Victoria Hospital

The group with Dr. Nasif Van Der Schyff!

On the Move…Almost!

Last night we made our debut at a club called Tiger Tiger, which was located in a local shopping mall.   Even better, there was a late night fast food shop selling pita sandwiches and hot dogs.  We had been told that Tiger Tiger (rawr!) was a dance club for people around our age so we figured, why not and checked it out.  When we got there I felt like I was back in the U.S. and was completely taken aback by the number of American artists they played throughout the night.  While there was definitely a good vibe amongst the group and the crowd there were still a good number of creepers—but what club doesn’t have those?

  We danced and stayed until about 2 and were back making pesto/soy sauce rice (what?!) by 2:30.  Since my roommate was spending the night with her mom and brother I decided I would stay with Emily and Anna for the night hence the pesto rice and some serious girl talk.

This morning we were all up by 8 to pack ALL of our things and have it shipped over to our house for the second half of the trip—needless to say I don’t think that I am a morning person here.  What a struggle!

For now I am sitting eating breakfast at our favorite Coco Wah Wahhhhh so that I can finish my paper, blog and figure out what we are doing with our free day—Green Square Market for sure and then the rest is up to if the rain holds out or not!

Tomorrow we are off to Kruger and Soweto for eight days.  We will be working in rural health facilities and touring the northern areas of South Africa!

Victoria Hospital Peds & Outpatient

Hello again!

I was doing so well at blogging every day until yesterday.  With my first paper due tomorrow and the pressure of not sleeping/ getting up early to work all day I needed a short break from blogging and journaling.

Today was my last day at Victoria hospital and was certainly one of the more rewarding days.  The whole week I was torn between being annoyed over lack of internet and an essay due combined with not being completely intrigued with the work at Victoria.  I think that this may be because not everything is such a shock to us anymore and I am more settled with working and observing the doctors.  However, I am still extremely happy to be at these various facilities and am of course learning so much.

A bit on yesterday—I worked in pediatrics and learned that Victoria has one of the best pediatric facilities around bringing children from all over the African continent to receive public care.  The majority of cases were such heartbreakers since many of the patients were children of drug/ alcohol abuser parents or mothers with HIV who had defaulted on their medication.  We observed a 6 week old baby boy whose mother defaulted on her HIV medication—the child is extremely underweight and HIV+ as well and will most likely not survive.  Other children had been caught in domestic violence between the mother and a boyfriend or were also HIV+.  Besides the saddening cases that we observed we were also able to play with the children who were a bit older and able to get out of their cribs—Reddick was my favorite.  Picture a 9 month old with a weave?  She was beyond adorable and doing well on her ART treatment.

Last night we went to the UCT library to get internet and study though when we got there we were told we will never get internet while in Cape Town since we aren’t full time students or semester abroad students.  At first I was really upset but then realized that I can pay for internet every once in a while and spend the rest of my time, what little time I have, enjoying the mountains and exploring Cape Town.  So after a minor freak out I was back on track and ready for a fresh new evening.  I went on a great run with two of the girls and then did a nice session of abs and squats.  The best way to relax from a stressful day in Cape Town? If it’s a Wednesday then definitely Stones for 2 for 1 specials.  If anyone comes across Hunters Cider—get some.

So for today I was back at Victoria for the last day.  I went in hoping to speak with the public health specialist but she was not in the office so I spent my time at the outpatient clinic with the head doctor Nasif.  He is honestly one of the most amazing people I have come across thus far in Cape Town and told us to stay in touch by both email and facebook and that he has access to grants if we would like to come work for us in the future!

The medical approach in South Africa is so different from the medicine I have experienced in America—so much more holistic.  Nasif spent so much time with each individual patient examining both their ailments and their lifestyles/ stories.  He told us that in order to truly understand the patient and know how to treat them you must get to know them on a more personal level and was surprised when we mentioned how short OPD visits were in the U.S.

It was also really interesting to be treated with such respect by both the doctors and patients—we were introduced as pre-med students (most of them don’t really get the concept of public health) and were explained the medical terms and how to read X-rays.

