Clinical Culture Shock

June 7, 2013

I just finished my first week in the Internal Medicine department at Victoria Hospital in Cape Town and it has been an unbelievable experience thus far.  As a first year medical student, I rarely got to spend time in the clinics and hospitals so it’s great to finally get the chance to apply what I have learned throughout first year, and it’s amazing how much I have learned in just a week’s time.

Walking into the wards of Victoria, I had my first experience with clinical culture shock.  In the wards, there are no individual patient rooms with TVs or bathrooms.  The wards consist of a large room full of patient beds only separated by curtains, and the bathrooms and changing rooms are down the hall.  While the doctors are faced with less room and fewer resources, the care they provide is exceptional.  Many of the doctors are very young since they begin medical school after high school, but they are all extremely knowledgeable.  I think in the US we sometimes rely on our technology too much to help us make diagnoses, but in South Africa the doctors have to rely on their history and physical exam skills and they all have those skills perfected. 

The roles and responsibilities of the doctors in South Africa are completely different than in the US.  The doctors are much more involved in the care of the patients due to the lack of resources and lack of support staff likes nurses, phlebotomists, etc…  My preceptor for the month is an Internal Medicine physician and he draws blood and starts IVs for all his patients, which is obviously different than what is practiced in the US.  He was shocked to hear that I had virtually no experience in drawing blood or starting IVs, and by my second day on the wards, I got to begin doing the blood draws for our patients! 

One of the most common patient populations that I have seen this week is the HIV/TB population.  South Africa has one of the highest incidences of HIV and TB in the world, and in many cases, people are affected with both which is a deadly combination.  I have cared for a few HIV positive patients in the US, but I don’t believe I have ever come across a patient with active TB so it has definitely been an eye opening experience.

It seems that the HIV/TB population tends to be those patients under the age of around 40 or so.  The older population is plagued with cardiovascular disease, pneumonia, and COPD.  I have had ECGs and chest x-rays thrown at me all week, and I imagine that by the end of my rotation I’ll actually know what I am looking at!

This week in clinic has been a great experience and I have learned so much.  I can't wait to see what the next three weeks bring!