Day 1 Working at Baragawanath 1st March 11

Day 1 Working at Baragawanth

Yeap this is the more Africa, I had a soft landing in Cape Town!

The day started at 5am, negotiating the roads to get to Bara which lays in the heart of Sowetto township in which I got very lost and had to compete with the minibus taxis on the uneven roads.

Finally after arriving I made it in for 6.15 am with the sun rising on the township, the trauma unit round began at 6.45am this consisted of the Prof leading it with approximately 24 attendees ranging from registrars, interims- surgeons and emergency medicine, medical students and nurses! The Prof D runs the trauma unit and is an excellent surgeon and takes pleasure in asking lots of questions and putting individuals on the spot! This is a famous teaching hospital so students come to learn and gain the experience. The traditional doctor system is here.

Patients in trauma resus where MVAs, assaults, penetrating and blunt trauma, patients were intubated and waiting CT scans, reviews or the wards. We all then trailed through the hospital’s old army barracks with corrugated iron and open corridors covering some ground to the trauma ward. This ward had over 48 beds full, one side trauma high dependency where some  patients were ventilated and the other lower dependency with exercise bikes for patients with ICD. Full of young patients average age 20-25, geriatric medicine is rare here. We had the full ward round and discussed all the patients, conditions mainly severe assaults, MVAs/PVAs post surgery and polytrauma,. All sick trauma patients… with suffering and hardship.

After on to 8.10am academic teaching on NET Neuro Endrocine tumours. Then up to the surgical handover room to discuss the days patients, surgery and roles for the shift. I then meet all the professors and got my famous bara scrubs, then visited ICU holding 20 beds, 8 for trauma, comprehensive ICU and well equipped- trauma surgical patients post GSW, MVA’s or mob beatings. The visit continued to the burns unit funded by Johnson & Johnson with 20 beds, theatre and ICU. One little boy in a side room wrapped from head to foot in bandages… crying. In the winter the unit is full because of burns from fires made to keep people warm, the summer is always quieter.

Eventually we made our way back to the trauma unit where I got stuck into resus. The nurses seem to have slightly different skills depending on the hospital but the core competencies are generic as deemed by the SANC. The doctors work 12 or 24 hour shifts. The trauma unit was built 2 yrs ago so the resus is new and well equipped, new vents and telemetry monitoring.

Trauma resus patients attended:

MVA’s including paediatrics

PVA’s with loss sensation L1/L2 and below! Wife ran him over.

Stabbing to T2- no sensation lower than that!

6 year old PVA, HIV +ve grossly displaced femur fracture 100% bony opposition. This little girl only looked about 3yrs old. :-(  The children look so much younger because of the poor development.

The trauma resus are efficient – if patient appears stable lodox first before off the ambulance trolley then primary/secondary survey, unstable lodox after patient stabilised. Efasts is at hand as part of the survey. Once stabilised resus trauma patients tend to wait for CT and CT results, the review and ward -some 24hrs.

Patients wait in the minors area to be seen by the surgeons, ortho or other specialties- patients waiting desperately.

Feels harder, life is even tougher here, the pain and suffering and poverty is everywhere- harsh…….. this is reflected with all the individuals and healthcare professionals too.

Today was the hardest for me nonetheless I need a thicker skin although it does not take away my compassion, morals and ethics as a nurse and why I do this job………. my skin will be thicker tomorrow otherwise one would not cope, this is how it is.