My Last Weekend in Cape Town

June 24, 2013

This past weekend was my last full weekend in South Africa and I spent it checking off the last few things on my list of all that I wanted to do and see while in Cape Town.  On Friday night, we began the evening with dinner at Canal Walk Mall, the largest mall in the southern hemisphere.  After Canal Walk, we met up with a group of students from the University of Cape Town and we jolled (partied) Cape Town style at the Tiger Tiger night club.  Tiger Tiger is located near the UCT campus and it was packed with students from about 10pm to 4am, and for those who went to KU, the people and the atmosphere was a mix between the Hawk Boom Boom Room and the Cave!  If there is one thing that I learned while in Cape Town, it’s that the people know how to party, and one of the best parts of Friday, other than the cheap or free drinks because we were the “cute American girls”, was the people watching!!  Friday night was definitely a good time and I’m so glad I got to experience a real Cape Town college party.  

Cape Town Jol!

  

On Saturday, we spent the morning souvenir shopping at the Pan African Market, and then we took a ferry out to Robben Island, the home of the prison where Nelson Mandela spent 18 years of his life.  There are parts of Robben Island that are absolutely beautiful, but the part of the island where the prison is located is another story.  The tour of the prison was definitely a sobering experience.  Our tour guide was an ex political prisoner, a former member of the African National Congress who was imprisoned for six years for fighting for the rights of his people.  The conditions inside the prison were brutal.  The kennels for the guard dogs were larger than the cells for the prisoners, and the prisoners spent long days working in the limestone quarries.    I’m so glad I got the opportunity to see Robben Island and the prison before leaving South Africa because it represents the tremendous amount of struggle that took place in the fight for freedom. 

Nelson Mandela's Prison Cell

 View of the Maximum Security Prison

Sunday morning, we visited the Hout Bay Harbor Market.  Harbor Market was very similar to Old Biscuit Mill, which we visited last Saturday.  There was live music, lots of shopping booths, and lots of food and drink.  I probably had my best meal in South Africa while at the market.  I had a Gemsbok burger (Gemsbok is a type of antelope) with cheese, tomato, caramelized onions, avocado, and pesto sauce on a ciabatta roll, and it was amazing!!  After the market, we finished off the day at Kirstenbosch Botanical Gardens.  Even though it is currently wintertime in South Africa, the gardens were lush and green and several flowers were still in bloom.  We have seen a lot of beautiful scenery while in South Africa, but the scenery of the gardens was equally as beautiful, just in a different way.

Harbor Market

 Botanical Gardens

Even though I would really like another four weeks to experience the Cape Town and the Western Cape, I feel like I made the best of my time here and got the opportunity to experience a lot of what this beautiful country has to offer!

Week 3 at Victoria

June 23, 2013

I just finished another great week at Victoria and got the chance to do and experience a lot of new things.  In terms of procedures, I got the chance to put in an IV line, perform a paracentesis on a patient with right heart failure, and perform a lumbar puncture on a patient with suspected meningitis.  It is such a great opportunity to get exposure to these types of procedures so early in my medical training, because I don’t get a lot of hands-on training as a pre-clinical medical student.  Since I am interested in emergency medicine, I have done a lot of shadowing in the ER and have seen a lot of lumbar punctures performed, and I always thought it was a cool procedure.  I was so excited when my preceptor handed me the kit and told me that I could do the procedure, and it was such a great feeling when I pulled the stylet out and CSF dripped out on my first try!! (I realize how nerdy that sounds but it’s true)  I also watched my preceptor perform a fine needle aspiration of a lymph node of a patient with a possible lung cancer, and he said the next time is my turn to do it! 

On Thursday, I went with my preceptor to Groote Schuur Hospital (where the first heart transplant in the world was performed!!) and watched him present one of his patients for dialysis.  In the US, dialysis is readily accessible and if I am not mistaken, it is free.  This is NOT the case in South Africa.  I believe that Groote Schuur is the only public hospital in the Western Cape that offers dialysis treatment and they have very few spots available.  So, in order for a patient to be put on dialysis, the doctor has to present the patient’s case to a board, the patient gets categorized based on his/her current medical and social standing, and then the board decides whether or not to accept the patient into the program.  It is a very stressful process for both patient and doctor, and there are tons of patients with end stage kidney disease that are denied treatment.  Learning about the whole process was definitely shocking, because in the US, we are very fortunate that patients and doctors don’t have to face such problems. 

On Friday, I got the chance to watch the University of Cape Town sixth year medical students take their practical exams.  The medical school testing process is very different in South Africa.  At KU, the majority of our testing consists of multiple choice tests on a computer.  In South Africa, the students have written exams, but they also have a lot of oral and practical exams.  In the exam that I watched on Friday, the students examined four different patients, all currently in the internal medicine ward.  I believe the four cases were stroke, heart attack, right heart failure, and bronchiectasis.  The students got ten minutes to take a history and examine the patient, and then they had to present the case to a doctor who then asked them various questions about their assessment, differential diagnoses, and their plan for treatment.  I’m sure this testing style really helps the students to perfect their clinical skills, but I’m sure glad that I was the one observing and not taking the test!

This past week has yet again been a great learning experience and I’m excited to see what this fourth and last week brings!

Weekend in Cape Town

June 19, 2013

Thanks to National Youth Day this past Monday in South Africa, I got to spend three days exploring Cape Town.  Even though I live only about 20 minutes from the city center, this past weekend was really the first time I got to venture out into Cape Town, since last weekend was spent along the Garden Route.  The scenery along the Garden Route was unbelievable and I didn’t think that anything else would be able to top it, but the beauty of South Africa continues to amaze me. 

