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A Chess Garden is Born

I wrote about Lucky and his Hlulabantu Chess Club and posted it on my blog, and Craig Mitchell kindly published it in his Khakibush Magazine.

After the publicity, some friends passed by and left money with Lucky. Lucky asked the children what they wanted to do with it. Unanimously, they all said they should play for the money as a prize. The winners then went to the local store and bought chips for everyone. Ubuntu in action.

Another friend donated another fourteen chess sets. I delivered these and two electronic chess timers on the Easter Weekend. Lucky and his students have now built a chess garden on the other side of the R22. The chess garden is set under the shade of trees and is bounded neatly by a rim of buried upturned glass bottles. The entrance is flanked by two neatly painted tires with white writing announcing the chess garden.

There is a table that seats six with bench seats. Then there are smaller tournament tables for two players with benches. All the woodwork was done by Lucky and his students. They buy used wooden pallets and new nails from the local store.

While taking this all in, I gave Lucky a cardboard roll. He unfurled the contents, a banner showing chess pieces and the South African flag and proclaiming the “Hlulabantu Chess Club.” He beamed and the students crowded around, taking in something that was theirs. Proudly they scouted a site and then hoisted the banner and posed beneath it for the victory photograph.

Lucky and I have been talking about contextualising and translating chess for his students. Lucky went to the Hlulabantu Primary School near where he teaches chess to the children of his village. This is my edit of our conversations and his texts explaining to me why he teaches chess and how he contextualises the game for Zulu children living away from cities:

“Chess, to me, is not merely a game but a symbolic representation of strategic conflicts akin to the battles waged between nations or clans. The intricacies lie in the roles of the pieces, with a king symbolizing leadership and a queen embodying the power and grace of a matriarch. However, when attempting to impart this understanding to my fellow Zulu-speaking community members, I encountered a significant barrier—language.

The challenge extended beyond mere language differences; it pertained to a lack of relatability and context. The conventional way of teaching chess often assumes a universal understanding, but the intricacies of the game can get lost in translation. To bridge this gap, I found it essential to contextualize the game, making it more relevant to the daily experiences of those I aim to teach.

The metaphorical association of chess with a war between nations might not resonate deeply within our community, where such matters are typically entrusted to soldiers or warriors. Instead, my goal is to anchor the game in the fabric of our daily struggles, demonstrating its potential as a tool for personal growth and problem-solving.

I explain the game as a clash between two families competing for fields. The king and queen are Mkhulu and uGogo, respectively elder or grandfather and grandmother. The back line of the board are their supporting friends, including the bishops who are good and bad witch doctors (the good move diagonally on the white squares and the evil move  diagonally on the black squares). Other friends include the horse that is easily understandable and the rook or castle. The Zulus still have rooms in their homes called “indumba” reserved for the ancestors, and I have called the rook after this. The pawns of the children of the family who need to obey the elders by moving only forward except diagonally when they can attack. In this way the children can understand chess in their own language and culture.”

At this visit Lucky asked me if I knew what terms his students used for “check?”

The students gathered around and pointed at an imaginary king with their fingers:

“Pasopa Mkhulu,” from the Afrikaans “pasop” for beware and the Zulu “Mkhulu” for a respected elder.

“And do you know what we say for “checkmate?”

Their little fingers motion the fall of the king and they answered:

“Lala phansi Mkhulu.” This blew me away. “Sleep peacefully, respected elder.” Lucky had single handedly removed the war imagery and lordship from chess.

“Now” Lucky said, “we are ready for a tournament!”

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A Lucky Day of Chess

Early in the New Year of 2024 I was invited to meet Lucky. He messaged me to say he had a gift for me.

A few months ago I was driving up to Tembe Elephant Park in northern KwaZulu Natal with Mike and Liz. The R22 winds along the flats from Hluhluwe north to Tongaland. Just before the town of Mbazwana you cross cattle grids into and out of a corridor of Isimangaliso World Heritage Park that connects the northern shores of Lake Saint Lucia with Mkhuze Game Reserve. There are raw concrete bus shelters on each side of the road before and after the cattle grates with speed bumps to slow the tourists and locals down.

As we crossed the northern cattle grate, I saw a road side stall that looked different. There were some iron braai stands and other implements, but I noticed old sheets of silver metal with black and which chequered patterns. We had slowed down because of the bumps but by the time I noticed the chess pieces, Mike had to reverse and we got out to investigate.

We shook hands with Lucky. He’s a well spoken, kind hearted gentle soul. His eyes were brighter when we asked about the chess sets.

“Are you selling them?”

“No, I invite the children to play.”

He has a 1980’s yellow Toyota Corolla parked alongside his wares for sale. The chess board was tilted on an old tired, but not enough for the pieces to fall off.

“Would you like to play a game?” Mike asked.

Lucky beamed. He motioned to Mike with respect to sit and they started. Mike plays chess, and used a standard beginners opening move to test Lucky.  The game was over soon with an invitation to play again. I bought a braai tripod from Lucky for Mike to use at his bush home, Twalambiza, to remember the day of chess.

Late last year I was driving to Tembe alone and on the way back saw a lone little boy sitting at the metal chess board. There was no Lucky, and I did not stop.

But a few weeks later I stopped at Makro in Amanzimtoti and bought ten chess sets, all made in China. 

Lucky was speechless when I drove up again with Mike and Liz and opened the boot of the car, saying “I have something for you”

“For me?” Like all we usually do is stop and haggle for a better price on his metal braai stands.

Lucky had a crowd of men he was busy with and we were on our way to Mkuze Game Reserve and could not stay.

Later that evening I received a grateful message from Lucky inviting me back.

I drove up alone. The rural R22 is in excellent condition and the landscape is dotted with homesteads and general dealers. Cows roam freely, proudly herded. It looked like rain and as I left Isimangaliso I saw a herd of zebra grazing with some illegally positioned cows.

Lucky’s car was there, on the other side of the cattle grate. There was a group of young girls huddled at a table next to the car playing chess. The on the other side was a long table and another, with eight pairs of young boys playing chess with the new boards, and at least as many watching.

As I got out of my car Lucky approached me. He was barefoot in jeans with a  white shirt and pin stripe waistcoat on. The smart waistcoat was a connection to another era and another time.

“This is your gift” he motioned to the players.

He had hired chairs for the to sit on and play. The winner of each set was given R10 as a prize. All the children received a small packet of potato crisps to sustain them. At the end of the games he challenged the winner to a game, wrapping his King in a shroud of the pink of a R50 note with a thread of green grass.

By now it was raining but Lucky won. 

Lucky's King with the R50 challenge.

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Broken

Thirty years ago I stood on the rooftop of Edendale Hospital in Pietermaritzburg where I had started my orthopedic training. 

I looked up the Sweetwater Valley. It reminded me of the  opening of Alan Paton’s book, Cry, the Beloved Country:

“There is a lovely road that runs from Ixopo into the hills. These hills are grass-covered and rolling, and they are lovely beyond any singing of it. The road climbs seven miles into them, to Carisbrooke; and from there, if there is no mist, you look down on one of the fairest valleys of Africa.”

I stood on the roof of the hospital watching a swathe of a Zulu men descend as an impi down the valley, over grass-covered and rolling hills that were lovely. The army of men moved toward a trading store and before they reached it, the occupants fled. It was as if someone had released a man-eating lion in the store. Then the impi engulfed the store and it burst into flames. The war machine continued on its path of destruction and killing. They approached homesteads, schools, clinics and the occupants fled. Then the buildings burst into flames. Later we would receive the casualties at the hospital.

Ten years later I was a qualified orthopedic surgeon in private practice in Durban. It was the 17th of July 2002 when I took transfer of a patient from the local provincial hospital further south from Amanzimtoti where I work.

She was eighteen years old. Her orthopedic injuries included fractures of one arm and leg and traumatic amputations of the other arm and both her legs. She had been attacked, raped and left on railway tracks for the cold steel wheels of a train to slice her up.

Three days ago I received news that my late father’s youngest grandson had died of Covid, leaving behind his partner and two small beautiful little boys. Yesterday I was told that  a close friend of my brothers had died. He was my friend as well. The lives of our families had been intertwined from the beginning.

Today my cousin called me from Australia to commiserate.