Some issues with the hospital that I encountered was the lack of organization…again.  I feel like the patients were also waiting for the doctors to find charts or medication lists or prescriptions.  Also, one womens chart was labeled as private but she was unemployed and unable to pay for her medications.  This lack of communication was causing a huge issue with both her COPD and high blood pressure. 

We spoke with one amazing woman who had recently started her second marriage and was experiencing some hardships with her husband—according to her he was not as she thought he would be and she seemed very sad about the situation.  However, after explaining the negatives of what was wrong she told us that the lord will help her through and keep her strong and that her health is in the lords hands since she had been doing all she could do.  Such faith and compassion, this lady was great.

Nasif took us to talk about the differences between the U.S. and South Africa and complimented the group on taking the leap to explore such a different culture and allow ourselves to learn from others.  He really put my whole trip into perspective for me by saying that with everything he takes and learns he gives back.  I swear I have never been more compelled to help people and give back, which is an amazing feeling.

After our long discussion with Nasif we were taken by our teacher to Red Cross Children’s Hospital which is regarded as one of the leading public children’s hospitals (tertiary care) in South Africa.   This quick visit made my day and was so uplifting to see a public hospital with resources, organization and more technology for the kids.  Red Cross Children’s was beautiful and closer to a hospital that we would see in America because of the generous donations from both individuals and companies.

When It Rains...

I never actually thought that monsoons were that common--okay i'm exaggerating on that statement but I honestly was not prepared for today...at all.  I woke up to sunshine and the beautiful Devil's Peak at my kitchen window and thought what a great day.  Little did I know that an hour or so later I would be faced with high winds and a torrential downpour. Luckily we were inside for the majority of the day working with the wonderful doctors at Victoria but we were also not prepared for walking the UCT campus in the afternoon to the point of soaking clothes and sitting through class for 2 hours drenched and cold.  Have I mentioned that South Africa doesn't really believe in central heating?  This includes the UCT campus.  However, I've been doing a great job of keeping my annoyance and emotions inside (for the most part) and kept with the usual comments of oh its so cold and I'm soaked.

Today at Victoria I shadowed internal medicine and was given the opportunity to speak with some patients regarding their admittance, happiness with the hospital facilities and post-discharge counseling. We were briefed on two cases of men with MDR (Multi-drug resistant TB) that had come from a TB clinic because of bacterial infections such as E.Coli and had developed sepsis. Another man had been admitted numerous times for leg and lower back pain but was unsure what was actually wrong with himself--the doctors did not seem to know either.  The more frustrating issue here was that they had lost his chart and were unable to dispense his medicine until they found it.  If that had happened in the U.S. I would sense a law suit in the near future but that is almost unheard of here.  One of the saddest moments of today was a 53 year old man who had just suffered his 3rd heart attack.  When I asked him what he thought it was from or if he had received any lifestyle/ health counseling he said he had no idea and that he had not received any but would in August.  Why would they not give him any sort of indication or counseling prior to leaving the hospital?  The doctor explained that no one has time and no one really wants to do it.  I feel like a simple preventive class or explanation on how to improve his condition after having an MI would improve his quality of life.  We also saw a woman who has suffered from COPD, stroke and was at the time experiencing an MI. She was also obese.

This afternoon as I mentioned we had class and then I returned to my apartment where I turned all the heaters on and bundled into my bed.  Currently I am sitting at Coco Wah Wah attempting to write my first paper of 3000 words on HIV/AIDS and TB but am unable to concentrate--not because the topic is uninteresting but because I am simply not in school mode. 

HIV Discussion

Today was one of the first days that I was actually angry and extremely annoyed at my inability to change the inequality and ridiculously flawed system here in South Africa.  In class we discussed the methods of HIV prevention and treatment throughout the country and the history of how South Africans became aware of HIV&AIDS.  Our professor, a previous EMT and Red Cross employee told us that many health professionals did not begin wearing gloves while handling blood and other fluids until 2005.  The class stared around at each other and I personally was in awe.  Coming from the USA with a mother that works in the healthcare system I was beyond shocked.  Our professor also mentioned the lack of general education regarding the virus and the district of health did not even begin taking full statistics of the disease until 2001 when I am sure it had already become a huge problem throughout the country.

