...a few more photos from the weekend

More fun at Malealea and Kit receives good news

LAST WEEKEND: From Matt’s previous blog you may have gathered that I survived a little adventure of my own the weekend before last when Jeepy decided to conk out far from anywhere and with little in the way of roadside assistance. It probably serves me right for leaving a poorly Matt back in Maseru. Luckily I wasn’t alone and many people did stop to enquire about what the problem was and offer help. The local children even offered me some donkeys and cows as an exchange...I was pretty tempted that’s for sure! But I politely declined (knowing that Matt would never forgive me) and after 3 hours and a new battery (and empty wallet) Jeepy was back on the road and we made it to Tsehlanyane national park. This park reserve is about 3 hours North of Maseru and is a lush wilderness where you can hike, pony trek or just have a BBQ and enjoy the surroundings. It was beautiful, but only the briefest of visits so we will definitely be going back to explore it some more.

THIS WEEKEND: Having been in Maseru for 2 weekends on the trot Matt had itchy feet to get away into the mountains again. We decided to head back to Malealea for some rest and relaxation and a bit of hiking. Helen joined us and we set off on Saturday afternoon. On Friday night it had rained a lot in the city so we were dubious about the weather for the weekend but we needn’t have worried as it was glorious sunshine and rich blue skies from start to finish...perfect!

We arrived at the lodge and discovered it was slightly busier than our last visit 6 weeks ago when we had been some of the only guests. It is such a spacious, relaxed place that it doesn’t really matter if it’s busy or not as everyone is off doing their own thing (hiking, pony trekking) and only come together in the evening for a communal dinner.

After a late afternoon stroll we had a pretty intensive hour of activity at the table tennis table...phew. This was followed by a much needed cool beer overlooking the blue mountains. After dinner we had several fun hours of cards and beer and chat accompanied by some rather interesting songs round the camp fire. Luckily our hut was far away from the main area so the singing did not disturb sleeping!

On Sunday, we donned our walking boots and headed out through Malealea village and down sandstone outcrops to the river at the valley bottom. Weeping willows and lovely hollowed out rocks made perfect resting stops along the way. There are so many routes to take and beautiful views that there is plenty more exploring to be done.

Besides the fun stuff, on the work front I received some good news on Friday via Matt’s consultant that the Ministry of Health had approved my application to volunteer at the hospital so I should be able to start after Easter. As well as working on the ENT ward at the hospital, myself and the other audiologist plan to travel to different districts to run screening clinics and train local staff. Sounds challenging but a good idea considering there is no longer any other outreach service in place. Watch this space.

This week we are off to Pretoria on Thursday afternoon to spend Easter with Greg and Elonah. Top of the list whilst there is a haircut for Matt...before he gets too attached to his mullet! On Easter Sunday we collect Jess and Kate from Jo’Burg airport for a 10 day trip travelling around Lesotho, the Drakensburgs and Kwazulu-Natal. Exciting! More blogging after that....

The changing of the seasons

It has been a little while since we have updated you on life in Lesotho but things continue to go well.  I have found my role at work.  I have moved to the male ward which I am running on a day to day basis, with the help of a jovial 4 man team (1 from Cuba, 1 from China and 2 from the DRC).  Dr Cooper supervises, mainly from a distance, but does his ward round on a Friday.  I have also been given the responsibility of running our Friday educational meeting and supervising the intern.  I decided to take on the TB ward too as it was a little neglected and I enjoy the atmosphere on there.  This fills my afternoons which previously were not always that busy. I am now looking at focussing on my research projects.  I heard last week that I was successful in my application for funding, so am now awaiting approval from the Ministry of Health to get started.  I will have to free up some time during my now much busier working week to work on them, but am hopeful.  There are still frustrations with the system, but on the whole I understand how things work or more often don’t work.  Work life is looking up.  Kit is still waiting to hear about her work in the ENT department, but is excited by the prospect of becoming my research assistant!!

 

Everybody seems to be talking about the changing of the seasons.  I must agree that the evenings are somewhat cooler and the days are not as hot as they have been.  There are more Basotho blankets out and about and the mosquitoes are less prevalent.  I must say that I am enjoying this new, slightly cooler feel to things.  I have stopped having cold water showers but the shorts can still be worn at weekends.  At work I was being warned about the impending influx of respiratory ill health.  Apparently the change of the seasons (both now and in spring) is when we can expect more people coming in coughing and sneezing.  I was a little sceptical about this...  I know the winter months tend to bring about more respiratory infectious disease because people huddle together indoors but it is nowhere near that cold here yet. 