“Every time we get news from South Africa, it’s bad news.  How are you holding up? Are you ok? Look after yourself.” I was touched by his concern. He is  compassionate and cares for many people. We joked about Australia being a “nanny state”.

Afterwards I thought about what I am writing today and was thinking of a title. 

“Bad News” did not make as much sense as when I wrote “Some Good News” when we started our vaccination program,

I write not only to share what I think are lessons and insights.   I write to help me cope. Sharing the narrative in medicine has been shown to reduce burnout. 

We were already burnt out like those buildings in that lovely green valley. Facing the third wave of Covid seemed an impossible task.

Now after last weeks event’s we are broken.

Things are broken in South Africa.

People are broken in South Africa.

The corruption that has drained resources from our country continues unabated and the only prison sentence that was upheld was for contempt of court. Not for corruption.

This imprisonment was followed by a systematic attack on the colourful fabric of our society. Joseph’s Technicolor Dream Coat is in shreds.

We all face these events which, like the impis burning in the valley, or the thugs raping and leaving a young girl on a railway line, scar us.

These recent events have brought previous trauma to the surface for me. I had never buried those disturbing events I had witnessed as a young doctor,  and then again as a young orthopaedic surgeon. I hoped  that theses  atrocities could be healed by the miracle of our inspiring path to democracy.

They were obviously not healed.

Now I know our democracy  is broken, and it is time to move on to heal.

A priest on Durban beach.

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Breaking Point

It was a cold day in Durban. Sixteen degrees Celsius is cold for us on the East Coast of sub-tropical Africa. 

I had made a trip through the suburbs to drop something off for my theatre scrub sister.  The roadblocks are manned by community commandos, most of who are my patients and it’s easy to pass through. 

On the way back to the hospital I passed a que of cars more than two kilometres long. They were on the road to the Galleria Mall or maybe just the filling station. There was an air of dejection and desperation hanging over the cars waiting. Ordinary South Africans waiting to get food or petrol. I was disheartened to see lone drivers trying to push into the que of orderly people.

I parked at the hospital. The doctors parking area was at about 30% full today. The last few days it has been at 10%. The faster cars don’t seem to be able to make it to the hospital.

I walked from the parkade toward the tunnel that goes under the medical centre to the hospital. I hate wearing only scrubs in winter. It is way too cold for sleeveless bravery. A striking young woman caught my eye as I laboured through messages on my phone. She was bald, well dressed and made up. Vibrant. No hair.

She was clutching a form and stopped me.

“Excuse me, is Ampath closed?”

Trying to wrestle my attention away from the little screen, I stopped to talk to her. “Yes, we didn’t have any lab service yesterday, and today we have one technician for the whole hospital. I am sorry” the famous South African refrain. “The lab is closed. Why?”

I glanced at the laboratory request form in her hand. In orthopaedics we keep it simple and don’t really ask for all the  tests after which  Elon Musk might name his children. This list was for things that scared me. Cancer markers.

“I need to have these tests before my chemotherapy tomorrow…”

I felt like crying and giving her a hug. Neither were an option. So I excused myself while I scrolled through my messages looking for something about laboratory closures and openings. In the end I called one of the doctors who knew how to work the system. In seconds my unknown patient took a photo of my screen and left to get her blood tests done in the nearby industrial area. 

I went into my office. It is a safe place that is more of an art gallery than a doctors room. That’s the way I like it. We have been closed to the public all week. I am not sure I like that. I had the tedious job of completing a report of a patient whose lawyer was suing the province for negligence. In this case there was no negligence. She just had bad luck. 

Instead of going home I went and did rounds in the hospital. Not the surgeon rounds where I check a patient’s limb  and movement. A round where I chatted to nurses and tried to understand their issues.

I ended up in the trauma unit. Luckily the first patient I saw had an undisplaced fracture of the wrist and I knew what to do. I showed a keen student how to apply a cast and explained the care to the patient, the father of a neurologist in another city.

Then they called me to see another patient. I am not an experienced general doctor. I decided soon in my training, after realising internal medicine was not for me, that I would concentrate my energies on the simple and straightforward subject related to bones. This lady was bleeding from her flank. I could see the bump on her tummy that meant she was pregnant. She was stable, fortunately. Her abdomen was soft and it seemed she and the five month old foetus had escaped major injury. I numbed the bullet wound with local anaesthetic to relieve her pain. The student put up a drip. I called the obstetrician and general surgeon. Their movements were hampered by riots. The patient was admitted to the maternity ward where the loving maternity nurses would care for her.

My day ended with humanising visits to friends to feed me and charge my emotional batteries.

I am very blessed to have such friends and to be associated with a medical team that cares so much. But we are all at breaking point. Remember that.

Baptism on Durban beach… praying for the rebirth of South Africa.
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Another Stray Bullet

I had an uneasy weekend.

One the one hand I was watching the Covid-19 figures around the country and in my region of KwaZulu-Natal. We are waiting for the third wave to hit our hospital. Last week we stopped planned surgeries and reviewed our planning and capacity to deal with the surge.

On the other hand I had been sunk by the images and reports of violent protests related to the imprisonment of our former president on the charge of contempt of court.

Last year the local provincial department of health closed my hospital following an early community outbreak of Covid-19. The bottom fell out of my practice. I had obliquely thought about the chances of this happening but the scenario where my patients would dry up and there would be no work seemed impossible. But it happened. I still don’t think that should happen to an orthopaedic surgeon, but it happened again this week.

I had a small case planned for surgery on Monday. The patient was supposed to have had the procedure three weeks ago but she tested positive for Covid-19 at the time so surgery was delayed. She remained asymptomatic and was booked for surgery on Monday without needing another test. There is a lesson in that for people and companies who expect a negative PCR Covid-19 test for return to work (or to attending mass parties or sports events) after a positive Covid test. My patient called the hospital early on Monday morning to cancel surgery as the road she needed to travel was blocked by protestors. Violent protestors. My adjective. I have seen the damage to the roads with my own eyes. I have been too scared to risk driving up to a protest. I want to keep safe.

I had consultations booked after my Monday morning surgery. As news filtered through the hospital group and patient grapevine ( I do not use social media), all my patients who were booked for consultation were postponed. The next day I decided to cancel all consultations for the week.

Monday was the start of my week of orthopaedic call for my community hospital. We are not a level one trauma unit so we deal with community accidents that often stay overnight and have planned surgery the next day. I don’t work at night except before Covid when I had big operating slates that took 12 or 14 hours to finish.

My first and only patient in my office on Monday was a local carpenter who had broken his toe while fishing the night before. He was a pleasant and polite man. He was very happy when I reduced the fracture under local aesthetic and sent him on his way.

Then I did a ward round. I have a patient who is lingering for medical reasons, but whose hip replacement is fine. Then I was called to see a new admission. At 830 am. A 24 year old smartly dressed lady who had been involved in a motor vehicle collision at 2 am earlier in the morning. Remember, we have a curfew from 9 pm to 4 am. So I asked why?

“I was at an after-tears funeral party”. I have an ounce of Irish blood in me, so I understood about wakes but was not in the mood.

“Were you drinking and driving?”

“I only had one drink.”

I examined her. She had minor injuries but needed a CT scan to exclude anything major. So I said we would book it and that I would order some standard blood tests.

“I will also do a blood alcohol level. I am asking you for your consent to do that.” She was stunned and said nothing, so I walked off.

An hour later the laboratory technician called to say the patient had refused the blood alcohol test. I did not need the result to know why she had the collision.

At home later on Monday afternoon I took two calls within thirty minutes of each other. The apologetic trauma doctor was referring a patient who was shot in the leg. And then another who was shot in the thumb. Stray bullets. They were both admitted on antibiotics and pain killers and had a Covid test. I made a few calls to book surgery for them the next day. No answer at the hospital. I called the manager.

“We don’t have staff. I don’t know when you can do them. All the other hospitals are in the same situation so we cannot refer out.”

I swore to myself. I was angry that I had to deal with a drunk funeral reveller and people shot by stray bullets. South Africa has a problem with stray dogs too, I thought to myself.

Then a general practitioner who is close to me called. His wife had just fallen and she had broken her wrist. It was deformed.

Normally I would say and organise at the same time: “Let’s get her admitted. Take her to the trauma unit. Get an x-ray. They can put a splint on and elevate it. She can have morphine overnight and I will operate in the morning.”

