Making the Rounds

Today was such a great day! I got to experience so many new things and really learned a lot. I spent the whole morning and part of the afternoon making rounds with Dr. Neil, who treats the children at Lighthouse. Janis dropped me off at one of the private hospitals in Rustenburg where Dr. Neil was going to be performing several surgeries this morning.

The first was a Caesarian section, which was especially interesting since I've seen so many back home and had something to compare it to. The surgical procedure was very similar to what we do in the United States except for a few minor differences. For example, here in South Africa they place a small surgical drain in the incision site to prevent the accumulation of blood and fluids. I've never seen a drain used in the States for a C-section incision.

The biggest difference was the nursing care of the baby after he was born. Let's just say that it was not what I would have done and that it was quite a struggle to contain myself.

After the C-section was finished, Dr. Neil and I sat in the doctor's lounge for a few minutes drinking tea and coffee. Have I mentioned how much tea they drink here? Next it was time for a tonsillectomy/adenoidectomy, which we've learned about in nursing school, but I had never actually seen before. After that was the removal of a ganglion cyst from a young man's wrist. Both surgeries were very interesting to watch.

The finally surgery of the morning was the circumcision of a 17-year-old boy. I was relieved to discover that he was going to be put completely under for the procedure and would not remember any of it. It was interesting to see how they did the circumcision since I've seen so many performed on newborns, and obviously it would be done quite differently on a teenager or an adult. Dr. Neil explained to me that many of the black South Africans are circumcised around this age to symbolize their "entry into manhood." Ouch.

After we changed out of our scrubs, we hit the road to go visit two of the rural AIDS clinics in villages outside of Rustenburg. On the way, we stopped to get litchi flavored water, which was very good, and I asked him about a million questions. Dr. Neil explained that there are 15 different rural AIDS clinics in this area and that he visits 12 of them every 2 weeks to see patients who are not responding to treatment or having unusual symptoms that puzzle the regular caregivers.

At the first clinic, we saw patients for about 30 minutes. I was able to see their lab values, many of which were like nothing I've ever seen in the U.S., and also to watch Dr. Neil examine them. Many complained of pains, weakness, or the inability to continue working.

patients gathered around one of the village AIDS clinics

After we had seen all the patients there, we drove to the next AIDS clinics about 20 minutes down the road. Here we saw many more patients and stayed a little longer than we did at the first clinic. Dr. Neil had to draw blood from a little boy who was about 18 months old and from a 4-year-old girl because the caregivers couldn't hit veins so small. I was the hand holder and comforter for these procedures. Sadly both of these young children are HIV positive and will need blood draws like these every few months for the rest of their lives.

outside one of the AIDS clinics

Before we left this second AIDS clinic, the caregivers asked us to take a look at a man who had been dropped off there by his family this morning. They wanted to know if he should be sent down the road to the AIDS Hospice. This man was a sobering sight. He was barely conscious, eyes sunken, skin and bones, lying on a cot in a back room. He had a horrendous cough that I'm sure was probably TB, and we noticed white patches in his mouth indicative of a fungal infection. Dr. Neil told the caregivers to get this man to the hospice as quickly as possible, but told me later he thought it was probably too late.

patients' beds in the AIDS hospice

Our last stop of the day was the AIDS hospice in Phokeng. We saw about 10 different patients, all of whom were very sick with infections due to their weakened immune systems. I expected that since it was a hospice that most of the patients would die there, but Dr. Neil explained to me that it's more of an inpatient unit for critically ill AIDS patients and that less than 50% of the patients admitted actually die during their stay. Of all the places we visited today, the hospice was the one I'd most like to visit again.

Dr. Neil dropped me off at Lighthouse around 2pm, and I headed over to Janis and David's flat where they were celebrating the 4th of July with American friends from the YWAM (Youth With a Mission) base in Rustenburg. The YWAM staff is going to be at the airport in Johannesburg on the 4th picking up students who are coming for their July through November Discipleship Training School (DTS). So we had to celebrate a little early with a braaii (the South African word for a cookout or barbecue). It was a fun afternoon!