Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps.


07cc7967ffd26d872fce5dafe4e3bd86The smell of blood permeated the ward I walked into that morning. Twelve beds with twelve women, who would be discharged that day and replaced by twelve more. And again. And again. Some women did not meet my eyes. Some looked angry. Some resolute. But the teenagers implored me with their big doe-eyes, waiting for me to pull back their sheets and discover the expelled products between their legs.

The night staff regularly refused to help the patients admitted for pregnancy termination. “It’s your mess. You clean it.” Many women would lie helplessly at night, groaning in unrelieved pain, with no assistance from the nurses sworn to care for them.

I was just an intern. I did my best. But maybe I should have done more.


4457445e1daf992adfbc37a6aa68a7e0An unidentified woman stumbled into the labour ward. Her long skirt was sticky with blood. She was diaphoretic, and breathing fast. She was weak with low blood pressure. She would not – could not? – speak.

“I think… I feel… bone shards?” the registrar reported on the vaginal examination.

An informal abortion gone awry. We will never know who did it, and the woman will never find justice. Abortion deaths were common in the days before legalisation. Our elders in medicine remember them well. These days, we are not meant to see women die from septic abortions. But that night, we did.


Today is the Global Day for Safe and Legal abortions. I feel like this protestor: I can’t believe we still have to protest this shit. How hard is it to leave women’s bodies alone? How hard is it to back off, and respect our autonomy?


I am tired. Tired of hearing how women must run from pillar to post to find a facility that will help them, because so many healthcare workers choose to “conscientiously” object. Conscientious my foot.

A very important report; worth reading. Click the image.

And I think that instead of suggesting a list of things readers can do, I’ll name just one:

Talk about it. 

Even just with your closest friends. If you can, talk to your colleagues. To family. Say the word out loud: abortion. Break the silence. You don’t have to have had an abortion to believe in choice and safety. Your voice is just as loud.

Say it.

I believe in the bodily autonomy, safety, and right to choose of all womxn. 

I believe that legal abortions are integral to the health of communities. 

Statistically, abortion is an everyday part of life. The sooner we start treating it that way, the better.




Off to climb a mountain

I’ll be flying off to Kenya today, on a Wilderness Medicine course. I never even knew there was such a thing as Wilderness Medicine, but this year has been a delightful discovery in medicine. If you want to follow us, you can click or follow @WildMedix on Twitter. I’ll give a proper update when back in the country!

Stop telling your depressed friend to go for a run

Gratuitous selfie at the top of Chapman’s Peak. This was a good day, and I DID feel pretty high.

“Go for a run, you’ll feel better.”

If you’ve ever been sad, you’ll have heard this. If you’ve been depressed, you’ll have heard it ad nauseum.

What depressed person has the energy, let alone the motivation, to go for a run? Realise that “going for a run” is a multiplex of tasks. First, you must get out of bed. Then, you must get dressed. You must put on shoes. You must (preferably) eat something. You must unlock the door. You must step into the sun. You may have to greet the neighbour. You must put one foot in front of the other. Then you must do it faster, and remember to breathe.

Some days the only thing a depressed person can do is get out of bed. Some days, that will be there achievement.

Image via Odyssey

I’m a runner (sort of). I’ve had the elusive runner’s high. But I’ve always known that running does not and cannot cure my depression. Until recently, I could never substantiate it.

Earlier the year, I attended an Essential Pain Management course, by Professor Romy Parker of UCT*. A large part of the course looks at chronic pain, and naturally there were a lot of parallels with major depression – one such parallel being the endogenous opioid system.

Endogenous opioids are those little chemicals that make you feel good. Endorphins – the ones you get from chocolate and (good) sex? Those are endogenous opioids. The runner’s high involves endogenous opioids (it’s probably a bit more complicated than just that).


As any student of biology will know, for any enzyme/peptide to have an effect on the human body, it must have a receptor. Serotonin has receptors, and that is why we have SSRIs. So do norepinephrine and dopamine. And so do endogenous opioids. If the receptors become damaged, or desensitised, or up- or down-regulated, the effect of that peptide changes. And that is when we get pathology, like depression.

Many people know the monoamine theory of major depression (and much of mental illness, actually). Serotonin, norepinephrine, and dopamine are all monoamines; and the idea is that changes in the levels of these peptides, be it by production or absorption, will bring about changes in mood.

What is less well-known is that many other compounds are involved in the regulation of mood. We know it, but we don’t know it. We talk about endorphins, but we don’t recognise that we are essentially referring to endogenous opioids, and that these therefore play a role.

