At the end.....

Rain followed to Cape Town! Alas…… so only tiny bronzing for me but rest in the Cape… sun appeared for my last two days though!

Last trauma meeting pleasure to meet President Trauma Society/Clinical head of trauma and transplant surgery Elmin Steyn what a lovely lady!! Very informative and knowledgeable, very lucky to have spent time with these trauma leads in SA. I also was shown around the Vincent Pallotti trauma/emergency unit and met the manager. J 

So 7 weeks later….

2 cities- Cape Town and JHB

9 hospitals private and government

4 airports

4 heli pads

1 response car

5 ambulances

Many prehospital shifts

Many more clinical hospital shifts

1 blogg

114 photos

£1000 on car hire

£400 on airtime

Signed numerous disclaimers on my life

9 meetings with SA trauma and medical leads

68 destinations into my GPS… and only 4 times dummy out of mouth in getting lost.. okay perhaps 5 J!

I recommend if you would like the clinical and cultural experience…. you have to come here! You need 3 prerequisites as stated by the infamous Prof K:

1) Thick skin

2) Sense of humour

3) Good personality

That man is always right…. You will then have a rewarding adventure!

Many thanks to the Professors, trauma leaders, EMSSA/ENSSA, Trauma Society, GS Hospital, Bara Hospital, Private Mediclinic, Net.Care, Stellenbosch Uni, Wits Uni, prehospital- western cape metro, Gauteng- heli, ER 24 ……and to all those who put up with me, looked out for me and the wonderful friends I have made and relationships strengthen ….. I am very sad to leave, very sad….!!!!! L

South Africa is beautiful and very moving, it encompasses all of the aspirations of the people to seek progress and improvement- with hope in its heart despite the challenges. I have had the pleasure to experience the real life of South Africans condemned to suffer extraordinary violence and disfigurement and disease, whilst the country itself is a beautiful landscape and offers great promise. You work hard at life here, but the rewards are endless, the South Africans love their country very patriotic and will fight for their rights, liberty and power. I have the up most respect for all here…. Be heard as you have to expel a voice here. It kind of reflects my own values.

The paper now needs to be written for journals international and UK …. Presentations carried out UK and SA- recommendations and experiences passed for others to learn.

I have learnt personally, spiritually and professionally I wish to pass this on sharing and growing, with international collaborative working for the nursing profession and the benefits of patients worldwide.

And so the travelling ups and downs, idiosyncratic moments, challenges, pushing the boundaries of the self, the achievements, the inspirations…

But most of all my humility has been augmented……

Homeward bound……. Not ready to leave… L

Who knows what will come of this….

I certainly will be back that’s booked already….

The journey hasn’t ended its only beginning……. J J

JHB.... WILL and onwards

Now my car…. Firstly I have got a speeding fine and secondly when my hire car was delivered in JHB it was brand new … yes brand new. On returning huge dents which look like I have run someone over as red sand is splashed up the side…. I didn’t nor did I crash it!

I did go out and see Goldfish live... well done SA!

My flight from JHB... jeez its a confusing airport I had to pay a dude to direct me to the car rentals. Anyway as I boarded the flight as I was the last on because I let everyone else get on first?! There then appeared to be no overhead bag storage, so the air stewardess preceded to march of with my bag, laptop and all- I did spit a small dummy out as I felt slightly uncomfortable about all my belongings taken off me after all I had survived JHB so far. My fears where somewhat confirmed 1 hour into the flight when I asked the girl for my bag... my bag please... where did you put it?.... silence then denial she took it for me... so I had to go through every overhead locker in the entire plane. As you can imagine after 45 locker heads later and lots of banging and redness from the air crew I finally found my bag.... incidentally the whole plane clamped with relief... probably because I didn't take their bag!! Note to all please...

Wow I am exhausted from JHB and worked so much but what an amazing experience…. the culture, history, violence, crime, the disregard for life, corruption, inequality, poverty, expectation, racism and classism- an anthology all living side by side. The differences are vast and I have understood why it is that way - culture heritage seasoned with a long history of apartheid and some politic drives- its all multifactoral! A stunning country full of contrasts embedded in a beautiful land.