Instead I had to apologise. “We don’t have capacity at the moment. No-one has. Can you put a splint on her and keep her comfortable at home? If you need morphine call me and I will arrange with the night super. I am sorry”.

It was not even the end of the first day of the week and this is what had happened. My hospital has been closed again. Not by Covid, but by violent protests in a young African democracy that should have grown wiser by now.

Cheetah kill in the Kgalagadi. No stray bullet.
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The Naming of People

T.S. Elliot wrote a collection of poems on cats. One of the poems is called “The Naming of Cats” and it starts like this:

The Naming of Cats is a difficult matter,

It isn’t just one of your holiday games; 

You may think at first I’m as mad as a hatter 

When I tell you, a cat must have THREE DIFFERENT NAMES.

Luckily I am not a cat and only have one name. However there are more than three Basils in my family. I am one of six first cousins named Basil after my maternal grandfather, the late Basil Moutsatsos, who had come to South Africa from Greece. His legacy was one of love and generosity. He also loved to watch his children (he had five daughters and four boys) perform Greek dancing.

So Basil is from the Greek word meaning “Kingly”. In Greek my formal name is Βασίλειος (Vasileios). The shortened version is Vasili. When I was at university I liked Vasili. Many years later a Rumanian colleague would call me Vasili. He would also call on every 1st of January to wish me for my name day. 

In Greece the villagers who had been to the United States called all the Vasilis “Bill”. So I became Bill, Billy or Billaco in Greece. Bill came from their arrival at Staten Island in New York City. The immigration officers spoke no Greek, so they asked with which letter of the alphabet the name of the immigrant started. Vasileios starts with a “B” in Greek. So they were all called Bill. 

The seven cousins needed to be distinguished from each other. So we had Big Basil (or Sili) and Little Basil, who was the youngest Basil until two younger ones came along: JB and Sil. In the middle was me and cousin Basil, son of my Uncle Basil. I had a few nicknames besides the Bill derivatives: Budgie, Charlie and maybe a few others I cannot remember.

Oh , and my cousin Big Basil married Athena whose brother Basil shared my birthday, along with JB.

Names are important. Sometimes they make who we are. A name can mean recognition and connection.

When we were in the second wave from December 2020 to February 2021 at Netcare Kingsway Hospital, the hospital was all Covid except for one small ward. We all wore full PPE including visors all the time. Everyone looked the same in gowns and visors. Everyone was tired.

“Hey you” was not a polite way to address nurses when at work, and patients had no idea which angel was caring for them. Remember, as a doctor during the Covid wave I was working with teams I had not worked with before as an orthopaedic surgeon.

I decided that we should label everyone’s visor with their name and position in the hospital. So even the head of the gastroenterology unit in theatre got her label: Sister X, Theatre Gastroenterology Sister. She ended up heading up the Rest in Peace Team, so her patients did not see the name on the visor.

My receptionist used my label machine and five cartridges of labels supplied by the hospital to make labels for the whole hospital nursing and administration staff and the doctors. Each cartridges has a ribbon that is twelve meters long, so she printed sixty metres of labels.

Covid-19 has presented like a cricket game with the statistics. All sorts of useful numbers have been extracted and then equally so, misinterpreted and used as a foundation for some outlandish conspiracy theory.

We are now preparing for the third wave at our hospital. Many of the staff have new visors in preparation for the battle. Most have been vaccinated. My labelling machine is doing the rounds as people print their name to stick on their visor. 

What the label does not say is that these nurses are angels. They are the ones sacrificing themselves and their families as part of their calling to care for the sick. The sick are arriving again at our hospital with Covid pneumonia, grey skinned with wide-eyed white eyes searching for oxygen and help.

Thanks to our nurses they will receive more than just help. They will be cared for and connected to their families by these superheroes with names we should remember.

Grass cutting visors from the local hardware store have become the preferred from of protection globally.

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The Tree of Life

I had been searching for a year. Because of the pandemic, in spite of the pandemic and to heal from the pandemic. Finally in May this year I was gifted what seemed to have become an impossible task.

I messaged the hospital manager : “the trees have arrived. I’ll come by later in the week to chat about where to plant them.”

“Excellent” was her answer.

We have a garden of remembrance as you enter our hospital. It has two benches, three tall aloes and a variety of African indigenous lilies. There are two glass walls with stainless steel plaques for anyone to pay homage and remember the departed. One wall has become the Covid-19 Memorial.

A few days later I popped into the manager’s office. 

“Hi.”

“ Oh hi Dr Stathoulis” . She always calls me that. We asked about each other. “Can we do a walkabout to see where to plant the trees?” 

“Sure”. She always makes time for me.

We walked into the sun of autumn, a warm day, with the trees huddled in their black plastic uterine bags.

Ziziphus mucronata. The tree of life. That’s what the Zulus call it. uMphafa. If someone dies  in the hospital they bring a  branch from the tree of life and reverently capture the spirit to take it home. They even pay for an extra bus seat on the way home. The branch that has captured the soul of the person who has died is tucked into the eaves of the roof of the homestead to rest. 

I have a plaque in memory of my father’s passing in 2008 on the first glass wall. It reads in Greek: “Η αιωνιότητα είναι ποιότητα, δεν είναι ποσότητα, αυτό είναι το μεγάλο πολύ απλό μυστικό” from Nikos Kazantzakis, who wrote Zorba the Greek. Translated it means “Eternity lies in the quality, not the quantity; that is the great secret.” When I finished school in 1980 I planted a  Ziziphus in the garden of our family home. After my father was buried in Johannesburg I took a branch from that tree and left it at my grandfather’s house in our village in Greece. 

It was difficult to find the trees. I had asked far and wide of nurseries and tree growers and finally a friend of mine, Jane Bedford, who had trained as a traditional healer with the Zulu’s, gifted them to me. A few days later the local nursery found another three small trees for me.

Jane delivered the first three trees as soon as  she got them. The thorns tore at her car seats. He forearms had bright red spots where the thorns had drawn blood.

The tree of life has a straight thorn that points to the future and a curved thorn that connects us to out past. The branch has a zig-zag pattern, much like the path we follow in life.

I had a dream in the beginning of the Covid-19 pandemic. I was moved by the pain of families who could not visit their loved ones in hospital. I thought of these trees after my dream, and knew I should plant them in our Garden of Remembrance. I finally found them. Rather, they found me. So Rachel the gardener at the hospital planted them. Three in a row. The other three small trees were planted in a group a but further away.

This weekend I mixed some concrete and planted a sign to remember the reason we planted the trees of life.

A sense of peace descended over me. Now my soul can rest a little easier.

Rachel, our gardener planted the trees of life.
The tree of life….
The Garden of Remembrance

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Some Good News

I have been distracting myself since the second wave. Our hospital has quietened down as far as Covid-19 cases go, and we started doing limited planned surgeries. After my last post which detailed the overwhelming and horrific difficulties we faced during the second wave, a friend of mine suggested my next post should be about some good news.

So I thought of telling you about a touching visit by a medical student to her grandfather. He had been admitted with Covid pneumonia and is now recovering at home. I also thought I would write about how we have resumed planned surgeries, and how it feels different to when we resumed after the first wave. In the background I have been working on a document detailing how Covid-19 has affected me as an orthopaedic surgeon. I think the latter post would not be good news.

But there is good news for this post: I received my Johnson and Johnson vaccine on Friday. It was injected into my left arm by a community clinic nurse at Prince Mshiyeni Memorial Hospital, a provincial general hospital in the south of Durban, KwaZulu-Natal.

There is so much to say about the vaccinations for Covid-19. The scientific endeavour and ultimate production and licensing is nothing short of miraculous. The first time use of mRNA vaccines in the Pfizer and Moderna vials is science exploring the envelope . The Pfizer story is worth reading. It details a humble event. Albert Bourla is a Jew born in Thessaloniki, northern Greece, who steered Pfizer as CEO to be the first to release and use a vaccine for Covid-19. The story of who was the first person to be vaccinated in Greece is where much respect goes to Mr Bourla. Mrs Despina, 95 years old and also of Thessaloniki, is a Jewish-Greek holocaust survivor. She received her vaccine in early January 2021.

