Surgery in Mpumalanga

Today I observed a C-section at a local tertiary hospital in Mpumaplanga--scrubs, mask and all I was right in the OR with the doctors and nurses.  Definitely was not about to pass up the opportunity to something that I would probably never be given the chance to do back at home.  The nurses even asked me to push the patient into the OR.  I looked at them like they were crazy and explained that I was not a medical student or MD and they told me that any extra hands were needed and shouldn't be taken for granted so I wheeled the woman in and helped get her onto the gurney for surgery.

The doctors in the OR were somewhat cocky just as any surgeon would be (sorry to generalize) but they were so willing to help explain the difference between a spinal tap and epidural and even give us detailed descriptions and visuals using their iPad. 

I understand that I am not pre-med but I still found this to be an amazing and valuable experience.  If anything it taught me more about the medical system and allowed me to see it in action first hand.

After a long few days of traveling up north to Mpumpalanga/ Nelspruit I realized how incredibly lucky I am to be here and I wish that I was able to share all of this with everyone back at home.  Anyone who gets the opportunity to come to South Africa should jump at the opportunity.  The people are beyond amazing--from their personality to their beauty and their INCREDIBLE food.  Not to mention the landscapes and natural beauty of the land--mountains and birds everywhere along with serious farmlands.

The north, where I am now, is so much warmer than Cape Town.  We were honestly so surprised when we arrived up here and it was in the 70s because our IES representative told us that it would be cold...definitely learned to check the internet on my own next time and figure out the weather.  

I was also able to get a new hat today since I lost mine out the window on the highway yesterday!

Tomorrow I will have the option of being at an HIV clinic, Outpatient or Casualty (trauma).  I hope everyone at home is having a great summer so far and are taking the time to enjoy beautiful Canandaigua/ rochester/ wherever you maybe!

Lebo's Backpackers- Soweto

Yesterday was one of the first days that I could honestly say I cannot go through life without coming back to South Africa.  After an amazing Friday of shopping at the Green Square Market and Pan African Market plus some celebrating of the end of our first papers I was ready for the 5am flight to Johannesburg.

The flight was quick and I honestly had no idea what to expect when we got off the plane—while going through Johannesburg aka “Joburg” as a connection flight I was a little skeptical.  We met our tour guide as soon as getting off the plane, Crazy Dav who runs the Old Vic Backpackers up in Northeastern South Africa.  He promised us a crazy first few days and week with him which I am sure will continue.  We are riding around all week in this green minibus type van that says, “Old Vic’s Travelers Lodge” with an extra trunk being pulled along—hilarious.

Yesterday we had two main events on our agenda:

Apartheid museum

Soweto Bike Tour

The apartheid museum was moving and reminded me somewhat of the holocaust museum but we were only allotted an hour to go through the entire museum which easily could have taken an entire day, or at least a few good hours.  It definitely portrayed the history and segregation of Apartheid and made me realize how young the democracy here really is—there is still so much to be done (for example, in Joburg there are street signs that are now being changed to non-apartheid related names but the old street names are still there just crossed out).

My true love for South Africa came rather unexpectedly when we made our way to Soweto, the oldest and largest township in South Africa.  Compared to Gugulethu and Langa townships in Cape Town I noticed that there seemed to be much more poverty and illness—you could see it on their faces and in their eyes.  When I realized that we were staying IN the township at this Lebo’s backpackers place with a local field that half the town (well okay maybe 30 people) were hanging out at I was really nervous…I mean I was freaking out as to why the program would put us here.

However, as soon as I made my way into the gate of the hostel I was hooked—it had a sort of carribean feel with tree houses and palm trees, chickens and even parrots.  The owners and chefs were so incredibly kind and instantly welcomed us into their establishment. 

The bike tour itself was really exciting as well—we rode around Soweto and learned a bit about the history (Nelson Mandela once had a house there).  We sampled Johannesburg Beer which comes in a milk carton and is made the same way that it always has been—weak but good and somewhat creamy?  The men that sat outside the “bar” or beer hut told us their stories—how their wives were mad they were drunks and how it was the local hang out for everyone who either just got out of work or had no work…  We were all invited into one of the rooms with our tour guide and sampled the drinks and spoke with some of the men there—it was mainly ALL men since the area of Soweto was used for many of the male miners during apartheid.

When we returned to Lebo’s we were greeted with BRAAI—probably the best meal I have had here thus far.  If anyone is actually reading this long post I promise that I will make some traditional food for you, including Pap (maize meal) which kind of tastes like mashed potatoes.

The best part of the evening had to of been sitting by the fire with a chicken sitting in the tree above us while we talked and drank some hunter ciders.  The atmosphere was so relaxed, happy and chill.  Older people from the community came and stopped by (the ones that are friends with the owners of Lebo’s) and they gave us the traditional handshake of the community where they say (peace, love, happiness…ironic?).  They were so welcoming of us and explained that much of the community actually enjoys having the bike tour since it shows them that outsiders are interested and care.

Enough of all the details and let me just say that I will be returning to Lebo’s someday in my life—or at least another place like it.  Words cannot describe how happy I was last night and how great everything was.  I felt such compassion from the people and they were all so happy to see us and hear our stories as they shared theirs. It took a lot to pack up and leave today, I felt like I owed the women making us breakfast something in return.   

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.