Onward to Cape Town to rest, see the sun, table mountain and one more trauma meeting …. wonderland city at its been quoted, one of the most beautiful place’s in the world I believe. J

I would like to reflect on one of Nelson Mandela’s quotes;

WILL

“There are few misfortunes in the world that you cannot turn into a personal triumph if you have the iron will and the necessary skill’

That’s why I am here, how this adventure came about, in your darkest moments you can conquer and grow stronger but hey that’s another story!...

And it’s not over yet!......

Lasts days at Bara trauma unit

Prehospital- house fire,  father and triplets all died, mother watched after trying to pull them all out.

Just got in and missed a emergency room thorocotomy! Gutted! I’ve seen all other text book conditions now… that was left!

Haemothorax secondary to stab…. Unstable dropping BP despite fluids and bloods… for theatre. Another ICD!

Paediatric PVA

Another adult PVA…. Immediate tube and full resus as airway severely compromised.  

Burn patient from petrol fire fully conscious... full facial burns, swollen eyes/face, singed nasal hairs, soot.... rightly so we intubated immediately.

Pleased I saw Prof Frank P, amazing surgeon and man- the dedication and skill. Big hug from him his protégée he says…. Hardly that!!

The weather has been thunder and lightening with severe rain… its very scary driving in this weather while lightening is striking apparently its common to have fatales due to lightening here! 

The day I finished I drove back through Soweto township, found the poorest mama I could and gave her all my new polo t- shirts…… she was so happy J!!!

Special thanks to Prof Efraim K, the SAISAR team all flew off to Japan, all the SA medical and trauma expertise went! Good luck!

Prof K another incredible man….. nicest compliment from him too…. SMS  ‘Its been great having you, please come back soon and keep up your incredible drive and passion’….. J

JHB has been tough and I do not mean clinically.....so that SMS was so great to receive. JHB is so different from the Cape you cannot compare them……

Days at Bara trauma unit JHB.

Final days consist of the same conditions and injuries. Severe MVAs, PVAs and stabbings…. Full resus traumas!

One 6 year old girl… hit by car… again full trauma.

MVA- full trauma resus and gross # tibia compound segment.

Pneumo’s

Haemo’s all secondary to stabbings.

One agitated patient stabbed 4 times who had taken drugs.... unsure what though.. we put a ICD in 3 times as he kept pulling it out…. He also bit me!!!! As well as being difficult to manage he become severly bradycardic after he was given more morphine? The ICD was situated okay at 20 so it might have been the drug interaction?? In the end we sedation and tubed him then we had peace and haemodynamically resolved!

Severe assaults- all ventilated and tubed due to the gross injuries in a row in resus until CT or a bed was ready on the wards. All prognosis=  bad.

Lower threshold to tube patients here as tubed patients are looked after on the wards by all staff.

Patients waiting 16 hours plus to be seen in the trauma and surgical area. All have idiosyncratic infections, tumours and conditions which we would not put up with but these people have them for a long time before they seek treatment.

We found a diabetic patient unconscious in a cubicle BM 0.7… brought her into resus… well the reaction from the nursing staff as she wasn’t a trauma!!!!!!

The nursing communication is a challenge…… and the relationships here!!!!!!!!!! but I do understand why......

Saturday night bara….. 116 patients, 27 resuscitations and 12 tubed, 9 to theatre……………….

Prehospital JHB……..!

Prehospital JHB……..! Response car and Heli

2 long days pre-hospital in the response car ER24 and fire EMS.

While blue lighting around the roads of JHB at 180 kmph with Jan an experienced paramedic while contacting control and back up negotiating  the JHB traffic and corners he casually drops in stories from 18 years on the JHB roads- GSWs, armed robberies in peoples homes and shops etc, mass shootings, hijackings, train crashes, plane crashes, chasing from heli’s, paediatric drownings, riots, multiple stabbings, MVA pile ups, watching patients burn to death in cars that explode as arrive on scene, house fires… these scenarios as recent as 4 nights ago…. disclosed so innocently with a raise of the eyebrows followed by a grin….its the norm here!!