 

I was proved wrong this weekend.  We had planned to go up north to a park for pony trekking and a braai (BBQ) with our Welsh teacher friends.  Friday afternoon I felt a bit run down... I blamed it on the busy week... but by bedtime I felt proper poorly.  I ended up staying home with “sefuba” whilst Kit and Jeepy went off without me!  More about “sefuba” in a moment, but to continue with the weekend’s events first.  I’m sure Kit will give you a more detailed lowdown on her weekend, but the most important event was that Jeepy told all that she missed me.  I was woken shortly after 9 o’clock by Kit ringing.  They had just turned off the main road, 20 minutes from the last town (Butha Buthe) when Jeepy wouldn’t work anymore.  I got some phone numbers of garages etc. whilst Kit and co tried to establish the problem.  This was the first time Jeepy had broken down.  A mechanic was eventually summoned and diagnosed a simple battery problem but it ruined their morning.  I best not let Jeepy go off without me in the future!!

 

Back to “sefuba” which is the Sesotho word for “chest” but also refers to any respiratory tract symptom or illness.  A patient will complain of “sefuba” whether they have a runny nose or are dying of TB!  It makes assessing patients in hospital somewhat challenging.  Another example is the Sesotho word for pain can also refer to illness.  When I first got here I was quite critical of the histories documented by other doctors, but I have come understand that it is very difficult to get a precise story.  But generally patients are very vague when describing their illnesses especially the chronology of events.  I have wondered if this reflects on the attitude to health and death here.  On a related topic, I was given a brief summary of some of the traditional Basotho health beliefs by a colleague recently.  Apparently ill health is often believed to be a curse or the consequence of an external force, such as a wrong doing by a relative.  Even some very educated people, including nursing staff hold this belief... some in an interesting combination with scientific medical understanding.  It has made for some interesting discussions with patients and their relatives about why something has happened, especially if there isn’t an easy or adequate medical explanation.  In summary, it would appear that the Basotho mentality towards ill health is to not be as fixated on the details of symptoms and more concerned about “balance” in their family or community.  Very different from the UK where in the past where I have been subject to some very long conversations about the details of bowel habits!!

A weekend NOT away

For a change Kit and I decided to stay in Maseru this weekend. The week just gone was interspersed with the first of many public holidays. Thursday 11th March was Moshoeshoe day in celebration of the first king of Lesotho, Moshoeshoe I. We had seen his grave last weekend on top of Thaba Bosiu. There was not as much going on in the way of celebrations, which was a little bit of a disappointment. The city appeared to make up for it on Saturday though, as there was music and partying into the small hours.

The working week, was otherwise unremarkable. Kit is unfortunately still waiting for the Ministry of Health to approve her application to volunteer at the QE II.

This weekend we played some tennis (again I lost!) we watched the rugby and this afternoon we ventured out with our sketch books. I thought it was time I got in touch with my "arty side". Some might say, I have yet to find it based on the performance below! We found an area of Maseru called Happy Villa, which looked out over the Caledon river towards the Free State of South Africa. One of the two interpretations is Kit's and the other mine... I won't say which!!

six weeks in and work is still going well

Six weeks in and I am very settled at work.  I have developed mixed feeling about what I have and can achieve.  There is definitely a lot of apathy in the system which is self perpetuating.  Like within any large organisation, it is difficult for the individual to feel like they can make change happen.  However, it seems even more of an issue in Lesotho as change is very much needed.  A lot of the nurses and doctors have accepted that the system is flawed, which is probably needed for them to be able to cope.  If I can provide a few examples to illustrate... drugs and other consumables often run out of stock.  As I understand it this is because when stock run low, the orders have to be made, processed and paid for before they can be delivered.  This takes longer than the stocks last.  Also a lot of the equipment is old and breaks down; we have been without an autoclave (to sterilise theatre equipment) and an x-ray machine on a number of occasions.  It is unlikely that this equipment is going to be replaced as a new hospital is being built which is due to open next year.  When there is so much need for your skills and attention, it is frustrating when administrative matters get in your way of achieving what the system could otherwise achieve.  I feel like the rest of the staff though, that if I tried too hard to get things changed, I would burn out.  I have therefore decided to focus on making little changes within the sphere of my influence.