The Astra-Zeneca and Johnson & Johnson vaccines both use the older technology of inactive adenovirus with the DNA of the Corona virus incorporated. Unfortunately the Astra-Zeneca vaccine gave less protection for the new variants of the Corona virus, including the variant which caused South Africa to explode in the recent second wave. The adenovirus DNA vaccines are more robust than the modern mRNA vaccines, whose cold chain storage at -70 degrees Celsius is difficult in a developing country. South Africa had already taken delivery of one million doses of the Astra-Zeneca vaccine as the studies unfolded about it not being as protective as we had hoped for. It was an disheartening blow to the nation’s health care workersw who were relying on a vaccine to give them real protection.

Before the dust had settled on the unused Astra-Zeneca vials ( which were sold to other African countries) South Africa took delivery of 80 000 doses of the Johnson and Johnson Vaccine. This is a single dose vaccine as opposed to the others which rely on two doses, given at an interval of a few weeks to a few months. Over the last week the Department of Health co-ordinated the distribution of the Johnson and Johnson vaccine under the umbrella of a trial for health care workers called Sisonke. Sisonke in Zulu means “together”. It is a Phase 3 (b) clinical trial which is pragmatic and set in the real world. Perhaps a little more real in Africa.

The Department of Health distributed the 80 000 doses between 14 state hospitals and used these initial doses to protect frontline health care workers. Their EVDS (Electronic Vaccination Data System) website allowed me to register as a health care worker. My hospital then stratified staff into risk levels, and then I was able to register on the Sisonke website to be part of the trial. Besides entering personal details this also involved digitally signing an informed consent. After this I received a voucher number and a booking to get my vaccine on Friday 26 February 2021 at Prince Mshiyeni Memorial Hospital. It was not all as simple as it sounds. 

The logistics of the vaccine delivery process has been difficult globally. South Africa has discovered the limitations of the public-private health care system. Some provinces allocated appointment times. When I received my invitation it was open ended: from 8 am until 4 pm. My heart sank as I thought of my visit two years ago to the Department of Home Affairs to apply for renewal of my passport. For that I arrived at 5 am to be close to the front of the queue. It could not be that bad, so I arrived at Prince Mshiyeni Memorial Hospital, 10km away from Netcare Kingsway Hospital, just after 7 am. I was relieved and reassured to see our nursing manager at the entrance welcoming and directing me. I was number 184 in the queue. Two hours later I received my injection. Then I had to wait the obligatory 15 minutes to ensure I did not suffer an adverse reaction.

I walked out feeling empowered. I had survived a mild dose of Covid-19 at the end of last year,  and now with the vaccine I was protected. As data comes in I will in turn protect others. But until a significant proportion of our population is vaccinated I will continue applying the appropriate precautions. We should all continue to wear masks, wash hands and maintain social distance. In the hospital and my office the minimum requirement remains a mask, visor, plastic apron and gloves. 

We still have a long way to go with this pandemic, but the vaccine is the most significant step in our battle to gain control of this novel corona virus.

I am grateful to the scientists who developed the vaccine and the South African government for choosing to protect us. Special thanks to the manager of Netcare Kingsway Hospital, Mrs Demetriou for her efforts to get her staff vaccinated.  Health care workers have seen a different reality to the rest of the population.

Thanks to Sister Nompumelelo Molefe
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In Their Memory

I cannot find a title that encapsulates what has happened at my hospital without being alarmist. This is all about death. 

In early January 2021 my hospital was overwhelmed with Covid-19 cases as the second wave of infections hit our coastal holiday town with devastating force. 

The senior emergency doctor contracted the disease and was unwell. The remaining doctors were stretched to cover the extra load. Our infrastructure was stretched. My measure of how we were coping was based on a few rough gauges: 

How many people were lined up outside the emergency department on oxygen? 

How many people were in the emergency department waiting for a bed at my or another hospital? 

A few weeks later I added another measure: how many people were waiting for ICU? 

We were stretched, no doubt. So I went to see how I could help. 

The nurses and doctors knew what they were doing, but it seemed chaotic just because of the sheer deluge of ill patients. We had a ward that was empty and accessible to those needing urgent care for Covid-19 symptoms. But we did not have the staff.  

As I walked through the ward I discovered the real measure of how overwhelmed my hospital was. There was a dead body in each of many rooms. Out of respect for the departed our staff were leaving the dead alone in a room. Their desire for those in the afterlife was to rest in peace with space. 

I am not at liberty to give the statistics as they are part of the information that the Department of Health disseminates. But I can tell you how it affected us. 

To make space for sick patients I seconded a porter and we started moving all the dead bodies into one room. A holding area. As we did this I met some of my operating theatre staff who were delivering a shrouded body to the new holding area. Beds in the ward were at a premium so it was more efficient to move the body to a holding area where the many professional undertakers have taken them away timeously. 

4180. 

That is the switchboard extension the ward staff call to get the RIP (Rest In Peace) team from theatre to prepare and move the body.  

The RIP team is made up of skilled theatre nurses, scrub sisters, recovery and anesthetic nurses. Once they get the call on extension 4180 they go to the ward where the patient has demised. They check the paperwork. They ask the family if they want the clothes left on or removed.  Then they wrap the body in two layers of plastic, each layer with three patient stickers identifying the body. Then they shroud the body with a white bedsheet. The remains are respectfully transferred to the holding area. 

We managed to staff and open the ward the next day and take patients from outside on oxygen and put them inside in a bed on oxygen.  

The odd thing is the number waiting outside remained the same for many days.  

It was sobering that number of dead arriving in the holding area was much more than we ever anticipated. 

The Holocaust Memorial in Berlin

Posted on by basilBLOGinc · 2 Comments

Sometimes I Think

Sometimes I think and nothing happens. That seems to happen a lot during this period of the second wave of Covid-19 that has hit my hospital. Netcare Kingsway Hospital is a community private hospital and has been overwhelmed in caring for patients with Covid-19.

Sometimes I think and something happens. That’s when a story takes shape and I wonder how I will tie it together to make it work.

Sometimes I think about the pandemic. I focus on the problems we face and work out solutions. I reflect on all we have done. I reflect on what we have learnt. Although we were all tired after the first wave, at least for the second wave we had systems in place. Systems to protect staff with PPE, systems to control the flow of patients and systems to deals with patients waiting outside and waiting for an ICU bed.

Sometimes I think that it is affecting everyone. It is affecting every nation. Uniting some and dividing others.

Sometimes I think that it is not only about the nurses and doctors and first responders. It is about the cleaners and security staff, about the porters and the kitchen staff. About the switchboard operator and the admission clerks. They are the ones that make up the scaffolding from which the nurses and doctors flesh out their caring and compassion. Without them risking close contact with sick patients health care workers could not do what they have had to do. 

Sometimes I think about the undertakers I see moving around the hospital. Death certificates in hand if they are lucky, otherwise their unfazed search for the source of that important document. I have seen families cry as a body has been transferred to the undertaker’s van. It was eerie to see a full length leg prosthesis pushed like a spare part above one body.

Sometimes I think about all of these people. I just have not written about them. Now I will write about them.

It may look like it’s only sometimes that I think about them. But today I walked out of my office holding a tray doughnuts. A patient brought them yesterday to celebrate his birthday with us. I didn’t save his life. I am just an orthopedic surgeon. I only fix bones as my clever anesthesiologist insists. I was grateful my patient thought of us but I never got round to having the doughnut.

Sometimes I think clearly. This time I took the doughnuts to the security guard that directs people in crisis to the back of the hospital for them to be triaged. He remains calm and polite and cares as much as any nurse or doctor. I know that because I see him every day he comes on duty. I wave as I drive in and he salutes me.

Sometimes I wish I could do more for them. The doughnuts for the security guard were a start.

Moving mannequins at a Durban outdoor market
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Superlatives

I could use superlatives to describe our nurses at Netcare Kingsway Hospital.

There are fancy words like  unprecedented, incredible, amazing, unbelievable, conscientious and self-sacrificing.

But I will not.

I will just tell you what they do:

Our nurses work twelve hour shifts. They arrive early and leave late. They wait in line to  sign in with a thumb print for work. Then they log in on their cell phones to be screened for Covid-19 symptoms and checked for fever. They queue up to sign in. Then they wait to be screened. 

From there they walk to their ward. There is not as much noise as before. It is quiet as they put their bag and food in their locker. Before they used to leave their phones in the locker. Now the phone is a vital tool to connect. Not to social media, but to hospital and doctor groups. Orders, stats and death notices fill the small screens.

