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From English General Practice - to Life with the Zulus

Elective report by Russel Fairhead, Kwa Zulu
"What can I do to help ... ?"

A Response
I write as a retired Family Doctor to anyone who has had medical or paramedical training at any stage. To find out what you can do, you can start by looking at articles and advertisements in journals, by writing letters and talking with colleagues about their experiences. Or you may already feel a clear, strong conviction or 'call' to a definite work. For me, such a call was based on years of informed praying for missionary colleagues, going right back to student days. God's guiding hand was in the training and preparation that was only partly used for much of one's practice life, but which became of vital use '40 years on' in rural Africa.

Getting Down To It
The opportunity to visit the rural hospital and clinics where I was to work was invaluable. It gave me answers to many questions, because it is important to know about the people you will live with and talk to. My worries about communicating were eased by finding helpful interpreters as I picked up the local conversational phrases and words for 'pain', 'cough', eat', 'drink', 'undress', 'lie down', etc. Where and how you live, what you eat and drink and where you get supplies soon becomes the 'norm', even in remote areas, if you have love and patience and your expectations are unselfish.

Joining the System
Hand-in-hand with applying our skills to the prevention and treatment of illness, go our attitudes to development, reconciliation and peace-making in changing African countries. We went to a small (180 beds) rural mission hospital in KwaZulu governed Natal. After it was taken over by the Government Health Service - with which I needed to have a Contract that I found quite fair - the hospital had been needing medical staff for some time. I joined a colleague who was successfully restoring the medical work, building on the remarkably skilful 'Triage' capabilities of some Zulu-trained nurses. I was able to take out some needed equipment through the good services of EHCO which I visited in Coulsdon. Government supplies of medicines and equipment looked good on paper, but delays and problems could be frustrating.

With a Partner
My non-medical wife found plenty to do adapting her housekeeping, befriending and distributing aid and advice to Zulu families, some of whom were victims of the local violence. She accompanied me on hazardous routes to some remote clinics, carrying amongst other things, containers of clean water. Children loved her story-telling and activities and the interpreter and watching adults joined in enthusiastically. It was excellent therapy!

Medicine the Same ... But Different
As in any clinical set-up, you soon recognise the gifted and dependable 'helpers' of whom we had some, expert at putting up I.V. drips in dehydrated babies' scalps and pulseless casualties. Because they have had to work without doctors, they diagnose and treat accurately. They suture ghastly wounds and immobilise fractures for which we could use I.V. Ketamine or Pethidine with Diazepam. Some, with advanced midwifery skills, selected out the poor-risk' ante-natal attenders and could deal with difficult labours brought in by Traditional Birth Attendants. They were glad to have a doctor to do the difficult forceps and Caesareans which, when you are alone, need the practical skills of spinal anaesthesia. I went armed with some practical text books, but the best way to find out about local needs was to watch these nurses. They were ready to share their knowledge and experience of malnutrition, dehydration, infestation, widespread sexually transmitted disease and the unfamiliar snake bites, rabies, TB and leprosy. To me they were an 'inservice' medical school and reference library, although they liked to be directed.

This Zulu hospital, with its outlying clinics and scattered surrounding dwellings, offered a good centre for Vocational Training in rural Primary Care and Community Health programmes. In South Africa, the doctors who qualify from the multiracial medical schools, are encouraged to go for such training. The Academy of Family Practice which confers a Diploma, recognised our hospital.

The Higher Aim
The hospital staff were pleased to have a missionary there again to help with prayers and Bible teaching. The Kwa-Zulu Government sent round a mandate to continue the Christian Mission emphasis in Government hospitals. Morning Prayers and Ward Services are expected by staff and patients; they are traditional to the missionary origin and vital to everyday living now, not least because of the increasing needs for terminal care of sufferers from advanced TB and AIDS-related illness.

Looking Back
There is often the element of adventure, travelling to remote places in a 4-wheel drive vehicle, or flying in a little single engine aircraft. Having to be resourceful and courageous because no-one else is there. In some areas violence and inter-tribal or political conflict make us glad of a God we can trust completely.

There is an immediate reward in seeing sick people comforted and relieved; in getting the diagnosis right and having some effective treatment to give. The Christian message of trust and hope lights up the dark patches and confidence in a planned preventive healthcare programme spreads out into the community through a teachable band of trained helpers. Community Health Workers can carry the Good News as well as good health teaching.
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