JHB has approximately 50 murders a day. SA has 1,200 deaths on the road a month and 60 000 South African’s meet their end violently every year

We attended MVAs, sports injuries, bike injuries, 1 x DOA. 1 x  ICU transfer actually the trauma patient from the heli earlier. Car on fire. Another call 12 people injured strike by lightening- 1 child died, 2 critically ill!

I experienced many of the private hospitals in JHB- trauma and ICU… and heli trauma patients.

The pre hospital system in JHB consist of provincial government and private companies, although both private EMS attends all calls with medical aid or not. Emergency calls are sieved by the individual call centres, as each company has they own public call number.

Pre- hospital is my favourite! Another shift tomorrow!

Heli for long day shift too... learning even more about SA history and culture... why its is the way it is...... its becoming clearer!!!

J

Bara, teaching and trauma

Last 2/7 I've been at Bara Trauma Unit, Thursday 8am EM reg teaching: intrapleural blocks, traumatic aortic dissections, triage sieve and sort, sepsis mediators and pathways and Mx of malignant hyperthermia and sux scholine apneoa to name some of the subjects discussed.

My UKISAR team is off to Japan, 2nd earthquake in over 2 weeks- sorry I cant go but good luck!

The rest of the shifts have been clinical- MVAs, severe assaults requiring ventilation.

One patient was brought in naked on a stretcher from the wrong side of the hospital ie back entrance which was strange?!…. he had GCS 3, unilateral blown pupil, bradycardic and beaten black and blue with rod marks anterior and posterior- poor prognosis eh….. now the story is this man was caught thieving (like so many) in the nurses accommodation…. So the students nurses beat him severely …. People do not mess with the student nurses!!!

Yesterday was so busy with surgical patients 18 waiting to be seen all been there since early morning still 10-12 hours later without being clerked, all so sick too. Every patient is so ill as they come in when they are at the sickest point as they have no medical aid, it really is sad and therefore more difficult to treat…

As trauma was fairly quiet for a Friday evening so far?... the trauma doctors helped out with the surgical, I clerked some patients and started treatments etc. The emergency side was heaving as usual… patients everywhere as trauma side lying on trolleys and off… tied to trolleys…. Awful smell and all with probable underlying TB.

Meetings, private trauma units, data and MVAs.

Well the last 3 days I've been busy with meetings, I had the pleasure to meet secertary of the Trauma society and head of Net.Care... now this highly competent lady runs the world as Ive been told and runs trauma in SA. Very productive meeting augmenting my knowledge of S Africa's trauma and the lack of a comprehensive trauma system.... more in my final paper!

Been catching up with the Prof K... great man!! And having trauma data meetings... statistics or lack of them in SA.... more in the final paper!

Today I spent time at a private trauma unit Net.Care MilPark. Impressive establishment - 4 resus bays which can go to 7. 8 nurses on duty. Unit see’s 30-60 patients daily. Approx 60-80 P1 traumas a month.

90 bedded ICU, 30 ICU trauma beds. Excellent burns unit the only private one in Africa so they get referrals from all over. The unit has its own theatre and ICU, they receive patients with 80-90% burns, survival rates 70-80%! This trauma unit is one of two that are just being accredited in SA now for a level 1 trauma unit. The first in legislation, hopefully this will ge the first of many to assist the SA trauma issues.

Driving back on the highway, some of the robots aka traffic lights do not work at busy junctions so its first come first served, whoever gets there first! I just missed and swerved a dumper track turning left into a minibus both going at significant speed….. the minibus was crushed into the dumper track… approx 10-12 casualties who where trying to get out. All eventually managed to get out through shattered windows or the front smashed end, one woman was trapped for longer but then freed. No P1 injuries surprisingly! I called Jan paramedic who called his teams to attend, interestingly a policeman arrived on his motorbike looked at the scene then left on his bike blue lighting somewhere else!!  20 minutes later no paramedics but the tow trucks arrived within minutes!!

Okay….. now out with Jan excellent paramedic with 18 years experience in JHB in the response car the evening shift!! J