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Mseleni Hospital, Kwa Zulu Natal, South Africal

Medical Elective Report by Julia Donaldson
A new place, new people, very new insects, a muggy climate of 40C and not much idea of what was expected of us. The day we arrived was a bit of a shock! I found myself praying one of those prayers where words won't quite come, but you know God listens anyway. In time each thing that caused terror initially became part of a great experience- even the insects!

Work in the hospital
We had been told that we would cover the wards weekly, including the labour ward for abnormal deliveries. This was quite amusing since I had only ever delivered 2 normal babies under the watchful eye of a midwife. My experience of the maternity ward was quite similar to home in some ways. I always pick the births that go on to Caesarean sections or get horribly complicated! However I assisted with a few Caesareans, managed a couple of deliveries and then helped in the crucial job of tying off the fallopian tubes. The ladies had declared "enough is enough!" after baby number six or seven.

We arrived in the wave of a malaria epidemic and many patients arrived unconscious or fitting from cerebral malaria. At least it is one disease that usually responds well to treatment, although drug resistance is increasing. While the medical wards were full of malaria and TB, sadly the male surgical ward was half full of patients who had been attacked by bushknives or had been shot. It seemed that between Christmas and the New Year was a particularly bad time for these attacks.

There were great opportunities to see patients ourselves in casualty and learn how to do spinal anaesthesia, drain abscesses, do lumbar punctures, pleural taps and so on. One of the highlights of each week was going out to residential clinics by four-man plane. You know you'll always see more than coughs and diarrhoea at these clinics!

There was certainly never a lack of patients in the paediatric ward! At one stage there was a family of eight who took over part of the paeds ward- they all had gastroenteritis. A large percentage of the kids on the ward were HIV positive - 50% of inpatients tested. You hear on the news about the scale of the HIV problem world-wide but it brings it home when you see people dying from AIDS face to face.

Where we lived
We stayed in the nurses' home, which was great fun. Without exception they were full of laughter and chat at all hours of the day and night. Singing and smiling can overcome a lot of language difficulties! I loved the speed of life in Mseleni. There was never a question of rushing, and walking was at best a modest amble. In that heat though it's all you can do!

South Africa is very much a meat eating country - we had chicken and rice or meat and rice nearly every day. It was a relief to eat some green vegetables and salad again later in Cape Town!

Spiritually
The hospital is very much a Christian environment. joyful singing that woke us every morning at 6.30a.m. However, as in any part of the world there seem to be a lot of people for whom Christianity is simply attending church on Sunday. The hospital aims to look after the physical and spiritual needs of the people. I was frustrated that my inability to speak Zulu prevented conversation with the majority of patients, so I did not get a clear idea of how the second aim was being met.

Conclusion
Firstly, seeing missionary work was different to what I had expected. It was not about otherworldly piety, rather the rough and tumble of meeting almost endless need in trying circumstances. Secondly, I saw how much more useful long-term work would be than a quick dash on and off the scene. Serious preparation in terms of understanding the spiritual needs of the area, as well as learning the language, would be vital.
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