On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.99 n.10 Cape Town Oct. 2009
IN LIGHTER VEIN
A striking 'Natal' experience
The strike was a day old. I woke up wondering what the day would hold. I was not concerned about the principles of the strike; they were sound. Physically deteriorating hospitals such as King Edward VIII have been unfit for habitation for several years, with collapsing roofs and nesting pigeons. Essential equipment is lacking, as evidenced by the collapse of any endoscopy service at a major regional hospital, despite four full motivations which were 'lost in translation since 2006'. Medical and nursing posts are deeply frozen, resulting in the curtailment of service delivery, which prevents staff retention and development and, crucially for budding surgeons, reduction in operating time. Then of course there is the matter of market-related wage for doctors in the public service. It has taken the focus away from the other just-as-critical issues.
I was concerned whether my interns and registrars were going to be there and how the surgical department can still run a semblance of an emergency service. I was not relishing being hounded by Human Resources to furnish a positive and negative roll call for my vigilante superintendent. I arrived at my hospital that was still standing despite several political health policy decisions indicating its demise as a regional hospital and its sale or demolishment. I headed for the lifts, the only ones in a state hospital where, on the premise of efficiency, you can only select your floor outside the lift prior to embarkation. In the short walkway to the lobby just next to the Today, Tomorrow, Together ATM was a commotion. A lady was lying on the tiled walkway with her legs splayed. Several matrons were faffing about her; one was comforting her at the head end and one was on her knees between the legs. The theatre matron had just arrived with a trolley - one with wheels which go round.
I was now a yard or two away from the meleé; the baby had emerged and was grasped by the matron on her knees. She was so astounded by nature's success that she immediately handed the baby to the theatre matron, who walked away with it to her trolley. There was, however, a slight problem. Nobody had either the means or the foresight to clamp the cord. It went twang, adding to the mess on the tiles, which was impressive, and it splattered around a bit more. Thinking that the baby might exsanguinate, I quickly put my replacement computer (from my recent highjacking) down on Matron's trolley and finger-clamped the cord. One of the other matrons with a modicum of obstetric experience took over this task. I then looked at the bloody mess on the tiles which was even more impressive than I'd noticed at first glance. The matrons were trying to provide a human shield to protect the lady's dignity from the rubberneckers in the passage. This was only part of their plan, as it was now evident from forlorn gazes that they expected me to do something. They even provided me with some gloves for the purpose. I may say that, usually, little fazes me but now I was expected to deliver the placenta, a task I had last done in 1974 as a medical student when, as I recall, I had an umbilical cord to help me retrieve it. There was no cord in sight, so I went groping for it in the vagina. I then remembered that she still looked pregnant so I pressed on the uterine fundus and pulled gently on the cord and the membranes. The placenta slithered onto the floor. It turned out to be intact.
There were no vuvuzelas to herald the great event - only the broad grin of a striking orthopaedic registrar who had joined the throng to witness my plight. By this time, the essential heavy-duty sanitary towel and another trolley with wheels which go round had arrived. The lady, with the aid of a caring matron and some strategically draped towels, clambered on board her transport to the postnatal ward. I am pleased to report that the mum, her third child (a girl) and my replacement computer are fine. I proudly reported my success to the head of obstetrics. Her district level department delivers some 600 babies each month, of whom 160 come into this world by caesarean section.
This experience certainly brightened my day and helped me to cope with the days ahead. Based on this, I was left wondering whether I should change my bank from Inspired, Motivated, Involved to Today, Tomorrow, Together. I hope the strike galvanizes all those involved in health care provision, to give these words credence.
Professor Thomson is head of the Department of Surgery, Addington Hospital, Durban.
Corresponding author: S Thomson (firstname.lastname@example.org)