It was a plain and ordinary wednesday afternoon. We found ourselves back logged between 100 odd patients all waiting to be seen at the soonest. Nothing unusual in my part of the world. We had worked tirelessly into the afternoon to try and clear the dreaded “bench” which consited of rows of wooden benches with no back rests that seemed to be the root cause of most patients back pain.
The volume i could eventually come to terms with , it was the monotony that was the problem. Just as i had settled into the redundancy of the chronic hypertension and diabetes, a nurse yelled for “a Doctor”. I excused myself promptly, almost relieved. Hopefully some action, i thought to myself.
As I entered the emergency room i knew there was trouble. The shrill of the Sisters voice should have given it away, but i remained foolishly hopeful. Mkhulu was around 60 years old , well built with a rounded belly and grey twirls of hair.
At first sight i knew there was a huge problem, I saw all the monitors attached to him flashing red with alarm bells ringing off, my adrenals began to kick in. What struck me first is the fact that He was drenched in sweat from head to toe. It had seemed as if he was bathed fully clothed before presenting himself to us.
His eyes were blood shot red and tears flowed freely onto his plump cheeks. He complained of severe abdominal pain and long lasting diarrhoea. I was surprised he could speak given his pulse was only 30, The usual range being 60 to 100. The ECG monitor screamed continuously as it plotted out his rhythm; sinus bradycardia.
I gathered a quick history and began examining mkhulu simulatneously. Besides his hypertension he seemed to be in good shape, so what could prompt this bizarre episode of a low heart rate?? He was bradycardic, with a low pulse and sweating from every orifice but surprisingly he looked well.
My mind began flipping through every text book i have ever read; searching for answers of this mysterious problem. Heart attack? Stroke? Poisoning? Infection? I probed and prodded, my questioning like a mad woman. “Mhkulu did you eat any other medication? Any traditional treatment?” He looked at me at point blank and denied any ingestion.
He clutched his coke bottle tightly and began sipping intermittently.
Now anyone who lives in South africa has to admit and appreciate that events that happen here will never happen anywhere else in the world. The sheer uniqueness of the South African way is a comical one, to say the least. Be it our corrupt government or the day to day activities which turn out to be more weird than wonderful. Expect the unexpected, as i was about to learn.
As I proceeded with the examination I noticed his abdomen to be a little distended so I began palpating. “No abdomen exam is complete without a per rectal exam” said the wise ones before me so i proceeded down under with my trippled gloved hand.
Nothing could have prepared me for what I found. It looked a nasty shade of green and as I prepared to dive away from the unsuspecting green muck that may have followed,but i noticed the unusual texture. I decided to explore instead.
In his rectum I retrieved a piece of sponge, and a small piece of green sunlight soap all neatly packaged with a leaf over it. I was shocked out of my wits. There was obviously an element of herbal medication at play here, although I had ever seen this type before.
I looked at mkhulu suspiciously as he looked away avoiding my glance. I guess technically he didnt lie as he didnt ingest the herbal treatment, just decided to insert it in the behind.
My mind began racing to puzzle together this mystery and my adrenals spiralled out of control. A Sponge, sunlight soap, herbs and plants, bradycardia, sweating, diarrhoea. Beside it being an interesting south african combination, it suddenly made sense to me.
I immediately jumped and ran to the emergency trolley and retrieved atropine, the antidote for organophosphate poisoning which is a pesticide used on plants, and injected it into his drip, watching his pulse rise steadily. My muscles finally relaxed.
Once the parcel was extracted from the rectum, the story fell into place. The mkhulu was feeling a bit weak and lethargic so he consulted a traditional healer who happened to be his neighbour, he then instructed him to insert the special mixture into his rear end. He obeyed and allowed the medication to work for 2 days before becoming unbearably ill.
It was obvious that the plant and herbs which were used were coated in a pesticide that was absorbed into his blood stream producing the classic signs and symptoms of organophosphate poisoning.
After a few hours mkhulu was fit as a fiddle and ready to go home. He sniggered at me as I left him a departing request to to please leave the sunlight and sponges in the kitchen.
The lesson i had definitely learned is the country we live in is a vastly interesting one. A big melting potjie pot of various cultures , beliefs and traditions which make us who we are. I have always taken a keen interest in various home remedies and rituals different cultures perform to cure different ailments, it is absolutely fascinating to understand the reasoning behind it.
It reminds me of a time when I found myself in the emergency department with a Sangoma, a goat, and a young girl who was possessed by an evil spirit… But ill leave that for another blog post!