After briefly discussing this towards the end of class I could not stop thinking about what could be done to improve this system.  They cannot even afford for everyone who has HIV to receive the proper ART or HAART treatment leaving many without the option of treatment until they are nearing the stages of AIDS.  CD4 counts much reach as low as 200 before individuals are able to receive the proper drugs from their local clinic.  This level is higher for pregnant women and children but is still extremely low since your immune system is so extremely compromised when reaching such low levels.  Any infection, especially TB, is likely to attack your system multiplying the HIV cells and decreasing healthy white blood cells.  

This class made me wish that I was able to understand more of the biology behind diseases such as HIV and TB and how exactly they effect the human body.  Now is when I wish I was pre-med or doing something more involved with patients, especially after working at Victoria Hospital today.

Victoria Hospital is a secondary hospital that focuses mainly on surgeries and more serious cases including treatment for chronic diseases and patients with severe TB and HIV.  They also have a specific ward for pediatric patients.  One of the worst cases I saw today was an 8 year old who was extremely malnourished and had Cerebral Palsy.  They had to switch him from a nasal feeding tube to a tube through his stomach. 

I also discussed nutrition and health with the dietician I worked with which helped solidify my love for the subject though I wish that I had more interaction with patients dealing with obesity and nutritional deficiencies.  I think that this experience, especially today, is making me realize that at least for now I would like to work directly with patients and then work towards the management/administrative side to healthcare which is a great discovery for me.

The only trouble I am dealing with now is what to do about the system and where to start--the entire healthcare system including other government agencies need to be restructured. It is the most frustrating thing I have ever dealt with and I am not even effected by it, I cannot  imagine being one of the South African individuals without healthcare (the vast majority over 70%) and with a severe illness such as AIDS.

Cape of Good Hope

I’ve been receiving numerous messages regarding my experiences here in Cape Town.  I am more than happy to answer any questions you have about my daily activities, the IES program or anything else—however, it is quite difficult to get any internet for free so it may take a while… please be patient and I will promise to return your messages as soon as I can!

So for last night-

We took a taxi down to the V&A Waterfront (the more touristy area of Cape Town) and had dinner at the Cape Town Fish Market.  The place reminded me of a really good PF Changs but specializing in Seafood.  We ordered two HUGE platters of Sushi and I was brave enough to try raw sushi for the first time.  I must say that the tuna, salmon and various rolls (rainbow roll) were amazing. For dinner I ordered a “Potjie” which was a hot pot of garlic cream sauce with mussels, potato, carrots and some sort of white fish—yum!  It was one of our first real meals out together alone which was really nice.  To get home we decided to walk around the mall for a bit and get gelato (sorry but it was much better than the Muar House) and pass the huge ferris wheel to the docks—not the safest trip but surely interesting since we had to sprint across a highway to get to the nearest hotel and call the cab home.  After hiking and getting up early for the market yesterday I was exhausted and fell right to sleep.

Today-

When I said that every day I experience something more amazing than the last day I was not kidding.  I for sure thought that yesterday was one of the greatest experiences of my life…Climbing devils peak was beyond beautiful and gave me one of the best views I have ever seen.  Okay maybe I am being ridiculous with my descriptions of these places but I cannot wait to post all of my millions of pictures.

