Hottentot Holland Hospital

Day 1:
Today was my first day at Helderberg Hospital. What is curious is that, a few years ago the name was changed from Hottentot Holland hospital (HHH), yet none of the signs from the road or on the hospital have been updated.

I am living with a Swiss medical student who speaks German and English. His name is Silvan and is doing general surgery and has been at HHH for 3 weeks.
There are like 14 national recognized languages in South Africa, from Afrikaans, to xhosa. Somerset west is in a very africaans area, which is really a crazy mix of dutch german and English. Usually every other sentence is English, so they mix languages together.

Here in South Africa medical school is 6 years right out of high school. Then you do 2 years internship in just general subjects, plus an extra year of community service (at a remote or underserved site). After that you are a general practitioner. Then if you want to specialize you do it after that. That means to do internal medicine and then GI, you would need to do like 3 years IM and then a GI fellowship. That’s a lot of years, but it is great because every south African trained MD will have atleast 2-3 years of just general medicine skills (you name it, they do it).

The doctor who is the student coordinator is Dr. V. He is a very youthful, fun guy, who has been at HHH for 13 years. Originally he wanted to do surgery but fell in love with family and community medicine. He is actually trained in hypnotherapy! Very cool. At the hospital he runs from outpatient high risk OB clinic, to doing C-sections, ectopics, appendectomies, then does medicine rounds. Here family medicine means, you do it all… As he put it, you become a “master of all trades.”

Turns out I am the only the second US medical student to spend time at the hospital. Lots of Germans and other Europeans visit. He is excited that I am interested in seeing everything, because most foreign students come just to do surgery.

The staff is a mix of young interns, young attending, local SA medical students, and international students (a german, sylvan and me).

My first day started dramatically. We are called to the maternity ward for a full term xhosa woman who was transported by ambulance from a surrounding clinic for active labor and cord prolapse. The women was laying on bed, her membrane had ruptured, and was having contractions. Surprisingly, the feeling in the room was very calm, the mother seemed neither excited nor worried. The intern used an older model ultrasound to look for the fetal heart rate, and only found a faint irregular bradycardic rhythm. Using suction, a very pale blue baby boy was delivered. He was not moving, no crying. Cord cut, to the room next door, chest compressions, oxygen, few attempts at IV placement… After a few minutes there was no sign of life. Dr. V and I walked back to the mother, “I am very sorry, but your baby had died.” She relied, “Died?” “no no no…” Shrieking and crying. “oh jesus, why why.” I didn't quite know how to process what I just saw. It was such a beautiful baby boy, and there he was not breathing... If only she had come earlier. Dr. V put his arm around me and said, “Well Justin, welcome to Africa." There are more patients to see.

The rest of my day was spent in the high risk OB clinic. To be high risk you need to have a hx of pre-eclampsia/HTN, previous complicated pregnancy (aka, ectopics)… What is interesting is that have a previous C-section puts you as high risk. How different is that than the US where c-sections seem to be the norm. Here it means something went wrong, so we need to watch out. Patients are called in groups of 4-8 and then seen one by one. HIPPA shmippa. Efficient and effective is the name of the game. Ultrasound is available, there is a skilled tech onsite to do AFI and dating.

Here they expect you to do the full Leopold maneuvers… man oh man, they still do those. Luckily he had time to teach me.. Within no time I did them on all my patients. By the end of the day I felt pretty confident.
39 week gestation, just seen for the first antenatal visit last week at an outside clinic. Now her first time here. She comes with her green card that all pregnant women are given in the governmental system (pregnancy hx, fundal growth, tests). It is my job to do exam and ask the pertinent stuff, checking your work consists of the attending popping their head in for a second. Hmm, can’t feel the head of the baby engaged… Pressing on the vertex… could be a head or just the butt. Ultrasound is busy. Pt was sent for an abdominal x-ray to see where the head is… Wow, didn’t know you could do that. The goes off for a bit and returns with her films. Baby is breech. Very cool to see an x-ray of a gravid female, don’t get to see that every day. Plan totally changes, now a scheduled c-section in a few days. Good thing we picked that up. Thank you Leopold, looks like I underestimated your maneuvers.
Another patient with epilepsy (well atleast thats what we called it), being managed on tegretol… Drug levels? Too expensive said Dr. V, they do the best med management they can without blood levels.

The rest of clinic consisted me calling for patients to a full waiting room with like 50 people, all staring at me. Eeks, how do pronounce ‘Ndw.’ I butchered the name, and I could hear the young docs having a chuckle.

It seems as though the general consensus is to work hard, but have fun. I couldn’t ask for a better match for me.

The day ended with a ruptured ectopic pregnancy… whaa… No general surgeon… Family doc specialist scrubs in. Open her up, clamp, cut, clamp, suction, sew her up… All done. No cautery, no fancy tools, get in and get it done. Wowza.
Well what a crazy, exciting, and full first day.