I wrote a journal entry reflecting on our first year at Madwaleni a while back… I thought it would be an interesting insight into our experiences. I post it now for those who may find it a helpful aid in deciding to join us in some capacity in the future.
“So much has happened this year. I think back to arriving at a wet, overgrown run-down ghost hospital with a hangry (a combination of hungry and angry) pregnant wife and a group of excited, expectant friends. We arrived to meet the girl we’d heard so much about, Thandi, who would turn out to be a dear friend. We also became quickly acquainted with Inge, the Dutch TB specialist who’d been soldiering away on her own for several months. She was very burnt-out and frustrated, but she too has become a good friend and colleague and has recovered a lot from the stressful experiences of last year. I think back to the wonderful surprise it was to find out there was a Dutch couple who were also pregnant who were to start along with us – the memory of having supper with Mark and Jet on New Year’s eve is very vivid – East London ‘Nina Deli’s’ Beef Lasagne with black Rooibos tea. The group from that evening were to become a strong team and a special community.
I clearly remember our first encounter with Mrs Pencil, the ‘Madiba’ of Madwaleni. Little did we know what an incredible woman she was and how devoted and passionate she was about the hospital. I remember how our working year started… sitting in her office signing documents, Sister Kweza, whom we would soon get to know very well, poked her head the office and very calmly said that there was a cord prolapse in labour ward. Mrs Pencil calmly nodded her head after which Sister Kweza gently closed the door and walked off. The three of us weren’t quite sure what to make of this, knowing that a cord prolapse is a serious obstetric emergency! We asked Mrs Pencil if she thought we should go and help, and she agreed. Andrew and I, dressed in shorts and slops trotted over to the labour ward where we found a woman who was fully dilated and about to deliver. We quickly put on some gloves and got ready. Andrew quickly confirmed there was indeed a cord prolapse, so he followed the necessary steps while I went off to fetch the ultrasound machine. As I put the probe on the woman’s tummy I was sure there wasn’t a fetal heart beat so I told Andrew I didn’t think the baby was going to make it. With the next contraction, she delivered a 1,5kg baby, which initially looked lifeless, but suddenly started to cry! With delight, Andrew picked up the baby and took it over to the resuscitation area. While he was busy with the baby, the lady promptly delivered a surprise second 1,3kg live baby along with a gush of amniotic fluid which drenched my clothes completely! In the days that followed unfortunately one of the twins died, but I followed the course of the second twin, who did very well. What a first day at work!
Over the next few days, the mammoth task of moving in to our new homes and making them liveable began. There were delays in the delivery of furniture due to wet, muddy roads. There were houses full of rubbish, peeling walls and mouldy ceilings that needed painting, cleaning and lots of work! But we all teamed up and helped each other and soon we started to make ourselves at home.
Work was interesting as we entered a 180 bed hospital that had deteriorated drastically with the near absence of doctors for the better part of a year. There was no x-ray machine, the wards were mostly empty, the nurses were despondent and the number of patients in OPD had plummeted as there had previously been no-one to see them. The phones did not work, there was no switchboard operator and we were trying to run a maternity service with no access to theatre and a referral hospital that was 2 hours away, aside from the delays in waiting for an ambulance.
For these reasons, we entered a stage of rebuilding where we slowly began to restore the services from scratch. Along with this there were many tragedies of unnecessary patient deaths which was hard for all of us to cope with, particularly maternity and paediatric deaths. Besides the challenges of life within the hospital, challenges outside of work also took its toll on us – frequent water and electricity shortages were hard to cope with, while life with a baby was at times tiring! Some of us got a bit burnt out as we learned to deal with all the frustrations of the hospital, but slowly we all began to learn about ourselves and about life at Madwaleni.
We were a small team, especially those of us doing calls, so we were incredibly relieved as our team gradually began to grow. First came Elpitha Bruce, a Brittish-trained doctor from Cyprus who arrived with her younger sister who was to spend a couple of weeks volunteering at the hospital before she started medical school in England. Next came Phindiwe Palie, a lovely doctor from Mqanduli who was originally a nurse by training and also had two small children back in East London. Last but certainly not least came Bob Solomon, an American Paediatrician, who, with all his eccentricities and first world background looked to be a round peg in a square hole to start, but has slowly become a much valued member of our team.
As the months went by we gradually started to make clear progress. We got a new x-ray machine and a working outside landline to make referrals. We managed to start up a 24 hour Caesar service, an MDR TB programme and even a clinic outreach program where each of the feeder clinics were being visited monthly. We have made small steps toward getting better equipment, such as servicing our anaesthetic machine, getting several CTG machines, IVAC fluid administration units and a new ECG machine. Our lab has also received a Gene Xpert machine and a new FBC machine. We recently performed our first general anaesthetic where we did a skin graft for a burns patient. I’m sure this is the first general anaesthetic done at Mads in many years!
In parallel to the growing disappointment of the NGO we found when we arrived, the Donald Woods Foundation, has been a growing excitement for the birth of a new NGO we have created, called Layitha foundation. While the work of the NGO has yet to get started we are very excited for the role it can play in achieving our dreams for the hospital and broader community.
Each of us were investing a lot in our nurses and slowly we began to win them over. We discovered many special characters amongst the nursing staff and have since made some good friends. As time went by, we noticed fewer ‘tragedies’ and I think we are all very encouraged to see the fruits of our hard work.
The management of the hospital has always been difficult as good strong leadership is so necessary to run a hospital. Dynamics in our team have at times been difficult as we have lacked a clinical manager. It has been difficult to run a team that is half a democracy, and half led by our CMO, Inge. There was bound to be friction, with 9 doctors and no clear leadership, especially when it comes to things like housing and leave policies. These challenges were greatly accentuated by the bitter-sweet arrival of the new hospital CEO, who initially promised everything, but was soon found out to be a very difficult woman, with very poor leadership and people skills. There have been many clashes and fights as we’ve tried to work under her leadership. At times it has felt like no CEO would be better than her, and we all longed for what could have been if Mrs Pencil had taken on the role.
Another very challenging aspect to our year was when the terrible news of the murder of James Thomas, Sarah’s father arrived. This was a terrible blow to Scott and Sarah, who had already been finding life in their small park home very challenging. We all mourned with them and supported them as best we could, but Scott and Sarah soon decided it was time to head back to Cape Town, to support their families.
It has been a very exciting year for Jade and I, spiritually. Our faith felt very exposed when we left the support of a thriving church community and we both felt like our relationship with Jesus was distant and luke-warm. This feeling climaxed in our trip to Turkey when we really began to feel desperate for a life that reflected our convictions. We soon received an invite from Dylan Sharp to go to a conference with him in Durban where a man called Todd White would be speaking. We went along and found our hearts stirred as he shared his testimonies of a life that we longed for. We went home stirred and expectant and have been digging into God again, allowing his love and grace to fill us and forcing ourselves to step out of our comfort zones to share that love with others. I have for the first time in my medical career, started to pray for patients and share my faith with them, which is really exciting. There is so much more for us we are trusting for God to explode back into our lives again where we see Him working through us all the time.
As the year has started to come to a close we look forward to what the new year brings. Stuart Poole and his wife, Leanne are joining us with their young son, Caleb. They are a strong Christian couple and talented medical team in a doctor and a physiotherapist – I’m sure they’re going to add impetus to the work we are doing. Beside a large group of rehab com serves, Garick Barber, a former church-on-mainer, digsmate and friend is going to be joining us. His gift with administration and making things happen is going to be greatly needed! Unfortunately we also mourn for the departure of Scott and Sarah.”