They don PPE to start work and care for their patients. They wear a mask, visor, gown and gloves all day. It gets hot. Their throats become dry.  Tea and lunch breaks are short and sometimes missed because they are busy. They cannot sit with friends. The tea rooms only allow two nurses at a time. I see them walking to their cars to eat lunch. There is no life in how they spend the time which is meant to recharge their soul.

The wards are full. We can give each patient an oxygen mask or rebreather. Not everyone can get high flow oxygen because our oxygen supply system will fail. This even after we installed a huge tank and free flow piping that we hose down every hour to prevent the freezing of the pipes. I do not need to explain the cap we face if we need to escalate breathing support. There are a fixed number of ventilators with a waiting list.

As I write this, the words seem without aim.

I have chosen my words to reflect the staccato world of talking through masks and behind visors.

Yet somehow richer words appear. The intensity of the ICU’s is cloaked in an almost church like peace as these highly qualified nurses work around the clock to save lives. When I talk to them all I see are tired eyes above the mask line, yet there is a gentleness and concern that pervades their every action.

My theatre staff have lost all sense of stability. They have to work in wards, ICU, the emergency department, triage or screening. They also call the families to update them of the loved ones condition. My theatre staff have another duty: they care for those we have lost. They do this with great dignity.

This week I got some grass cutting helmet visors (I am holding two in the photo) for some of the theatre staff. We all know they are the most comfy and safe as well. They are bulky and ugly. One of the nurses put her visor on and walked as if on a catwalk. She was showing off her new visor as if it was a designer handbag.

As she walked she tilted her head to show the large blue helmet with clear plastic screen and said “fabulous!”.

Now that is a superlative I did not expect to hear.

Holding the grass cutting visors in a stainless steel hospital lift. See my phone in a plastic bag.
Posted on by basilBLOGinc · 27 Comments

Burials: We can’t keep up!

Those were the headlines in one of the Sunday papers.

He was around fifty years old and with his wife. They stood in front of me in the supermarket. He was in shorts and a light blue t-shirt, wearing beach flip-flops. Standard casual wear for the holiday beach town where I work at Netcare Kingsway Hospital in Amanzimtoti, on the KwaZulu-Natal South Coast of South Africa.

I could see him reading the headlines. Then he shook his head and muttered something to his wife.

“News” was all I heard. It was accusatory, devoid of any connection to the surge in Covid-19 infections we are experiencing in this province. 

I was not in my surgical scrubs. I too wore shorts and a t-shirt, although not as smart as his. Instead of flip flops I wore my Crocs. Every day at the hospital I wear closed restaurant Crocs that I wash every day with my scrubs. It was good to be in my beach and bush Crocs.

“It’s true, you know” I said. “ I can take you to Kingsway Hospital down the road and show you the people waiting outside.” I knew they were there,  sucking on oxygen from  battered black cylinders. They would have been triaged by a team of nurses, vital signs recorded and placed on the oxygen as they waited for a cubicle in our emergency department. A colored sticker on their shirt or blouse would identify them: BLUE for family members, YELLOW for non-Covid medical problems ( the minority) and RED for COVID-19 patients.

“I don’t believe it. I don’t know anyone who has it. I don’t know anyone who has died from it. I know hundreds of teachers, and not one has it. But I do know people who have been murdered in the last year.” He was calm and spoke his truth.

His words hurt me.

I chose not to argue. He would not recognize me when he came to the back of the emergency department. All he would see is my eyes above the mask and behind the visor. I would be unable to help him. Not because he did not believe that Covid-19 was a real problem. I would not be able to help him because there would be twenty other patients waiting for a hospital bed. Maybe he would get one on the other side of the city, or even in another town. I would not wish ill on him. But he should see the eyes of those pleading for care and attention. He should see their eyes when the person lying on a stretcher next to them dies. He should see all the bodies waiting in the holding area.

They are waiting for the undertakers who can’t keep up with the burials.

The nurses at my hospital can’t keep up either. I cannot keep up with how many get sick with Covid.

One of the emergency doctors steeled himself before a shift. “I can’t do this anymore.”

He was tired of seeing patients and not having beds for them. He was tired of seeing people die. He was tired because two of his colleagues were sick with Covid and he had to carry the extra shifts.

Still he went out to face the death and destruction that this disease forces on us.

The man in front of me at the supermarket que would not believe any of this.

The amazing thing is he would still be treated at my hospital like anyone else if he needed help. He would be treated by nurses and doctors who just can’t keep up. 

He may end up with a RED sticker on his blue t-shirt…

Begrafnisse: Ons kan nie voorbly – Afrikaaans for Buritals: we cannot keep up
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Circles of Light

We had survived the first wave of Covid. The Covid admissions at my hospital were down and we had resumed elective surgery. Things were running as smoothly as they could in the new normal.

I washed alone in the darker scrub room. I always use this scrub time to focus on the case at hand. Surgery forces one to be very mindful, unlike other high pressure jobs where you may have to multi-task. In surgery all you have to do is focus on the next case.  

I looked through to my operating theatre, the room lights bright with the scrub sister positioning the brighter operating lights for me to make my incision. Over the decades these were the third ,and by far the best, set of lights to work with, I thought to myself. Was I thinking more today, or was I just more aware?

Surgery is a privileged profession, one which captivates and entrances. It is also a demanding discipline where failure stabs at your heart with no forgiveness.  But this morning I was captivated by the lights. For the first time as a surgeon I realised the operating room light is a representation of the primeval force of fire that bound humanity by giving light in the darkness. This light was the result of our forebears discovery of fire. Nothing less. 

Back to scrubbing. Palm to back of hand. Left then right. Then each thumb. Forearms then rinse. I always worry about the waste of water. I should change to a dry scrub. But I find the noise and sensation of running water soothing.

I glanced into my theatre. My eyes focussed and stayed there.

The light shone in a circle of circles, each emanating like a ripple in a pond from a stone thrown by some child. 

It is my twenty third year of operating here. I have survived a few medical mishaps of my own: a few kidney stones, a cardiac stent, amoebic colitis, surgery for arthritis to my thumb and now I think I have COVID.

It was as if I could see the virus now. There were halos I had not noticed before. Maybe it was from all the scratches of cleaning my visor. Last week I worked with a nurse in that same theatre for two days and they tested positive for COVID after that. 

It was five and seven days since my exposure. As a health care professional I could continue to work until I had symptoms. 

But the light does not shine on premonitions.

The next day I tested positive.

Posted on by basilBLOGinc · 4 Comments

H.O.P.E.

Even as the postcards started arriving the signs of the second surge were present. The statistics are anywhere to be found but a retired colleague of my brother has done his own programming and has a useful site to look at the numbers if you need to: https://www.covibes.org

Back to the postcards. They are being collected in a box held at reception at Netcare Kingsway Hospital. 

I have collected twice and will check again next week. I feel like an old fashioned village postman.  It tugs at the memory of the film Il Postino, a beautiful film about how words can change lives.

Each time I took the pile of postcards to my office and left them in the corner of my empty desk. When my work day was over and I could focus, I sat alone and read each one. I cried easily at the intensity of emotions expressed about  how events had affected staff at the hospital. 

After each reading I went to the front desk where my receptionist Anina is protected behind Perspex barriers and shook my head in disbelief as I spoke  of the trauma. Anina scanned each one in so that the card was digitized, and from those files I was able to make the first collage that makes up the picture that accompanies this article.

One postcard ended simply: 

“No words.

Only emotions.”

There are so many emotions that we have all experienced to a greater or lesser degree, from closer or further than others. I could identify with all of them, from the anger to the zeitgeist of social distancing and lockdown of our new era.

The sense of loss is profound. Loss of family members and friends stab into your heart. The loss the nurses felt as they were the only ones to guide patients into the next world hurts so much that tears flow. 

There is anger. There is a sense of growth and achievement. There is an acknowledgement of lessons learnt. My writers have defined what is truly important to them. 

Despair makes an appearance but is won over by hope.

So why H.O.P.E.?

Hold On Pandemics End.

Keep hope alive by wearing your mask and social distancing. Think very carefully about your festive season travels if you really have to. Remember it’s as much about not contracting the virus as much as it is about not infecting someone else.

Posted on by basilBLOGinc · 6 Comments

A Postcard to Covid

A Postcard to Covid

One thing has worried me during Covid and initially no one understood.