Much recent research illustrates that opioid receptors in the brains of those with major depression are somehow dysfunctional, compared to the brains of neurotypical individuals. In other words: people with depression (and chronic pain, and some other illnesses) do not get the same effect from endogenous opioids as do healthy people.

So, when you drag your depressed friend out of the door and make them run, you are not helping. They won’t feel better. They started the day off depressed, and after their run they will be out of breath, sweaty, in pain, and still depressed.

There are other ways to help, but this is not one of them.

For more information:

  1. Dysregulation of endogenous opioid emotion regulation circuitry in major depression in women; Kennedy, Koepe, Young et al.
  2. Major Depressive Disorder: Looking Beyond Monoamines (pdf); Gus Alva
  3. Endogenous opioids: The downsides of opposing stress; Valentino, Van Bockstaele

* I highly recommend attending this course if you find one near you. Check out the EPM SA website.

Anatomy: my big mistake

I had a little giggle to myself while charting the notes of a patient with shoulder pain the other day. Specifically, I was thinking of this post of yore, and my belief that I could get by just knowing what anatomy looked like, and not necessarily its various descriptions and qualifiers.

Boy, was I wrong. (And young. And obstinate.)

Image via

Continue reading “Anatomy: my big mistake”

Finally had my “magical paeds moment”

Not the same child, photo with permission.

The little girl had come in hurt and bleeding. No too bad, a small gash that was easily approximated and taped (gosh, I love steri strips).

Next: the Tet tox.

She doesn’t know about it yet. For a moment I consider not telling her at all, but she is old enough to feel betrayed. So she sits on her dad’s lap, and we tell her about the special injection that will prevent her from getting sick. We may have used some imagination and invoked superheroes, too.

I braced myself for the struggle the moment the needle pierced her skin.

Nothing. Nada. She sat chewing her candy while I taped the injection site.

You know all those cute videos of doctors giving kids their shots without them noticing? I finally got mine, and that felt kind of special. Sometimes, you need just one small success to give you a bounce in your step.

Read This Book: An Unquiet Mind

11552857I love that more healthcare workers are talking about depression these days. It’s something I did not see while I was studying, and that meant that I felt very alone. You might even have seen (or participated in) #crazysocks4docs, which was meant to highlight the high rates of depression in the medical profession. (Some took exception to the term “crazy” – but I’m not going to discuss that right now.)

Anyway, more and more HCWs are doing their part to delegitimise stigma by sharing stories of their own depression. But some mental illnesses are still “off limits” – bipolar mood disorder and schizophrenia, for example; and it’s not hard to know why. For a doctor to get sad and burnt out? Most people can wrap their heads around that. But few are comfortable with the idea of an “unstable” doctor. Society hasn’t become comfortable talking about those disorders that may lead to losing touch with reality. Continue reading “Read This Book: An Unquiet Mind”

The Best GP Advice I’ve Received: Part 1


(c) Simon Prades

The night before my first shift in general practice, I frantically messaged one of my doctor-heroes on Twitter (@sindivanzyl). I think I was hoping for a cheat sheet, something about hypertension and diabetes, but the one thing she emphasised was, “Please, please, always examine your patients.”

For medical students that would probably sound absurd. Duh, how can one not examine the patient? 

But I learned quickly that, in an environment where there are always more patients to see, it is sometimes easier to make a quick observation from across the desk than to do as we have been taught. Continue reading “The Best GP Advice I’ve Received: Part 1”

An Africa Day Collective

Image via Mocha Club

Today is (was) Africa Day. My favourite way of celebrating Africa is by celebrating her literature – and by implication, her narratives.

I have loads of posts about South African books, but not one about the continent. Here is a handful of my favourite pan-African books. There are many more. I am shamefully missing a bunch of countries on the continent – please do recommend some good books in countries not listed below. Preferably written by an author from the relevant country. Continue reading “An Africa Day Collective”

Doctor. Counsellor. Freedom Fighter.

She was a healthy young woman who came to see me for a “complete check-up” before a holiday overseas. Although I tend to think “complete” check-ups are somewhat overkill, they do present a good opportunity for health promotion and disease prevention. As one does, I asked about sexual history and family planning. She hesitated just a split second before answering, “Well, my only partner is a woman, so I don’t have to worry about pregnancy scares.” And then, we moved on.  Continue reading “Doctor. Counsellor. Freedom Fighter.”