 

From a clinical perspective there remains a large volume of sick young people coming through our doors.  Last week I found particularly taxing.  On Thursday the ward was overflowing, with all 30 beds full and 12 on mattresses on the floor!  Assessing patients on the floor and when there is no room around the bed is very challenging, never mind trying to do procedures like lumbar punctures!  Fortunately things have since calmed down a little.  I also managed to keep tally of the number of patients I saw in diabetic clinic... in 4 hours I saw 80!  It didn’t feel like the busiest clinic I’ve done either.  I understand attempts have been made in the past to cap the number of attendees, but this proved impossible.  I don’t see a solution to this.

 

It is not all depressing work though.  I have been trying to make careful assessments of patients within the limits of the system.  This has allowed me to make diagnoses despite the lack of investigative tools, which has been rewarding.  I am also hopeful that this is rubbing off on the rest of the staff, to try and reverse some of that apathy I mentioned earlier.  I have also been taking a critical look at prescriptions, especially for antibiotics.  It is an easy improvement to make both in patient care and drug expenditure if I can stop unnecessary prescriptions.  Related to this I have looked at developing new charts for prescriptions.  This was in part due to the fact that the hospital had run out of the old prescription charts.

 

I have had a useful meeting with Dr Cooper (the consultant) since his return.  I am now looking at running the educational aspects of the firm as well as developing protocols for use in casualty, and such like.  I have also taken over supervision of the TB ward which felt a little isolated under the old system with only a weekly visit from a doctor.  I am also looking at freeing up one day a week to undertake my research, go to the TB and MDR-TB clinics, which are located out of town.

 

I must now get ready for work... hopefully more positive news for you all in due course.

Mountain top graveyards and dams

I just thought I'd update you on yet another great weekend of travel... I hope you're not getting too board of our stories. This weekend was a special one as we had our first guests come and stay!! My cousin Greg and his delightful fiancée, Elonah came up from Pretoria for the weekend.

I returned from work for lunch on Friday to find, to my surprise, Greg and Elonah having a drink with Kit. They had left much earlier than I had imagined. We enjoyed a lunch before I headed back to work for a meeting with my consultant, more about that in another blog. Whilst I was at work, our visitors caught up on lost sleep. It was then Friday evening, which meant Sesotho classes. We left Greg and Elonah in the garden of the Alliance Francais with a drink each and had our lesson. They used the hour and half to walk around Maseru and inspect the buildings... these funny architects! After class we went for a curry!! It felt odd sitting in a restaurant in Maseru enjoying a butter chicken and naan bread!

On Saturday morning there was a slow amble rather than a flying start to our trip into the mountains. We first had a Skype chat with family in Jordan. Greg's mother, Eileen and mine were enjoying a break near Petra at Gail (Greg's sister's) hotel. It was quite bizarre for family that normally lives in the UK, Sri Lanka, South Africa and Jordan to all be chatting together in one conversation! After the excitement of the chat, we eventually got the car packed. We had to stop off at the mall on our way out of town for some essentials... double sided sticky tape... Jeepy has some new letters which needed sticking on.

Our first stop was Thaba Bosiu, a mountain 30 minutes outside of Maseru where the first king of Lesotho, Moshoeshoe I, lived and defended his nation from the Boers and the British. It is also where he, his descendants and all the important chiefs in the country are buried. It was a good experience, although somewhat tiring and very hot in the midday sun.

After the exercise, we sat in the car and drove up into the mountains. We stopped on the way for a picnic by a stream under a willow tree. It was great... I did some real offroading down to water... a full 30 yards!! After lunch it was off to the second of our dams, the mighty Mohale Dam which holds back a similarly impressive load of water to the first and provides for some great vistas. The dam itself is much less impressive as it is more of a mound than the double arched wall of the Katse Dam. After a brief cup of tea at the Mohale Lodge, we headed further into the interior to our lodge at Marakabei.

The lodge is located by the banks of the Senquanye River in a secluded valley. The building itself showed signs of former glory with a grand reception and cosy bar, but this weekend we were the only guests. The evening drew near, the braai (Africaans for BBQ) was lit and we settled down for meat and beer under the stars. It was a fantastic evening and got a little chilly, for the first time I actually had to put on my jumper!

On Sunday we came back to Maseru after a relaxed breakfast. Greg and Elonah carried on to Pretoria and a further 5 hours in the car. Kit and I waited for the afternoon to start to cool down before playing a game of tennis. I actually managed to win!! Kit blamed her performance on the heat... I'm not so sure, perhaps I was just good for a change!!!