Well unbelievably, my time at Zithulele has ended. 6 weeks have absolutely flown by. 3 months have flown by. I guess I'll write some experiences I've had in my final week, and then have some final reflections.
So I am sort of an idiot. I entered the country on a 3 month visitor visa, but thought I could just extend it last minute. In fine print you need to apply for extensions 30 days before. On the day of expiration Jan. 11th I thought I should probably call home affairs, and they informed me that if I did not visit them that day I would be slapped with a 2500R fee and potentially barred from visiting again for a year =o. Whoops. So I promptly made the 1.5 hr journey to the Mthatha home affair, and faced a very scary large black woman. Luckily I came with a formal letter from the hospital, and somehow charmed my way into getting an extension! I was sweating bullets, but knew that it would work out. Seems like that has been the general flow of things here. Get pulled over by the police, tell them you work at Zithulele, and they let you go...
On a lighter note. A few weeks ago I was on the paeds ward helping out with rounds and I saw one of the mothers playing peak-a-boo with her baby using her breast! I was laughing so hard. The baby would get so sad when she'd put it away, then just giggle and smile when she showed it. It was even funnier when the mama noticed me. We just laughed and laughed. Maybe all mothers do that, but it’s new to me.
In the past week the hospital has become sort of famous for the MEASELS OUTBREAK!!!! aHHHHHHHHHHH. Shouldn't everyone be vaccinated... Well guess not. Not even the doctors are immune. The two main female doctors and the new community service doctor got measles! 2 of them went to get hospital care in east London! It’s hit the local and national news, and the health department has been working on it. Any kid that comes in with a new rash, cough, conjunctivitis its MEASELS. Now there is a measles ward for adults and kids. Craziness. We can do IgM urine and blood to confirm the acute measles infection, so that’s great.
So don't remember if I talked about this kid before, but he is a young teenager who came originally presented with severe edema. Turns out he had severe nephrotic syndrome, and he came back as an atypical acute hepatitis B infection. Eeks. Really bad news for that guy. So we sorted him out, got his edema under control, and did some over the phone renal consulting for med management. Well a week later he ends up in my OPD room with a cough, rash, and conjunctivitis! So here is this kid with acute hip B w/ complications, and now measles! I don't think he really knew too much about what was going on, but he looked miserable. Crazy how young people can get so sick from preventable illnesses.
My last week I prepared for my presentation on palliative care and pain management. I informally interviewed the OT/PT department to learn what they can provide and gave the long term (>1 year) staff a questionnaire to assess how the hospital was doing with pain and end of life care. Very interesting responses. I will attach some of the slides. One of the head doctors recommended that I create some guidelines for the hospital handbook for chronic opiate management. Some sort of formal protocol for the nurses and doctors to fall back on. When I get some free time for a week I'm going to take on that challenge. It will be a great learning experience for me.
To download my presentation visit: http://www.mediafire.com/?flmonn15con
In the unexpected page of the local news. X-RAY is BaCKKK. haha. So crazy. One morning this white guy with red long hair showed up at the hospital asking where the ultra sound machine was. I said, "holy crap, are you the x-ray Guy." to which he responded, "yeah..?." I remarked, "It’s like the messiah has come!" By the end of the day it was fixed, that easy. It is funny because it took some time to actually sink in that there was x-ray. Like I would take off a cast, and be like, hmm don't know if it’s healed... And the PT was like, "why don't you x-ray it idiot." haha. It was fun not x-ray for a while. Makes you really appreciate medical technology. But still, it makes medicine more fun to use your physical exam skills then confirm with the scan (or just skip the scan when you are confident in your exam skills).
Second to last day, I caught the head doctor quickly wheeling a 32 week pregnant female to the maternity ward. Turns out she was actively seizing aka fitting. She had ecclampsia. Really long seizures, very scary experience. We ended up stopping them with benzos, and then protected her airway. Over Christmas she had come to OPD for some nipple discharge issues and her blood pressure was mildly elevated with some trace protein. Crazy how it progressed. We transferred her to Mthatha.
I know there are tons of other stories to tell, but I think I've written a good variety of them to get a feel of my experience. Also, I got lazy and didn't write them down as diligently my last week.
And thus ends the Wild Coast portion of my blog. I am heading back to Cape Town to visit family before I return to the frigid Midwest. Below is my thank you note to Zithulele.
"Dear Zithulele Hospital,
Thank you so much for an amazing elective. I had such a fun time with all of you. Learned a ton and it has given me a new perspective on rural medicine. Thank you for your generosity and making me feel part of the hospital community. I am going to tell all of my colleagues about my experience and hopefully you'll get more students from Minnesota. I will never forget this experience and hope to return in the near future, as a resident. I'll miss all of you!!
Sincerely,
Justin"
Going to Zithulele was the highlight of my trip and medical training thus far. It was challenging, fun, educational, exciting, and life changing. I am returning to the US a much more confident individual and future resident. Doing this whole trip completely solo has taught me a lot about myself. I'll never forget the moment when I blew out my front tire while I was driving solo back to the hospital on an isolated dirt road. No cell phone, no AAA, you just have to deal with it... Just like doing medicine here, this is the problem, and you have to sort it out. Being in the US in a major city, you just don't get those moments often! What I will remember most are the people...the incredible family doctors, skilled therapists, local nurses, volunteers, medical students from all over Europe, and all the crazy international backpackers and capetonians. So many new friends and wonderful experiences. I can't help but just smile. It will be months before I fully digest everything.
When I arrived in the US, I went through the customs line, where a very Minnesotan officer stamped my passport and in a cheerful local accent smiled and said "welcome home." Welcome home, hmm. Welcome home to the US. Here I am arriving home, partly excited, partly not. Within the first few weeks I felt at home in South Africa. I had been there a few times already; my Grandma grew up in Cape Town, so I have much family there. The customs officer has made it apparent that I now have two homes, the US and now South Africa.
It is now February 6, 11am. I am now back in the US. I returned Feb. 1st, and have been acclimating for the past few days. I am actually now on a plane to my next medical elective on the big island of Hawaii, specifically Kona. The elective is focused on integrative medicine and the healing traditions of Hawaii. More to in the near future. Weather forecast is 80 degrees F and Sunny.
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