We had a big family gathering...

at my boyfriend's parents' house this weekend. It was in honour of his dad's 'evil twin' visiting from Australia (but that's another story in itself). There was a huge hand-me-down trampoline passed down from a rich uncle for the kids and we decided to keep it at their grandparents' house. They spent most of the day on it.

It was fairly hot and since their pool has recently taken on the appearance of a small swamp (frogs and all), the kids asked grandpa to hose them down with the 'tuinslang'. Grandpa was only too happy to oblige! My 20 month old son saw this and thought it looked like great fun! He snatched the hose pipe from grandpa and proceeded to chase and spray anyone within range. My boyfriend happened to be in the firing line (watering line?) and got squirted. He later told me that as our son was squirting him, he was shouting " 'skies papa!" (sorry daddy!).

T.I.A.

Yesterday I called for an ambulance to transport a patient with suspected meningitis to hospital. After about an hour the ambulance had not arrived yet so I asked a clerk to call and find out what the delay was. Meanwhile, I continued to attend to other patients. When I went back to the clerk, he told me that the ambulance service had simply told him they were on the way. I waited a while longer and still there was no ambulance so I called the dispatch myself. I was told that the reason for the delay was that there was only one ambulance that day servicing the entire draining area for our local hospital. I was shocked. I was also told that this ambulance first had to go to three other clinics before coming to collect my patient. I asked why there was only one ambulance. The dispatcher eagerly told me that they normally have TWO but that the other on had been involved in an accident the previous day.

I ended up having to ask my patient's family to take her to the hospital in the back of their bakkie (pick up truck).

What's in a name?

I was recently given a sample of a new deodorant out on the market


It's quite a cool little bottle and has a very pleasant fragrance



but I can't figure out why it's called 'Bamboo Splash'



when it's made with aloe vera?

Sugar, we're going down

I received an e-mail from the South African Medical Association yesterday. As some of you may know from reading Bongi's posts on the matter, Mpumalanga health is in crisis. I read a related article recently, but the real reasons are in this e-mail:

Media Release:	SAMA speaks out on Mpumalanga Hospital closure
Date:	29 January 2008
Embargo:	None, Immediate Release

The South African Medical Association expresses its grave concern about the closure of emergency services at hospitals in the Mpumalanga Province.

Reports have been received that Bethal, Standerton, Secunda and Ermelo Hospitals – all district hospitals, have shut down after-hour emergency services due to shortage of medical officers. In addition, the Rob–Ferreira Hospital in Nelspruit, which is classified as a provincial hospital and referral hospital for the above hospitals, has closed its maternity ward and is not admitting new patients after hours since 25 January 2008.

Of great concern is that patient care is compromised when interns who have to work under the supervision of a medical officer in a hospital, are now expected to work without such supervision. This problem has emerged as a result of the two-year internship programme which was introduced in 2006, as opposed to the previous one-year internship programme. It has therefore created a gap in the provision of Community Service doctors who normally fill posts of medical officers in peripheral hospitals when they complete their internship.

The Provincial Department states that they do not currently have the budget to finance additional overtime for doctors, and that funds will be made available when the new financial year starts on 1 April 2008.

In 2007 the South African Medical Association made suggestions to the Department on the envisaged shortage of medical officers for 2008. They were very receptive to the suggestions and advised different provinces to implement them to avert a crisis. However, some provinces such as Mpumalanga have not, and hence the problems that they are currently experiencing.

SAMA urges the Mpumalanga Department of Health to engage urgently with medical officers in the affected hospitals to ensure continuity of patient care, as well as considering the utilisation of additional capacity from doctors in the private sector who are prepared to assist in containing this crisis. We would like to urgently meet with the Mpumalanga Department of Health regarding these issues.

---

Issued by the SAMA Corporate Communications Department to the South African media on 29 January 2008
Corporate Communications Manager - SAMA

More funny presenting complaints

As I've mentioned before, because most of my patients don't speak English, we have interpreters who take their complaints and then write them down in the patients' notes before they are seen by a doctor. I have seen some pretty funny complaints:

"Sore chick".

"The patient fell and the finger knows it's painful". Does he?!

"Virginal itching" (spelt eaching). If it's itching down there it's probably not virginal.

"Sport in the body". Isn't that a good thing?

"Sport under the feet". Dito

"Sore leg and week". I've also had a sore week dude.

"Lazy body". Yep, I have that too.

"Little beat eating". What?

"Headache side by side". With what?

"Anus liking pus". Bwahahahahahahaha!

"Buttocks rash". Okay, there isn't really anything wrong with that, it just sounds funny.


And here are some strange names I've seen (maybe South Africans will appreciate these more):


Rice
Eggy
Storom
Dankie
Jernniffer
Ingelinah
Dephne
Preciace
Exson
Renwel
Pleaseman (yes, it's a real name)

The Good the Bad and the Ugly

As with everything in life, in medicine you get the good and the bad: good doctors and bad doctors; good patients and bad patients.

I recently had a very bad patient.

I work at an NGO and we operate on donations. Patients also have to make a contribution. If someone says they are unable to pay and they live within our catchment area, we send someone out to do a home visit and assess the situation and if indeed they cannot afford medical care, we treat them for free. If, however, they do not fall within our catchment area, we refer them to a facility close to where they live where they can receive free care. This makes sense right?

I had a patient recently who said she could afford to attend our clinic (they are told our fees when they come to reception to open a file). After I'd seen her though, when she was to pay before her file could be sent to the pharmacy, she could suddenly no longer afford to pay. The medical superintendent was called, she assessed the situation and cancelled her medication (it was chronic medication). She made a note in the patient's file saying that if she was unable to pay next time, she must be referred somewhere else. Some people might think this is harsh, but you must bear in mind that we have to buy the medication - we don't get it for free - and pay for equipment etc. and if someone who can afford to pay doesn't, that may well be detrimental to someone who really can't afford to pay.

A month later she was back. I asked up front if she could pay and she said that she could, but then afterwards claimed she could only pay part of the fees. I let it slide because, this time, she had a serious condition and I admitted her to the inpatient unit. She was transferred to another hospital the next day because her test results showed she had a condition that we could not treat (the medication is too expensive so we can't afford to stock it - we only have stat doses). Two days later she was back. She said that they had refused to admit her at the other hospital and had sent her home with the medication. Now, as bongi from other things amanzi has already mentioned, you can't always believe what patients tell you. She may very well have refused to stay there. She probably did.

She told me that she still had symptoms and wanted medication - she said that she had paid at the previous visit (although she'd only paid part of the fees) and had been discharged without any meds and therefore wanted some now. I explained that she would have to take the medication that she already had for a while before she would start to feel better and gave her a follow up date to come get her chronic medication (she didn't have any money that day). Two days later she was back again. She wanted her chronic medication. This time she said that she did have money, although only enough to pay what she still owed, not enough for the consultation that day. I was fed up! I just wanted to get rid of her now, so I decided not to charge her for that day and only asked that she pay the money she already owed. I wrote the prescription, but I made a note next to it to the pharmacy instructing them not to dispense unless she paid. A little while later a staff member came to me to say that the patient had said that she doesn't have any money. I'd had enough. I cancelled her prescription and wrote a letter to a clinic where she was already attending on a regular basis to take over her management entirely.

I have no doubt that she'll be back.

Sad Update...

...on that patient I spoke about in failure. She was admitted for 3 days, rehydrated and then discharged in an apparent stable condition. She died in the car on her way home. I was extremely upset about it, but as my boyfriend pointed out to me, she was going to die anyway. The disease had already gotten the best of her.