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Exhausting, but rewarding - Dr Brian Wilson
Below is the story of Dr Brian Wilson. This doctor worked at Madwaleni hospital, as well as a few others for several months - returned home to Hawaii - and is now back working in rural South Africa. Read about his experience as a rural doctor and why he came back to work in the Eastern Cape:
"I thought I would take some time and describe some of my experiences here at Madwaleni. I arrived five and a half weeks ago. As you well know, Madwaleni is situated in a very pastoral setting in the Eastern Cape. There are very few villages, but instead miles and miles of rolling hills dotted with rondavels in small clusters on the hilltops and hillsides. They are reachable only by rutted dirt roads and trails through tall grass. The Xhosa people raise goats and cattle and ducks and sheep and have small gardens and plots of maize. Schools are scattered throughout the hillsides in isolation from any larger community, and the children walk to school. Some of the rondavels have water cathcment tanks, but many people walk to small streams to obtain water. There are very few cars or trucks seen. There is limited electricity. Cell phones are ubiquitous, and I think it is fair to say that cell phone technology is the one modern technology to reach the Eastern Cape. The hillsides at this time of the year are still quite green and the setting at first glance seems idyllic.
But again as you know it is not exactly what it seems to be. The remoteness of the area with lack of transportation, lack of reliable clean water, and food security issues would be a challenge for any community. But layered upon that is the HIV and tuberculosis epidemics which have taken hold in a big way. I have been working alongside Jennie Linneman who is a young scottish general practitioner. She is has been here for the past eight months and has been primarily taking care of the kids in the hospital. She is a very skilled physician with a caring heart. We see a variety of patients in the hospital who are usually admitted with complaints of diarrhea and dehydration or pneumonia, but are subsequently often found to have underlyling HIV or TB or both. There are a surprising number of infants and toddlers who are admitted with marasmus or kwashiorkor. I say surprising because at first glance South Africa seems to be a fairly wealthy country with enough resources to feed their population. And indeed that is the case. Most of the children in the Eastern Cape appear healthy and fit. They often have worms and anemia but are not terribly malnourished. However those children who come in with severe malnutrition represent a special population whose lives have been impacted by a series of events which culminates in malnutrition. For example we have repeatedly admitted children to the malnutrition unit whose mother has died or is no longer caring for the child. The care taker may be a granny or aunt, and she may have limited resources. The family may live remotely and may not have access to clean water. Their remote location and lack of resources leads the caretaker of the child to stretch resources by watering down formula or porridge. In some cases lack of knowledge about good nutrition plays a role. A series of diarrheal illness weakens the child who then eats poorly. When the child is finally brought to the hospital, there may be puffiness of the face and extremities due to lack of protein, with sparse copper tinged hair and skin rashes that appear at times to be burns. The children are often febrile with infections that are hard to define. Fortunately most of the children who are brought in to the hospital in this condition respond to our therapy. But at times it is not the case. Just last night a nine month old infant who had been admitted several days ago with severe kwashiorkor died. The mother was HIV positive, and the infant had been lost to followup and may have also had HIV. Another infant presented with severe hypoglycemia and hypothermia due to malnutrition and died within hours of admission despite our efforts. These cases are always upsetting.
I have seen many missed opportunities for prevention. You can imagine that maintaining good immunization rates would be difficult in the population and it certainly seems to be the case. So some children have been admitted with meningitis that could have been prevented with vaccines. Some are not yet available here such as the pneumococcal vaccine. Today I saw a child who had been treated during infancy for tuberculosis. The following year the child developed TB meningitis. It was only on the second round of treatment for TB that HIV was diagnosed. As you know, TB and HIV are so commonly found in the same person that when one is seen the other should be checked for. This infant would probably not have developed TB meningitis had the HIV been diagnosed at the time of her first round of treamtment for TB. Another mother brought her young 4 month old infant in for the start of ARV therapy. She has a two year old who is also on ARV therapy for HIV. Unfortunately the prevention of mother to child transmission did not happen for the second child for whatever reason. These missed opportunities are the result of a public health care system staggering with great demands and little resources. Expanding the community health clinics with trained nurses and health aides that could visit the isolated families and provide nutrition counselling and vaccinations would improve things a great deal.
I have been primarily working alongside of Jennie during ward rounds. However, on two occasions there were only four physicians for the entire hospital and I was asked to cover the pediatric ward by myself. I managed to slowly make my way through the rooms filled with children with diarrhea and dehydration, pneumonia, malnutrition, TB, etc. It was a bit exhausting but rewarding.
But truth be told I am learning more and recieving much more than I am contributing. If I were a bit younger I would definitely want to return for a longer stay."
