It is already my final week. Crazy! I finally am feeling comfortable here. I’m still slightly under the weather. I think the flu or whatever it was knocked me down a bit, so I’m trying to sleep more.
Yesterday I assisted with a few surgeries, among other things. Today I went back to Gordon’s Bay clinic. The other Stellenbosch medcial students finished their family medicine elective so it was just me and one of the community service doctors (3rd year resident). What a fun time. A packed waiting room of patients, and two very young looking doctors, haha.
Once again I reminded of the violence that is occurring under most foreigners radar. One elderly patient was visiting Hermanus, a cute little beach town known for whale watching. Actually I was there just this past weekend with some of the international medical students. While walking home from a restaurant someone assaulted her, kicked her, and bashed her head into her car window. She showed me the pics. Unbelievable. I couldn’t believe that could happen in such a safe looking town. Well since the event she has had constant headaches, and was in tears when talking about her experience. Her private general practioner wanted her to get a CT scan, but she couldn’t afford it. So she was asking for a referral to tygerberg… In the states, she would have had one at the small hospital, or within a few days. Does she need one? Here is where clinical judgment must rule out, since there needs to be clear indications to scan. Things get interesting when resources are limited, and you can’t just do every test. We decided to refer her to the hospital outpatient department to re-assess her in a week.
I also saw a handful of patients with issues of high blood pressure. Many patients come just to get theirs checked, I’m not sure everyone understands the physiology or contributing factors. It is interesting how similar this is to the US primary care clinics. Many of the patients are overweight, low activity, and relatively young. Just like in the states, medications are prescribed easily and only little energy is given to education. I tried my best to encourage one patient to increase her vegetable intake, less on the rice, potatoes and meat. At only 34yo, she was on a scary path. The governmental system was created to provide medical care, but there are limited resources to encourage healthy living behaviors. Wouldn’t it be great if the government would pay for visiting healthy behavior counselor for those patients at high risk. They could come to your house and help cook a healthy meal, set-up goals, work with the family. There has to be a better way to encourage healthy living than leaving it for a few minutes at a primary care clinic. You’d think a governmental system so limited in funding would be much better at this than our bloated US system. I mean if ½ of their hypertensive patients with risk factors improved their diet, and got more active, imagine the money saved in hospital costs from downstream diseases.
I am heading back to Cape Town to stay with family before making the long drive to my next hospital. I hope I will be able to apply my new knowledge and skills. The cool thing is that the head doctor said any other medical students from UMN could come to the hospital. Thanks a great experience.
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