Greyswtone Hospitaql

     Today Jamil, Larissa and I along with an attending went to visit Greystone Hospital, a satellite of the Pietermaritzburg hospitals serving a more rural community.  The hospital is staffed by 12 physicians doing community service.  These are generalists w3ho have had 2 years of internin g following medical school who are required to put in a third year, usually in more remote areas.  There was a young man who was very sharp and who covers the entire pediatric service alone for 6 months before moving on to another specialty.  There are about 60 pediatric beds, and his only support is a once a month visit by an attending.  Otherwise he has to rely on telephone advice.  Night coverage is by 2 physicians for the entire hospital which includes all specialties, emergencies, anesthesia, c-sections and surgery.  Again the concept that if you do not do it, nothing gets done.
     The physical plant was very nice and the nurses seemed the best we have encountered.  It is very apparent to me that one has to stop and think that the patient population is so much sicker than what we are used to at home.  Already, we take it for granted.  The three big entities of HIV/AIDS, TB, and malnutrition are all pervasive.  There was a ward just dedicated to malnutrition far beyond anything seen in the US with the addendum that many of the children on the other wards also had malnutrition  accompanying other illnesses.  The mothers sitting at the bedsides are frequently sicker than their kids and the social conditions are daqunting.  We saw a baby who was very ill, probably secondary to some traditional medicine by a local healer.  One has to bite their tongue and realize that one has to work in coordination with these healers because they have the confidence of the people.  A typical African balancing act.
     Larissa has been working with occupational therapists and seems to have hit her stride.  We travelled with 2 young psychologists who were visiting a mental hospital near Greystone.  I had a long informative discussion with them that touched on many subjects.  How does one separate mental illness from cultural behavior when one is not part of that culture?  How does a white woman win the confidence of Zulu men to facilitate treatment?  How does one diagnose depression in a community devastated by death, disease, and starvation?  The answers are difficult and I will share my limited understanding when I return.  The young psychologists also brought up other interesting issues.  One of them was very light skinned colored (mixed race).  Under the present system in 2011 South Africa, affirmative action is practiced enthusiastically.  She applied for school referencing her black origins and was told that she was not black enough.  Under apartheid she was not white enough.  In school, the professors were told that all blacks must pass, so it left all the competition between the whites and mixed races.
     Bill and Hennie continue to work on making Thokomali Nathi a viable entity.  They are now at the vicious cycle where they need a full time director to create enough viability to pursue fundraising.  To finance the project they need about $30,000 US to pay the salary of the director.  If anyone has an extra $30,000 or a sugar daddy in South Africa please let us know.  In the absence of that, we push on beating the bushes (bad expression here).
Marty