The way we lived. 42. (Part 1) Bad times and good times in a Kwazulu/Zululand mission hospital.

My three years in Zululand, now Kwazulu, were both the best of times and the worst of times professionally; socially or personally, it was excellent. While my blogging is related chiefly to Cape Town, the time I worked at Ceza Lutheran Mission Hospital was a critical period in my “living with apartheid” experiences from 1972-1974 before returning to the Mother City.

Ceza is located about 300 kilometres south of the Mocambique border and a similar distance north of Durban – see Google map route above from Ceza, with a red dot, to Durban.

Several million people with a proud history lived in a kingdom established by King Shaka Zulu; Africa’s Black Napoleon ruled from 1816-1828. His military prowess was based on short stabbing spears, likened to the effective old Roman swords and long protective shields. He emphasised the need for fitness, with young men undergoing mandatory military training with their age group peers in military divisions known by the similar colours of their cowhide shields. Their weapons were no match for cannons and bullets when the Voortrekkers defeated the Zulus at the Battle of Blood River in 1838. In so doing, much of the Zulus’ land and cattle were confiscated, and missionaries could establish a presence in what had been a largely closed kingdom. Under the apartheid system, it was declared a Bantustan Homeland in 1970, allowing the deportation from city areas of South African citizens regarded as “illegal aliens” – those without a Dompas. To many deportees, Kwazulu was a foreign land.

The red sand around Ceza contrasted pleasantly with the grasslands of the mainly hilly area. The lush summer growth was mythical as the land was of poor quality with the topsoil washed away by the summer rains, leaving behind ragged red scars or dongas. Malnutrition was rampant in the area. This is a winter shot taken before the summer rains during a family walk close to the hospital. Dongas scar the distant hills. My decision to go there was based on a need to get my young family life in order, as my 6-month-old son did not know me. I was a stranger to him as I was an absentee father away from home on call every second night and every second weekend, as well as twelve hours every working day from 0700 hours during my year of internship at Somerset Hospital. At least my three-year-old daughter knew me because I had much more time on my hands as a student in the university years preceding my first year as a novice medic. My going “bush” in Zululand was also based on a desire to expand my broader clinical experience in a rural setting before returning to Cape Town to start my speciality training as a surgeon. Little did I know how my life would unfold during my time there. It was good to have breakfast, lunch and dinner with the family every day of my three years at Ceza Mission Hospital (CMH). My son soon got to know me and my on-call time was not as burdensome as my Cape Town days. The primary mission for our move was successful, with a firm bonding with my offspring to this day.

Here I am on a working day with my dapper colleague, Ismail Tayob. I often wore my black-and-white Zulu car tyre sandals, which proved to be nearly indestructible over the years, with not much tyre wear visible.So, let’s start with a set of “good” cases. Two comatose young adults arrived at our little emergency department frothing at the mouth with excessive sweating. Their pinpoint pupils were a clinical giveaway sign of organophosphate poisoning. They had ingested the toxic insecticide by drinking home-brewed maze meal beer prepared in a metal container initially holding the poison. It was so satisfying to see the patients virtually come back from the dead when given an intravenous injection of atropine. On recovering, one of them wanted to know where they were!

The photo below is of the hospital staff outside our eventful ED. The last two are distant members of the royal family – Francisca and Paulus Zulu, theatre charge nurse and our sole radiographer, also the local tennis champ. Ma Gogo, a bit of a character, beside Francisca, was one of the cleaning staff.

There were a few heart-stopping moments over the years as a medic, though none could be worse than feeling a child’s pulse beating away to nothing when I was the anaesthetist while my colleague operated on a young teenage girl gored by a bull. She could only come to the hospital a day later as they lived far from the hospital. She died on the operating table of overwhelming sepsis, as the bullhorn had penetrated her colon. Without a doubt, this was one of my worst cases ever. I often wonder how much pain she would have had. It’s as if I can still feel her pulse weakening while my spirits sank lower and lower over an hour or so during the attempted surgery. On a brighter note, I had a problematic Caesarean section to perform on a woman in whom the low-lying placenta blocked the baby’s exit from the womb. These cases of placenta praevia can bleed catastrophically, as was the case with this young mother. We were out of blood at the hospital and I undertook urgent surgery with only bland intravenous fluids available to maintain her blood pressure. Imagine cutting through the tissues with only a light pink oozing from the wound instead of dark red blood. I had to perform a classic incision through the upper uterus with hardly any bleeding, which is the norm. The foetus was stillborn, but the mother survived. At the ward round the following day, we were still awaiting the arrival of a batch of blood for a very, very pale lady whose low haemoglobin was unrecordable. When I asked her how she felt, I could hardly believe when she said she just had “a little headache, doctor.” The blood came through from Vryheid a few hours later so we could infuse her with a life-saving transfusion. (Part Two of my CMH sojourn will follow later.)