Well I’m back again! Just posted my final entry from Somerset West. This week I made the multi-day driving journey to the Wild Coast of South Africa. I luckily have upgraded vehicles from my old 1983 leaded gas guzzler Mercedes Benz to a 2009 Honda Jazz 1.5L hatchback. My god, drives so well, tight steering. Good thing because the drive from Cape Town to the Wild coast has these windy, mountainous, awesome roads… it feels like you are in a video game. Its about 1300km, to the wild coast.
The drive from Cape Town to Port Elizabeth is called the garden route… must be because of how beautiful it is. Right along the coast, through small river port cities, large resort areas, various game reserves. As you keep driving things get more rural, mostly small towns between port Elizabeth and east London (two major cities). Many townships, with just corrugated steel homes.
On Sunday I left for Zithulele hospital. I had no idea the adventure that in store. I get off the major N2 highway toward the coast, which drives by the small town of Mqanduli, and on to Coffee Bay. I stopped at the Mqanduli Super Spar grocery store to buy my food supplies for two weeks! Not so easy to do. As I began the 70km drive to Zithulele white clouds turned dark, and a fog began to….
Holy crap, quick time out. A big rat just ran into our little hut. I tried to get it out and it jumped on my legg. Ahhhh. We cornered him and he politely left…
Ok, so yeah it was super foggy and the tar road had more potholes than functional road. My poor avis vehicle… After 50km of some amazing swerving and slowing down, I got off on the dirt road to Zithulele. Only issue is that the whole 17km is totally under construction, and it’s the rainy season. So it was so gnarwly, sliding all over, mud splashing everywhere, crazy lane changes, haha. I almost hit a cow. A dog. A horse. Some drunk guy with a walking stick… that was a close one. Tons of locals, dressed colorfully, all asking for a ride…
Finally I make it to the hospital, surrounded in small steel huts, wonderful African music playing from the funny little auto shop. I am directed to the student housing, which is a round hut (a traditional structure called a rondavel), with thatched roof, about 24 ft in diameter with a kitchen and bathroom off of it. I met Graem, a medical student from Johannesburg and Kathlene, another medical student from the UK. It is a sweet little place, kinda like being at summer camp, except I’m in Africa.
It is the rainy season so lots of low clouds, fog, thundershowers, with days of sunshine in between.
Day one at hospital. Surprisingly, the hospital has some wonderful facilities. Lots of new buildings, with big open wards, windows, covered walkways.
The language spoken by patients is primarily Xhosa, no Afrikaans or English unfortunately. Luckily there are lots of nurses who translate for the non-xhosa speaking doctors. In the out patient department every morning, the patients and staff all sing! Its really cool. Why not, they are waiting. Imagine a waiting room in the US belting out in song… meh, US is way to reserved.
Once again, my first day at a SA hospital began dramatically. We were doing rounds on the female ward, and we saw one severely ill 30yo HIV/TB patient. She was a bit confused, rapid breathing. We couldn’t get a good signal from the oxygen saturation monitor from her finger… As we moved to the next room the nurse grabbed us because the patient stopped breathing and had died.
30 yo mother just died. Nothing else to do, she was already on ARV and TB medications. I imagine this won’t be the first death like this.
In the OPD, we saw one patient who was assaulted. He needed a police report filled out, except he had lost his health history folder. To make things worse, the doctor who initially saw him and who needs to fill out the form was away in Mthata until tomorrow. We apologized, and he said he would stay overnight here.
Confused, I asked the Dr. where he would sleep? She replied, “likely on the beach.”
Transport is so difficult when the roads are wet, it is interesting how some patients just get stuck here without a formal place to stay.
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Did my first lumbar puncture today. Not so difficult after all. The doctors here just grab you to do something, “hey you wanna do an LP?” The doctors say the locals are not like US or European patients that scream and yell. Patients here are very strong, and have high pain tolerance. I guess it’s a cultural thing. It makes being a student much easier, since you can be calm, the patient is calm, and you can get confident in your skills.
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25 yo M was assaulted with a broken bottle and had a huge slice around his ear down to jaw angle. He came to clinic because even though the sutures put him back together, still had a facial nerve palsy. After some effort, we got ahold of a surgeon in Mthata (referral hospital in the region), would wait until January once the inflammation had calmed down.
Drunken violence, not fun.
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Apparently every doctor in South Africa and even the international students use a book called Oxford handbook. There is like an emergency medicine and procedure one, medicine, surgical one. They are amazing! Its great because it has more than just clinical medicine, but like OB/Gyn, procedure, casting… it just a great book to have here since everything comes at you. I’m going to definitely buy one when I return.
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One really cool thing is that patients all have their own health history book. Whether they go to a local clinic, hospital, ARV clinic, they bring it. So in addition to inpatient notes, doctors also fill out a summary in their book in case they leave the area or they show up in OPD (hospital charts are not readily accessible in clinics). The funny thing is that they are these colorful exercise notebooks. Some are small, some are large. Some have newspaper covers folded on. Regardless, these patients have a better record of the their health history than the majority of Americans! We have our electronic and paper records everywhere and we say, hey clinic/hospital, yeah you just keep track of it… I think we should definitely move toward patients keeping a electronic copy of all their records so no matter where they go, they have the info. Some books are really beaten up, but its obvious that the community has embraced the concept since everyone brings theirs.
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During morning meeting, one of the doctors was concerned about the lack of open male ward beds. Turns out, some patients had been discharged but just never left! So some had been there for a like a week, kinda like a hospital motel. What a crazy place. Not sure who’s job it is to get them out. In the US, I guess most people run out of the hospital trying to reduce the damage to their wallets…
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For patients who need more specialized care they are transferred to Mthatha. Transfer should be easy right? Well the road to the hospital is really bad, and for whatever reason their was an argument with the ambulance service so no one was being transferred. It is crazy because it’s not like you can just call another service, options are limited out here. One of the main docs ended up going to Mthatha to meet with the ambulance service to sort out the dispute.
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Very interesting case showing interplay between culture, health and medicine:
16 yo boy, painted in colored mud and covered only in a traditional blanket. He was participating in his puberty rite of passage and last week had received a community circumcision. For a few days he has had pain and discomfort from his penis. Luckily his family was Ok with bringing him. Some families would disown a son who sought medical attention during this very important ritual. His penis was wrapped in a long dark cloth… when we exposed the head it was infected. He was in severe pain. His family consented to him being admitted, and we pumped him full of antibiotics and continuously cleaned the wound for a few days.
Apparently in the Eastern Cape about 55 young males per year are lost due to complications from circumcisions. Most are issues related to unsterile instruments, and not properly trained practitioners. Its easy to assume a judgmental stance, but I think its better to think about how to improve the problem. Some areas are bringing doctors and the community members who perform the surgeries to meet and discuss how to reduce the morbidity and mortality. One of the head doctors said some cases of septic penis are so bad that they can actually lose a part or all of their penis. It just become necrotic. And complicating the problem is that the boys typically are not allowed to drink fluids for many days, so they come in severely ill.
Definitely never learning anything like this in the US. I’m definitely in Africa…
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Well that’s a bunch of random stuff. Its already my third day. The sun came out so I went to the beach for a few hours after work with the other students. By beach I mean, we drove 20 minutes on crazy, bumpy road past huts and over huge hills. Ending in this magnificent beach, with only us and some local kids playing soccer on the sand. Soon after we arrived the clouds rolled in… likely rain and t-storms again tonight.
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