Cape Town has so much more to offer than just beautiful scenery.  Cape Town is also well-known for its wine and its endless variety of foods due to the diversity of the population.  We spent Saturday morning at the Old Biscuit Mill, a huge market that really has something to offer everyone.  There are booths selling clothes, jewelry, arts and crafts, beer and wine, and every type of food under the sun.  There was also a tent for live music.  The atmosphere of the market was amazing and I’m pretty sure I left there about 5 pounds heavier.  After spending way too much money on souvenirs and eating a week’s worth of food, we spent the evening relaxing at the Asara winery in Stellenbosch.  The winery was beautiful and the perfect way to end the day!

 Old Biscuit Mill

 

 Asara Winery in Stellenbosch

On Sunday, we left early in the morning and spent the day touring the Cape Peninsula.  We started off the day with breakfast at Casa Labia in Muizenberg, a popular surfing town.  Casa Labia is a Venetian style mansion that was once home to Prince Natale Labia, the first Italian ambassador in South Africa, and we enjoyed a fancy breakfast overlooking the ocean.  After Muizenberg, we stopped at Boulder’s Beach to visit the African penguin colony.  From Boulder’s Beach, we drove down to the Table Mountain National Park to see Cape Point (the point where the Atlantic and Indian oceans meet) and the Cape of Good Hope (the most south-western point of the African continent).  The national park was beautiful and we even had an encounter with a baboon.  Within the park we kept seeing signs warning us about the baboons (apparently they are very dangerous and they will jump inside your car window and they will pick-pocket you) and it wasn’t until we were leaving the Cape of Good Hope that we saw one.  It was sitting on top of a Land Rover and we got out to take pictures, and it really did not like the attention so he jumped off the car and started chasing us!!  I really wish we could have had that moment on video because I’m sure we all looked ridiculous as we sprinted back to our car screaming…

Muizenberg

Boulder's Beach

 Cape Point and Cape of Good Hope

After we left the park, we drove up the Atlantic coastline along the famous Chapman’s Peak Drive.  The drive was stunning.  We were surrounded by beaches and mountains and we stopped at Hout Bay to watch the sunset.  The night ended with dinner on the beach in Camp’s Bay.  It was a long day and there was a lot of driving involved, but I can’t complain about driving alongside mountains and coastline all day.  

Chapman's Peak Drive

  

Monday was a national holiday so we got the day off work and decided to spend it climbing Table Mountain.   We could not have asked for a more perfect day to hike.  The sun was out with no clouds in the sky and it was about 80 degrees, all of which is a little rare for this time of the year since it is winter in South Africa right now.  The hike took about 2 hours and was actually a lot more difficult than I expected.  There were tons of stairs and really no flat areas, but the view made up for the fact that I’m in terrible shape.  We overlooked the city and the ocean as we were climbing, and once we got to the top of the mountain, I truly felt like I was on another planet!

Table Mountain

This weekend we were able to cram in the majority of the big tourist attractions that Cape Town has to offer!!  The time has flown by since I’ve been here and my days are numbered, but we still have one more weekend to enjoy the city!

Week 2 at Victoria Hospital

June 17, 2013

I just finished my second week in Internal Medicine at Victoria Hospital.  I spent a lot of my first week learning about the flow of the hospital, the roles of the physicians, and getting to know the staff, but after my second week, I really settled into my role at the hospital and got the chance to get even more involved in patient care. 

The pace at Victoria is extremely fast as the hospital is currently overflowing with patients.  The emergency department is constantly at capacity and rarely are there many open beds in the wards.  At one point, the ED could not possibly fit in any more beds and patients were being admitted and forced to sit shoulder-to-shoulder on chairs along the walls.  On Tuesday, I spent the day in the ED with my preceptor examining patients that were bound for the Internal Medicine ward once beds opened up, and it was one of the best learning experiences of the week.  We had a lot of patients to see in a very short amount of time and I was forced to think and examine patients quickly and learn procedures on the fly.  The day was challenging and a bit stressful at times, but my diagnostic and my blood drawing skills had improved dramatically by the end of the day!

There were so many highlights this week, but there was one experience that really stuck out.  This week I learned how to draw blood from the femoral and radial artery and run an arterial blood gas, I learned how to do a blood culture using sterile procedure, and I correctly diagnosed a heart murmur, but the real highlight of the week was learning to read ECHO’s with Dr. Anthony Lachman. 

Dr. Lachman is a world renowned cardiologist from Cape Town.  He spent 28 years in Connecticut working for the NIH and teaching for Yale Medical School.  Also, he and his colleague Dr. Barlow were the first in the world to diagnose and publish an article about mitral valve prolapse.  Dr. Lachman is an extraordinary physician, and after 28 years in the States, he decided to leave the fame and the fortune behind and return to Cape Town to help the people of his hometown.  The most amazing case that I saw while working with Dr. Lachman was a 7 year old girl with Tetralogy of Fallot.  Tetralogy of Fallot is a condition that we actually learn a lot about in medical school because it ties in a lot of physiology and anatomy, but it is a condition that I figured I would never actually see in my life as a student or physician.  There are different forms of the disease, but in this girl’s particular case, she had a hole in the wall between her two atria and her two ventricles (an ASD and a VSD).  She was also missing the connection from the right side of her heart to her lungs and because of this she had her vena cava (the large vein that returns blood from the body to the heart) surgically attached directly to her lungs because the right side of her heart was essentially non-functional.  It was a truly unbelievable, but very unfortunate and sad case.  I hope to get the opportunity to spend some more time with Dr. Lachman before I leave.  I learned so much from him in such a short amount of time, and he guaranteed that I would get to see some more cases that I would probably never encounter again in my life!!