To survive and heal after this pandemic we need to remember the story  of what happened. 

Our modern instant access to newsfeeds and intrusive social media have overloaded us with statistics and disease progression. In a few years’ time if we look back and do an internet search we will have access to all the details of what happened. We will be able to recount the spread and the death rates, the financial fallout and effect of the recession. The debate on wearing a mask will hopefully have been silenced. There will be articles on the development of a vaccine. Science and medicine and economics will dominate the records.

But the story of how we felt, how it affected us, the way our minds took a beating, all those will be lost in the millions of pages of data.

That is unless you send a postcard to Covid and let the virus know how it has affected you and how you feel. At least you don’t have to say ” I survived 2020 and Covid and all I got was this lousy postcard…

I am sure that writing a postcard uses another part of your brain. It forces you to find a spot  to place the card on a table and pick up a pen. You may not put the tip of the pen in your mouth for inspiration because you are wearing a mask, but the ideas will come. There are different pathways in the brain that engage more cells than when you pick up your mobile phone to send a message. Trust me, picking up a pen in itself can be healing.

Yes our stories during the pandemic have the power to help us heal. 

We have all been traumatized. If I look at our little hospital that was closed by the Department of Heath early on in the pandemic because we had an outbreak, I knew already then that there would be suffering. I do not want to minimize the suffering that anyone has gone through, but our nurses are the ones who put their lives on the line. They are the ones who held the hands as patient after patient died from lack of oxygen on their watch. They are the ones who stood in for the family who could not visit. They are the ones who escorted the dying to the other side. They have a sad story to tell.

The idea of a postcard came to me in the last few weeks while I was studying a course hosted by the University of Cape Town on Medicine and the Humanities by Associate Professor Susan Levine and Professor Steve Reid. I have also been attending a  course hosted by Laurel Braitman of the Department of Narrative Medicine at Stanford University. It is Laurel’s inspiration ( and very likely one of her prompts) that made me realise that we had to find a way to tell our stories through this pandemic.

So pick up a postcard and tell us what Covid has made you feel. If you need to talk about it tick the box and we will get back to you.

I know the strength of the human spirit that prevails and look forward to sharing your inspirational stories.

Posted on by basilBLOGinc · 9 Comments

The Ocean

I wrote this poem a few months ago at the end of summer…..


As the world

Unfolds and bursts

Where seams

Never existed

I crawl to the ocean

In the darkness

Leaving it all behind

Summer does not

Seem to want an end

If only other things

Would end as well

Clear skies echo

The Ocean quiet

Our windless Halcyon


I lie in bed

Exhausted yet

Today I contributed

My life’s tapestry

Is richer in this dark hour

As I watch sea and sky

Posted on by basilBLOGinc · 5 Comments

A Note for Future Generations

Covid-19 is still with us. The South African curve is not flattening, and the number of new cases and deaths continues to rise.

I am seeing my first Covid-19 positive patient at Netcare Kingsway Hospital.  He is fortunately well. Unfortunately the surgery for his broken arm will be delayed for two weeks. I am not prepared to risk spreading the New Corona Virus in my theatre if it can be avoided. This said, if we needed to operate my team would do it safely.

I have consulted and seen other patients with Covid-19 before our hospital was closed and then reopened last month. But they had been admitted under other physicians, and were not strictly my responsibility. Although ownership may be a better word. We bear great responsibility as the doctors of these patients.

I was prompted to write this piece by Laurel Braitman, a professor and the Director of Writing and Storytelling at the Stanford School of Medicine at Stanford University. She hosted an emotional online writing workshop this weekend. The prompt was to write something for a  time capsule that would be opened by future generations. 

Back to my patient:

He was the last patient I saw on my ward round. 

First I see green patients, then yellow patients, and finally the red patients. Negative swabs, awaiting swab results and positive swabs respectively. 

Besides being red my patient is also black,  and I am white. Yes I notice that. Especially after all the other colors in my hospital. We are both born in the same country, but we come from different cultures.  We are the Rainbow Nation. Diverse and rich in color and ethnicity.

Our categorization of the disease in South Africa is also divided into race, as it has become all over the world. Black and white. I say this with great respect as America burns with human rights protest.

To save on PPE (personal protective equipment) I took him his breakfast. This meant a nurse would not have to don a special N95 mask, visor, gown, apron, hood, booties and gloves. No more pleasing hostess serving patient’s food on a tray with plates and cutlery in the hospital. Just a polystyrene container with food heated in the microwave. Delivered by an already tired doctor.

South Africa has always had constraints, and we all live in fear of not having enough PPE. So being able to serve the patient his food was my way of saving PPE for the tsunami we are expecting. It also allowed me to connect with him. I had to explain the delay in surgery. I reassured him that it was not going to jeopardize the ultimate result and clinical outcome of his injury. We also spoke about his work. His family. And Covid-19. We are all facing the same storm, yet each of us is in a different boat. 

Then my ward round was over. I spent thirty minutes with the nursing team going over the donning and doffing processes to be sure they were safe. Then I changed in the large change room the hospital has created for staff dealing with Covid-19 patients. I changed from hospital scrubs back into the new scrubs I wear to work every day. 

At home, after a  shower, I changed out of those scrubs into shorts and a t-shirt, and started my sanitized day.

Thank you to Laurel Braitman for the inspiration.

Durban beach baptism
Posted on by basilBLOGinc · 6 Comments

A New Sense of Responsibility

Surgery is a privileged profession in so many ways. But under the cloud of Covid-19 I discovered a new profound privilege.

I had to operate on a 16 year old girl. She had injured her knee before lockdown and we had planned a knee ligament reconstruction. She was due to come into Kingsway Hospital with her mom and be treated with care and attention in our orthopedic ward.

We had to delay surgery because of lockdown. Then the hospital closed and re-opened, and at last we were able to schedule surgery for this past Saturday.

Surgery is not about the incision. It is about the healing: people entrust their bodies to the surgeon to remove, repair or relieve. There are moments on the path that the surgeon and patient walk that stand out. There is the introduction, understanding who they are and what they want to become. Assessing them clinically and then interpreting the investigations. Discussing options and guiding them to what you believe is the correct choice. Then the surgeon has to engage about the details and obtain consent. The capacity to make choices about your body, even as a child, is enshrined in our constitution, so it is good to engage with minors although their guardians have to sign the consent.

I had an new responsibility on Saturday. In the consultation we had decided that her mother would not come into the hospital with my patient. It would be an additional cost for her mother to be tested for Covid-19, and there was also the small risk of possible exposure. 

It felt awkward at the time to exclude her mother from her hospital admission. She would be in hospital for a little over 24 hours. Even so, I had never done this before. 

That meant my patient was taken to the front entrance of my hospital by her mother. There she would be left to enter alone with a clerk showing her the way to the ward. 

This whole thing had been preying on my mind for days. 

I saw her pre-operatively in the ward. She was alone in a normally occupied three bed ward. As  healers we have had touch taken away as part of our skillset  by this virus. Our faces are guarded by plastic visors and hidden by masks. Intonation and smiles are lost, and breathing and speech is difficult. Communication fails even though the need to care is heightened.

Over the years I have had children with injuries whose parents have given telephonic consent for emergency procedures to be performed. So seeing a teenager alone in bed was not something unusual. Yet the knowledge that her mother would not be allowed in as we had decided not to have her tested for Covid-19 meant that my patient was alone because of new policies and requirements to contain the possible spread of the disease.

I felt a sense of loss in that some of the humanity of my profession was gone. When she was wheeled into my operating theatre I realized I was entirely responsible for her. She was in my care in a manner beyond my commitment to my patients before this pandemic.

It was a new sense of responsibility. It was almost as if she was my child for that moment.

Antarctica is the only continent free of Covid-19.

Posted on by basilBLOGinc

So Now Your Hospital is Open…

The seven days that Netcare Kingsway Hospital was closed completely became a long week. 

There were moments of self-doubt. Finding calm in the moments that made up the closure of our community hospital was difficult.

I was paralyzed during the week my hospital was closed. I limited my news intake, and as I don’t use social media, I was spared the barrage of funny videos, false news and frustrated outbursts that we all experience under lockdown. My paralysis left me unable to read documents that were important to the functioning of a hospital, and further, the functioning of an orthopedic surgeon in a hospital. No hospital, no function: paralysis.