Today we topped Devils Peak by going on a peninsula tour around the Cape of Good Hope, the most southern tip of Africa.  We took a tour bus along the coastline and Atlantic seaboard going through the beautiful ritzy area with huge homes and gated apartment complexes.  Before I knew it we were on a cliff with the mountains at one side and the sea down below.  Words cannot describe it—wait for the pictures!  I had no idea we were even going all the way to the Cape since the drive looked as if it would take much longer than an hour and a half but before I knew it we were at Boulder point scoping out the penguins that reside there.   After a lunch on the bay with fish and chips we took the bus to the Cape of Good Hope.  All that came to my mind was, wow unbelievable!  The sun came through the clouds and the rain stopped as we approached the summit to the lighthouse at Cape Point (literally though I swear I’m not trying to write ridiculous posts) and we were able to see for miles.  The Table Mountain National park is home to baboons and antelope so we passed many signs stating, “do not feed the Baboons, they are WILD animals.”  The best way to describe this would be through my pictures so I hope to post soon.

This week we will be at a different hospital working with various units.  I am hoping to hone in and specialize working with a nutritionist, dietitian or someone working with obese patients.  If this is unavailable I will most likely work with patients who have diabetes or other diseases such as hypertension so I am able to speak with them regarding nutrition and weight for my final research paper.  Wish me luck!

climbing Devils peak

Short and to the point: today I had an impromptu hike with a few friends up to Devil's peak.  It doesn't look that steep from here but the two hour hike was high and mighty.  With every few feet we were taking more pictures because the view was beyond amazing...Definitely one of the most amazing experiences I have ever had in my entire life!  Cannot wait to hike it again!

pictures week 1

Gugulethu: HIV/ AIDS treatment & A Birth

Wow, what an amazing week.  I honestly never thought that one week would have such an impact on me.  While I still have a lot to learn and experience I can now say that I’ve worked abroad in a health clinic, taken blood pressure, worked with HIV+ patients who have noncompliance issues, saw a woman deliver a baby (more to come) and test urine for pregnancy and abnormalities.

The doctors and sisters at the clinic quickly grew to love us and showed sincere gratitude for what little help we were able to provide.  Our teacher put it perfectly for us as we discussed our work in the pharmacy packing bags of medication for patients—though the work was boring and tedious and not always as exciting as working with the patients themselves, we helped over 300 people get their meds for the following day. 

Today in class we discussed the issue of the government intervening in healthcare.  The problem? No one knows where to begin.  These people wait all day, literally, for sometimes even the simplest issue such as a headache or sore throat.  Whether it be the lack of education that leads them to conclude they need the doctor that badly or not they’re still sitting there.  The conditions of the clinic are as good as they can afford with the resources they have but sanitation is a serious issue.  Even the nurses working in the HIV clinic lacked some of the knowledge of what exactly ARV drugs do to stabilize or improve the condition of someone with HIV.  I have never experienced something so frustrating—from sanitation to the management that leads to the patients lining up at the door at 5am when the clinic opens at 8.  The worst feeling is knowing that something could improve but no one knows how.

As for the fun and exciting part of the day:

After thinking that I had missed my opportunity to see a birth in the maternity ward I was pleasantly surprised when we were passing through the department and heard screams from one of the women in the labor room.  The women are placed in one of three rooms—the room for post-delivery where there were about 10 girls (very young teens to older) with their babies, another room where they lay waiting to dilate enough for labor and then the delivery rooms.  The woman was pacing and grabbing the beds in the pre-labor area and we were told she was 8cm dilated.  Our best decision of the day was to skip the beginning half of our lunch shift because within 25 minutes she was ready to push. 

The conditions are soooo different from an American hospital—there are no men or family allowed in the Maternity ward (MOU).  The women are by themselves and know when they are ready to go to the delivery beds.  Until then they are pretty much on their own.  Sister nurses and mid-wives are the ones that deliver the babies since there is only one doctor for that ward and she is shared amongst about 5 other clinics and only comes once a week.

This particular woman was HIV+ and I was extremely surprised when the nurses did not take more precautions with her than another HIV- patient.  They helped her to get in the right position and then instructed her to push—no fancy breathing or hand holding.  The woman was in extreme pain but was alright with us being in the room which allowed for us to have such a great experience.   The tools used come in a big metal bucket along with some towels and gloves.  We stood behind and had a full view of the whole birthing process.  To be honest I didn’t know if I would be able to watch the whole thing (especially the after birth) but I realized that I would most likely never get the opportunity again so I grabbed Emilys arm and watched the whole process.  When the baby was finally cleaned and began to cry the mother just started whispering, “thank you jesus” over and over again.  It was one of the most amazing experiences I have ever had.

