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Occupational health

I breeze on to High Care ward for my morning ward round. Well, I say High Care. What I mean is it is the ward in the hospital where patients have their blood pressure measured and urine output charted. More a sort of Care Care ward. The nurses here went to nursing school and ask questions. Perhaps most strikingly of all when they call you to tell you a patients “is gasping, Doctor” it generally means they are still alive but very sick. Nomfundo was called urgently to a ward last week for a “gasping patient” only to discover they were cold and had clearly been dead for a few hours.

The ward is strangely quiet today. Sister is hunched over the desk, her arms wrapped around her head. The other nurses stand nervously round her muttering. I go to the desk. Sister’s shoulders are shaking and she is clearly crying. I ask what is wrong. She does not answer. I sit next to her and ask again. Slowly it comes out. She was placing an IV line into a baby with severe malnutrition and dehydration and stuck her finger on the needle as she took it out.

I look at the baby. It is emaciated. Skeletally thin. I check the notes. The mother is HIV positive. Looking at the baby it is hard to persuade myself that it might be negative. Any “it is not necessarily positive” platitudes would be misplaced.

Sister continues crying. When did it happen? Just a few minutes ago. We talk about the chance of transmission if positive, the drug treatment she can take to reduce the risk of acquiring HIV. She begins to calm down. I send her off to the Staff Clinic where she will be started on a month long course of anti-viral medication. The side effects can be pretty grim – many people do not complete the month’s therapy. I talk to the mother who has now started crying as well, devastated at what has happened and the upset it has called. She agrees to allow the child to be tested.

I pop back in the afternoon. Sister is back. She is sitting with the mother. I ask how she is.

“I am just telling the mother I am fine and she must not worry about anything.” Sister is smiling now. She has taken her first dose. “I do not think I will get any side effects. It is what is in your head that is most important and up here,” she says, tapping her temple, “I am very well!”

Comments

Esther said…
Hi,
The parts of your blog i read, i found very interesting. I am a dutch medical doctor, specialising in tropical medicine. I am thinking about working in South Africa also. (Eshowe hospital) Could you recommend working there? How is working in an area where there is such a high HIV prevalence? Do you perform operations yourself? How is the area Kwazulu Natal?
Regards, Esther Adema
11 May 2007 at 09:43
Ed Moran said…
I do not know anything about Eshowe hospital itself. Working here is fascinating, amazing, exhausting and sometimes stressful but I wouldn't be anywhere else right now. MOst of our work is HIV related which can be a little despressing even with an increasing level of ARV uptake. In many hospitals you do perform operations yourself - trained by those already there. At Hlabisa I am not as we have a fair number of people with proper formal surgical training. KZN is beautiful with lots of amazing things to see. Tremendous wealth and tremendous poverty.
12 May 2007 at 10:48
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