It was late Friday night that I heard that we were allowed to open.  The weekend would be taken up by dusting off everything and ensuring that all the things that are vital to a hospitals functioning were working. This meant checking things like oxygen, air, vacuum (for suction) and back-up generators were all working. 

Then we had to meet to train. We had to appoint new key players in new departments that make up the new normal of working in a hospital during the Covid-19 pandemic.

So after a week of mental paralysis how do you focus when you seem to be starting in the beginning again?

My mind races and there are many answers to the many questions. The answers that ground me are not technical. They are the emotions that will enrich us: empathy, gratitude and answering the question why for this period.

Firstly we  need to have empathy, as each one if us has been to dark places in the last month. No one knows exactly what path anyone else has tread, but caring for each other is important. We need to be kind-hearted, concerned and considerate.

Secondly, and equally important, we need to be grateful for everything we have and everything that has happened to us. We need to be grateful we had time to slow down and recalibrate. We are now all more grateful to have a place of work. More than that we are grateful that the public trust us to take care of them in our place of work.

Lastly, we need to answer the why of what has , is and will need to be done. We can easily answer the what and how, but why will reveal the foundation of our plans and protocols so that the team can incorporate them as part of their fibre. United in understanding we will achieve much more than just with protocols and procedures. 

An extended period of closure for any business can be devastating. For a hospital, closure speaks to a further loss. The feeling of failure settles easily on your shoulders if you don’t stand tall. Stand on your foundations of empathy and gratitude, and answer why it happened. 

Then what we do in the new normal will be greater than we would have done before.

Posted on by basilBLOGinc · 4 Comments

What Does “Closing Your Hospital” Mean?

Toward the end of last year I was reading an article on disruption from Singularity University. The writer challenged businesses to think how they would respond if their customer base was suddenly lost. The challenge seemed to be based on climate change extremes and technological advances. It was a good article,  and I thought about it.

My hospital, Netcare Kingsway, is set in the lush coastal bush of a tall dune on the South Coast of Kwa-Zulu Natal. I thought that even with a significant rise in sea level we would not be affected. The dune is at least seventy metres above current sea level. 

So what could else cause me to lose my patients? The answer is clear four months into the new year: the economic and political chaos that has followed the Covid-19 pandemic. 

I have seen fewer patients during lockdown than the fingers on my surgeon hands. For one week in April, the Medical Centre (a building adjacent to the hospital housing over fifty doctors) in which I work was closed. It underwent a deep clean by professional cleaners brought in by our hospital management. This despite there not having been a patient or doctor or receptionist who works in the Medical Centre testing positive for Covid-19.

Since the deep clean a handful of doctors returned to consulting in the Medical Centre during the last week of lockdown. They were seeing a fraction of the number of patients they normally see. Seeing these patients during the pandemic is difficult with protocols in place to enforce social distancing, wearing of masks and visors as well as increased hand hygiene for all. With the adjoining hospital still closed we cannot use the laboratory or X-rays department to help us make diagnoses. Worse still, we cannot admit our patients for treatment, be it medical or surgical

The patients we have cared for feel that we, the doctors, have abandoned them. I have cared for over twenty three thousand individuals and families during  the two decades I have worked at Kingsway.

My last operation was on Easter Monday, over three weeks ago. Shortly after that the hospital was closed to contain a Covid-19 outbreak. My patient was a ninety-two-year-old lady who shattered her thigh bone. The theatre staff and I were in full PPE (personal protective equipment) to protect her and us from Covid-19. She was discharged from Kingsway last week. Her thigh bone was fixed and she did not get infected with the New Corona virus in hospital.

I am pleased lockdown has been lifted in phases. I am not sure if I will be able to send her flowers for her ninety-third birthday next week.

I believe that Netcare as a group has been proactive with policy and protocol before Covid-19 was declared a pandemic by the World Health Organisation. Kingsway Hospital management has upped their game: they spent on more PPE, created more negative pressure ventilation cubicles, paid staff even though they are not working, converted a day ward of twelve beds into a Covid changeroom for staff, allocated only one patient to a cubicle even in three or four bed wards. This management team ran the hospital efficiently before Covid-19. Now they are risk managers as well, dealing with unimaginable crisis after crisis that has become the hallmark of this pandemic.

We have ongoing cleaning of the hospital including with an Ultraviolet Robot since we were closed to new admissions. We have emptied the hospital of all patients and closed the Medical Centre again from the end of April and have repeated the deep clean. We have trained staff and doctors in Covid-19 protocols. We have taken a team that has always cared and been cautious, and have made them better. 

All of us are dealing with all the unknowns of the Covid-19 pandemic. For us at Kingsway Hospital an additional unknown is when our hospital will be re-opened. We have lost a great part of what defines us as doctors.

Kingsway Hospital’s front door is closed.
Posted on by basilBLOGinc · 9 Comments

The Simple Truth About Nurses

Dear Nurses

In another world I would have been an engineer sitting behind a computer solving other management problems.

But thanks to an inspirational ICU nurse I changed from engineering to medicine.

Now in this world, as a doctor, I am a humble part of the team at Kingsway Hospital that is managing the Covid-19 threat.

We are all, the public and health care workers, faced with the stress of the effect of the pandemic. There are economic fears of retrenchment and real money issues. Then there is the psychological stress of losing our right to move as we please, and with whom we please. 

Covid-19 is a disease whose spread we cannot control. Even worse, some  patients who get a severe infection cannot be cured, and will die in our care. I ask the public to think about the precautions we have to take to reduce the spread of the virus in our hospitals. We have to be vigilant: anyone can spread it in the asymptomatic carrier stage. We screen endlessly. We wash our hands so often our skin cracks. We live in masks, and as the risk increases we spend the day and night in uncomfortable protective gear. I challenge any member of the public to watch a video on the donning and doffing of our PPE (Personal Protective Equipment). Some of this process is not entirely new to people exposed to the operating environment. But I can tell you, as a surgeon, the new processes are not easy for me, and are much more demanding and tiring.

The nurses have been forced to learn so much that is new. This is not like dealing with a superbug in the sense of the word before Covid-19. Superbugs like MRSA and CRE remain a challenge for all hospitals. The management of those is difficult, and we have extended and increased our systems of safety and control for the Corona Virus at least a hundred fold. 

Some of our nurses have been in isolation, and fewer have actually been ill with the virus. Thank you to them for taking time out of your life to keep us safe. Thank you for accepting sometimes blunt orders from your hospital. I understand the trauma you have been exposed to. 

Some of nurses have temporarily lost the job they were so good at. I think especially of the theater staff, where no operations have been undertaken in over ten days. I know you want to contribute. The only way we can contribute is to train even more to deal with this threat.

Other nurses with great clinical skill have been put on point duty to man sieve and screening areas for 12 hours at a stretch, exposed to the elements. Durban is not such a mild place if you are outdoors all day. Thank you for being so patient with the public that still come in needing our hospital.

We all have to pay so much more attention to detail. The equivalent performance by a sportsman or woman would be a hole in one or an ace with every shot, or a goal with every penalty shot in soccer. There is no one that can do that. Let’s not beat ourselves up about failures from which we can learn and do better the next time.

I know we all use Facebook to stay in touch with each other. A lot of good comes out of being in touch with people far and wide, and being able to share your life with them. 

What’s happening with the negativity toward nurses by some members of the public on Facebook is just not right. But Facebook gives strength to the weak, and should never be the judge of the calling you all hold dear to your heart.

What is happening in our community with nurses being ostracized in public and common areas speaks to the lack of understanding of what we face with this pandemic.

Those people, like us, need to learn to manage their stress and ask for help. There is no need take it out on the nurses who will care for them when they are sick.

Our nurses are the superheroes of our new world. Take some time to acknowledge them. 

They will be the ones looking after your loved ones in hospital.

For those patients that die in our care the nurses are the closest they will have to family. They will be with them when their family members who want to be close, cannot. Many of the nurses will feel the pain of their passing as keenly as family, with the added weight that they may feel they failed. They have not failed.

The disease is the killer. Not the nurses. That’s the simple truth about nurses.

Winner of the 2014 MPS/ SAMA Photographic competition
Posted on by basilBLOGinc · 9 Comments

A Dream in the Time of Covid

Is this all a dream?

