have a problem’ is not something I can tolerate.

I felt terrible Thursday night when I woke up ill and realised there was no way I could work in that state, and in fact shouldn’t go in while potentially contagious. But I was worried about what people would think, that it didn’t seem believable or realistic that I was ill on my last day, and I felt guilty. Still, I made the right decision and informed them I couldn’t work. They said they’d planned to give me the day off anyway as a treat. I pulled myself together and got out of bed and went over to say a few farewells and give one of the doctors some clothes, shoes, bags, toiletries and bed linen for her quarterly visit to the local orphanages. It got quite emotional on maternity and they had clubbed together to buy me gifts, as well as three of them buying me individual gifts too! I may have shed a few tears, especially the realisation that certain members of staff actually liked me and had got me a personal gift when I’d thought they weren’t a fan of mine to say the least. Then I went round the wards where I’d worked and up to HR before popping into the tail end of the doctors meeting. Finally time to go! After counting down for the last few weeks like “yey, only x more shifts to go!” it was now “oh no, only x more days before I leave the country!”

I have to say, work wasn’t all bad. I actually enjoyed it clinically, in maternity and on the medical wards. I worked with lovely nurses and made some friends. I was able to be far more hands on than in the UK, doing caesareans, spinal anaesthesia, surgical chest drains, and lots of suturing. We were short of some resources, but I found stock control and monitoring to be more of a problem than actual financial constraints and that was a frustration along with timekeeping and attendance of colleagues. If I could have just done the ‘official’ job of one doctor full time, it would have been a much easier workload than home, but in reality I tended to cover 2 wards most of the time, not uncommonly 3, and one afternoon all 4 wards plus maternity. Burnout is a real issue, and I saw the staffing numbers pretty much double in my first couple of months, only to drop right back down again before I left. That said, in spite of all the frustrations, it’s a year I would recommend people experience.

Training

28th May – 3rd June

Monday: 3×1 mile efforts.

Tuesday: 3.1 miles – short hill reps.

Wednesday: 4.3 miles – long hill reps.

Thursday: REST

Friday: REST

Saturday: Kidd’s Beach parkrun + 1km Cool down then after a leisurely breakfast a tempo 14km as the last long run before Comrades. Kidd’s beach was my favourite South African parkrun so far with a mix of tar road, trail and Sandy beach.

Sunday: REST

Total weekly mileage = 22.5 m / 36.5 km

4-10th June

Monday: REST

Tuesday: REST

Wednesday: 3.1 miles as 1km steady, 1km easy, 1km hard, 2km easy around the hospital.

Thursday: 2 mile easy run and 30 mins yoga.

Friday: REST

Saturday: Piggly Wiggly Parkrun which was actually short at 2.8 miles.

Sunday: COMRADES 56.6 miles.

Total Weekly Mileage = 64.5 miles / 104 kms.

11-17th June

Monday: REST

Tuesday: REST

Wednesday: REST

Thursday: 3.2 miles easy run around the hospital. I had said I was never going to run another mind numbing lap of the hospital perimeter, but I was really craving a run and had laundry to do at the other side of the hospital so why walk if you can run?!

Friday: REST

Saturday: 8 mile easy pace run with Daniel and Franco.

Sunday: REST/ on call

Total Weekly Mileage = 11 miles / 18 kms.

18-24th June

Monday: REST

Tuesday: REST / work party

Wednesday: REST / On call

Thursday: 30 mins yoga

Friday: REST

Saturday: Imonti parkrun in East London – a new course that just started up a few weeks ago. I raced it and had a good battle with Jess who had also done Comrades 2 weeks ago and I finished just 9 seconds ahead of her.

Sunday: Rhino Run 8km/5mile race. I finished 2nd lady in a new 5 mile PB, though I’ve only actually ever raced a 5 miler once before in 2009 and was less than a minute faster. So I’m disappointed with my time, though do have to remember I have Comrades in my legs and this was hilly while last time was flat. Either way, time to get some speed work in when I go home.

Total Weekly Mileage = 8 miles / 13 kms.

25th June – 1st July

Monday: REST

Tuesday: REST

Wednesday: REST

Thursday: REST

Friday: REST

Saturday: Sunrise on Sea parkrun. My 10th and final one here, 26th in South Africa, and 130th overall. I was gunning for a course best time (sub 22:41) amd to finish the way I started my time here as 1st lady, but I found it hard. Not from a tired leg point of view but cardiovascularly. I had a sore throat, was thirsty, and my breathing was a struggle. I even stopped to grab a cup of water half way (during a 5k for goodness sake!). I asked Wesley to pace me for a 22:30 And he tried his best to rally me on, even after tripping up himself. But it wasn’t to be and I ran a 23:57. Lovely breakfast afterwards with lovely people and a lovely cake made by Sandra’s mum.

Sunday: 5km worth of running around Karen’s garden alternating run laps with a full body circuit set on the decking for 30 mins total. Nellie the dog joined me for the running and Kathryn joined me for the weights.

Total Weekly Mileage = 6 miles / 10 kms.

Total monthly mileage : 99 miles / 155 kms.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s