Christina Munford

KwaZulu-Natal Province

Language: Zulu

Area: 2.2 Sq Mi

Population: 5,534

Density: 2,500/sq mi

One of the most HIV prevalent areas in the world

Manguzi

Founded in 1944

280 beds

Majority of physicians there for 1-2 years on requiredcommunityservice

Majority of patients are HIV + and many exposed to TB

35 Mobile Sites Physician/nurse

visits about once per month

11 Clinics Staffed by nurses Physician visits 1-2

times per month

1 Hospital

Traditional healers

Believe that body, mind, spirit & ancestry are connected

Believe that sickness is caused by witchcraft or punishment for disrespecting ancestors

There are approximately 200,000 Sangomaswhile only 25,000 trained doctors in South Africa

About 60 - 80% of the population will consult a Sangoma for their primary care

Sangomas provide care through a variety of ways Speak to patient’s ancestors for advice and guidance Animal sacrifice Curative medicines called Muthi Cuttings

Muthi may contain: Animal or human

products (bones, brains, skin)

Plants, bark, herbs Chemicals, oils,

minerals

Concoctions can cause: Vomiting/diarrhea

severe dehydration Hallucinations

i l

Sangomas will make multiple incisions on patients skin

They will then rub muthi concoctions into the cuts

This leads to infection, pain and multiple scars

During my time at Manguzi hospital I saw the many negative effects of Sangoma and muthi:

Babies with severe malnutrition secondary to muthi

Patients stopping ARVs per advice of the Sangoma

Advanced diabetic feet that failed sangoma treatment resulting in amputation

Unfortunately not much.

The Sangoma is a very significant part of South African and Zulu culture

The hospital must work to educate the community and it’s patients while respecting their beliefs

I saw this being done through patient counseling and outreach clinics

Patient: 32 yo M with right hand tendon injury by machete

Procedure: Tendon repair under local anesthetic (the patient watched!) A tourniquet was placed on the patients arm and he was given

lidocaine boluses for anesthetic

The Mistake: nurses removed the tourniquet and all of the lidocaine went to the patients heart at once The patient went from unconscious to seizing to psychosis

with severe tachycardia The hospital had no lipophilic agents to bind the lidocaine,

thus we had to just wait it out

Lesson Learned: Release the anesthetic a little at a time

I was able to assist in a “caesar” (c-section) in the operating theatre (OR)

During the case I started hearing singing, I assumed it was a nurse, but when I looked up the patient was singing in Zulu

The entire OT filled with both male and female nurses joined in. It was awe-inspiring.

Lesson Learned: Culture is beautiful and unique, appreciate every single opportunity you have to

be exposed to it.

Sundown (sunset) on the Water Tower

Pool Time!

Our Grocery Store

Elephant

Impalas

Monkeys

Snorkeling!

Estuary

Baby Sea Turtles

http://www.southafrica.net/za/en/articles/entry/article-southafrica.net-traditional-healing1

https://en.wikipedia.org/wiki/Traditional_healers_of_South_Africa#Beliefs_and_tradition

http://www.capechameleon.co.za/printed-issue/issue-24/cover-story/

http://www.avertaids.org/avert-south-africa.html