Six weeks ago I was placed in self-isolation by my hospital for ten days.

“I had a dream that you asked me to polish your shoes” my maid, Londiwe, messaged me a few days later. Now you should know I have never asked her to shine my shoes. Erasmus does my shoe shine at the airport regularly (I fixed his shoulder years ago so please look out for him at King Shaka Airport after lockdown). I had asked Londiwe to stay away from work until I was cleared of a possible Covid-19 infection.  Londiwe in Zulu means “protected or kept safe”; I truly hope that both of us stay safe.

I knew immediately what her dream meant.

It has been a long journey and we are still in the early hours of the first morning of the months that will unfold in social and economic upheaval. I have found it important to choose my words carefully during this time. This pandemic is a global crisis but I believe it will change who we are and how we do things for the better. At a price, I know.

Yesterday at the screening entrance of my hospital I saw the matriarch of a Zulu family with her daughter and twenty-year-old grand-daughter. They were tense, as most people are now, and were huddled too close around the Perspex shield protecting the nurse attending to them.

In my surgical mask outside the hospital I introduced myself, and then asked them to move apart and stand two metres behind one another. There was a sense of loss and fear in their eyes, from old to young. 

“I’m sorry” I said, “we need to keep social distance to protect each other.” They didn’t move apart and I stopped myself from being authoritative. 

“Can I help?” I am saying that many more times than I used to. I act on it many more times as well.

I cannot remember what the nurse said. I should. It was important. But it was a blur of “they have come to see or pay last respects” to the grandmother’s husband who had died in ICU. 

No visitors are allowed into the hospital now. No one can be at the bedside of a dying family member, and no one can gain closure by seeing or touching the cold lifeless body of the departed.

“Please wait here. I’m afraid we cannot allow you in. I will find a manager to help you”. You have to speak clearly and loudly in a surgical mask in order to be heard. That removes any tone of sympathy. The assistant nursing manager grasped the urgency and went out immediately to explain. As I turned to look back the daughter and granddaughter walked away, their souls battered by the new normal. The next I saw was the nursing manager opening a big official book, with carbon copies, for the matriarch to sign away the body of her beloved outside the hospital.

I was shattered. Even in my first world hospital I had once seen a young man reverently carrying a branch of the Mpafa tree, the Zulu Tree of Life. A Straight thorn points to the future, while a curved throw connects us to our past. He was taking a branch to the ward where his father had died. He would rest it on the on the body and capture the soul of the departed and take the branch home to tuck into the eaves of the homestead. On the way home he would buy a ticket in the taxi for himself and the spirit in the branch.

In this dream in the time of Covid I thought we could allow families to bring a branch of the Ziziphus mucronata,  the Mpafa tree, and we could put it in yet another safe plastic bag, and leave it with the body. They would never be allowed to take the branch home. It would burn or be buried with the body.

Londiwe, may we be kept safe, had a dream to prepare my shoes for this long journey. A dream in the time of Covid.

A storm over the Indian Ocean, Friday 24 April 2020
Posted on by basilBLOGinc · 21 Comments

Stay safe..

Dear Nurses

I am so proud of all of you.  You have applied yourself to everything that is new. You have patiently listened as we explain protocol after protocol, and then frustrated  you by changing it the next day. I am proud of how you showed care to my 99-year-old patient whose hair is perfectly coiffed and her makeup is ready for a BBC interview.

Like you I don’t know what day it is. I need to check a calendar to see if it’s a working day or a weekend. Not that it makes any difference to you, working shifts and three-day weekends every second weekend.

I try, and yet I fail to talk to you in the corridors and in the nurses’ stations and in your offices in management suite.  

I failed to act ten days ago when someone asked me to write something motivational for you. This is a time when failure is commonplace: the only solution is to acknowledge it, learn from it and move on. With this letter I hope to move on.

We are facing a global crisis in our little hospital that has always served our community to the best of our ability. It seems sometimes that nothing we do is enough for our patients, our hospital, the whole world. But we have not failed!

The sense of failure, the fear of not being in control, the quarantine, the concern for our families causes us all to feel anxiety.

Feeling anxious about things in today’s world is completely normal. Although I am no master, I’d like to share with you how I have learnt to deal with my anxiety over the years and what works for me now:

We need to deal with it. Learn from our failures. Consolidate and move in a new direction with calm and strength and compassion. I believe we all, and especially you, have this ability.

In our medical training and our experience at the workplace over the years we have all faced stressful moments: a patient’s death, a complication, a disagreement with a colleague. Think back to those times. Now empower yourself by reminding yourself that you dealt with those crises before, and you have the tools to deal with this crisis. You have achieved so much, and will continue to achieve.

Over the last decade I have been blessed to meet many wise and caring people who have helped me deal with fear and anxiety. The essence of their help for me can be distilled into three words: 

Remember to breathe (even if it is behind a suffocating mask).

Breathing is the essence of life, and we can control it. In the beginning just acknowledging your breath is enough. Start to feel the place where your in–breath gently fades into your out–breath. Feel your diaphragm move. If you want you can pause, and count to four at the end of each breath.

It is as simple as that. Now you have something you can control. In controlling that you can reduce your fear and anxiety. 

I salute you all. For once the world is recognising your calling.  They are appreciating your service for the greater good of humanity. They understand your sacrifice. 

Stay safe.

Ask for help if you need it.

Best wishes

Basil

Sunrise over the Indian Ocean …
Posted on by basilBLOGinc · 12 Comments

Blessing

This week sees me in the office only for a few hours. I decided to drive across the city yesterday to meet with supportive friends for lunch. All three of us are fully vaccinated.

Along the way in the suburbs there were still people parked at strategic barriers erected to prevent free movement into the suburbs. Some of the residents still stood guard. There was less traffic on the highway and very much less traffic in the suburbs.

Our lunch, the sharing of a simple meal, was punctuated with intense discussions about the ethics of what has happened to our country, and about the wisdom of the courts. Although we are close friends and understand each other, there were differing opinions. We are also generally a positive group, which is why we are friends. Somehow there was not the same energy of positivity amongst us this time.

Later in the afternoon after we had eaten and spoken, I drove to the nearby La Lucia Mall to see if I could get some grocery shopping done. The shops where I stay had been closed all of last week and I thought the upmarket area might have better stock.

The parking area was empty and there were no queues to get into Woolworths. Everyone, shoppers and workers, were subdued. I spoke to a lady shopping. We were in the meat and poultry aisle.

“Isn’t it just crazy?” I said to start the conversation.

She paused. I was still in my scrubs. She looked at me. “Hectic. I am Muslim and there is no chicken. The meat is not Halaal.”

“Get some frozen fish? I am not sure if there is any?”

“Have you just come from work?

“Yes, I closed the office. It is so quiet.” There are other reasons, like I am overstressed and have withdrawn to have time to myslef, but I chose not to tell her that.

“OK, be safe”. I echoed the greeting and moved on. I got most of what I wanted except garlic to ward off evil spirits and chicken.

On the way out I stopped talk to the manager. I asked about stock and staff, and he was positive. He stood in front of the empty in-house coffee shop.

Happy to have enough groceries for me and others that I could share with, I pushed my trolley out into the dusk of Durban winter. 

“Doctor, doctor” I heard a voice calling out. No one should know me around here as I haven’t lived in the area for five years. I turned. A young man was running toward me. He was small, and wearing a worker’s overalls with reflective safety strips.

I stopped pushing my trolley and faced him.

“I just want to thank you for what you do for people. I am so happy you studied so hard to do what you do. God bless you.”

I had tears in my eyes. I really did not know him. Yet I felt an instant connection.

He rolled up his left sleeve and pointed to a scar on the funny bone of his elbow. “I have had a debridement” he said and pointed to his elbow. “I have met doctors like you.”

Lucky Ndlovu had no idea I was an orthopaedic surgeon. Thirty years ago I would have treated young men like him for injuries with debridement, a French term for removing damaged tissue. I debride aggressively now, and then hand over big skin defects for my plastic surgeon to close.

Our country needs a debridement, I thought to myself.

Lucky was truly grateful. I was moved. I took his number. We chatted a bit. When things are better I will go back to the La Lucia Mall and have a meal with him and talk. He inspired me more than he knows.

He alone, with his open gratitude, has given me hope to carry on.

My cherished messages from a stranger.