One of the most interesting aspects of the birthing process in this clinic and I believe South African culture is that the baby is cleaned briefly and placed directly on the mothers stomach with a blanket—no incubator or taking away for minutes/ hours for tests.  They do this within a few minutes of mother/ child connection giving time to create an instant connection. 

Tonight we are having a Braai (BBQ) with our RA and made a trip to the pick and pay (grocery store) to get cider and frozen mojito mix.  Up early tomorrow to visit the more touristy area and see the water front!  

Gugulethu Day: Maternity and Outpatient

Lets start with last night, the fun stuff of course.  A few friends and I went running and we stopped to pick up notebooks for class.  We went back to our flat and made a pretty amazing dinner if I do say so myself.  Peas, rice and sauce—the dinner of champions.  Later on we all went to this bar in the next town area called “Stones.”  It reminded me somewhat of Eddie Obriens or Parkers in Geneva and had a good American feel to it.  Matter of fact, we met a bunch of Americans studying here and volunteering.  Our RA came with us as our protector which was probably a good thing since the young doctors at Gugulethu informed us that we really should be with a South African when walking around where we live…how inviting.  The two for one special was a hit and I downed a few Castles (the main South African Beer) which was actually pretty light and tasty.  I had a great time going out and getting to know our group better and make some friends from different places.  I swear there were people from all over the world in this one bar and we were told that Long Street is even better and more exciting with famous clubs and bars.

Today we went back to Gugulethu and I really tried to go in with a clean slate.  I brought my trusty peanut butter sandwich and orange along with me.  The woman who had given me some problems yesterday was not around the area I was in so I felt comfortable and able to talk with the various nursing (sisters) staff and doctors that were doing their community rotation.  One really interesting thing about medical school or degrees in the medical profession is that students must give back ot the community by doing a year to two years of community service in these hospitals such as Gugulethu where no one wants to come work.

Today I was placed in Maternity and was able to see the tiniest baby being transported to a larger hospital.  At one point the power went off and we were so fearful of the effect on the baby but the sister nurses did not seem to think that it was an issue at all.  One thing that I found extremely interesting was how natural the birthing process is here.  While I did not see a birth today others in my class described it yesterday and we spoke with the nursing students who confirmed what they had seen.  Compared to America it is so much more relaxing and kind of in and out.  For mothers who are having normal pregnancies with no complications they can come to gugulethu and walk around a waiting area for mothers in early labor.  They groan and walk until they are dilated enough.  When it is time they move to a bed (there are about 4-5 beds for birthing) and the process begins.  Men are not allowed in the ward.  Post-labor the women all lay in beds in one room and they are there with their child the whole time by their side—breast feeding is much more open in south Africa as well.  I went to speak to one of the young mothers and she lifted her shirt to begin feeding—at first I was shocked but then realized that they are used to this sort of thing.  I should mention that many girls start having children at age 12.

The maternity ward was pretty quiet today and soon our nursing student left us to fend for ourselves.  I was moved to Outpatient (OPD) and that is where the real fun began.  I was given gloves and was able to call names of patients, take blood pressure and assign them to either a doctor or nurse.  The most saddening thing about this is that going to Gugulethu means they are there the whole day.  The lines are extremely long and even once they have been in line to be sent to the doctor or nurse they still must wait to see them too.  In addition to taking BP I also worked with another kid on my trip testing a few urine samples (yes we had gloves but NO it was not anywhere near as sanitary as in the US). 

I apologize for these being such lengthy descriptions of my day but there is so so much to tell.  I can try and make some more condescend posts that describe my experiences but I am also handing these in for grades as journal entries.  I will have a total of 3 papers (all around 3000-5000 words) as well but we are all hoping that they wont take away from our traveling and adventuring!