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!!

Weekend on the Garden Route

June 12, 2013

This past weekend we spent three days along the Garden Route and really got to take in and enjoy the beauty of South Africa.  The Garden Route is located along the coastline of the Indian Ocean and is surrounded by mountains and forests.  The scenery is absolutely beautiful and really like nothing I have ever seen before!!

We woke up at around 4 am on Friday and made the long drive from Cape Town to Mossel Bay.  Our trip began at the Cango Caves with the Adventure Tour.  The tour began with a brief history about the caves, how they were discovered, and how the different structural aspects of the caves formed, and then we began the adventure segment of the tour.  I figured it was kind of a joke and that it would really just be a leisurely walk through the caves, but I was wrong.  We climbed over 1100 stairs and maneuvered our bodies through the tiniest of openings.  One of the obstacles that we had to maneuver through was called the “postbox” and it was about 3 feet wide but only about 27 cm high.  It definitely took some skill to complete some of the obstacles and we got a pretty good workout in the process.  

Cango Caves

After the caves we visited the Oudtshoorn Ostrich Farm and got the ability to ride the ostriches.  I never really believed that the ostriches are the nicest of animals, but I didn’t realize how ornery they really are or how fast they can run.  In order to ride one of the ostriches, the jockeys have to chase one down, lasso it, and then cover its face with a mask which causes it to calm down a bit.  The jockeys then bring the ostrich up to a small enclosure where you can jump on its back, cross your feet underneath, and then grab onto its wings.  Once you are in place, the jockey removes the mask and the ostrich flips out and takes off running!!  My ostrich’s name was Michael Jackson and he was exceptionally pissed off that I jumped on his back for a ride.  The jockeys had a hard time pulling off his mask so he just decided to sit down and smash my ankle in the process, and then after trying to buck me off a few times he finally got up and started running.  It was a crazy experience riding the ostrich and I’m just glad I made it off that thing in one piece!    

 

 

Ostrich Farm

Saturday was really cold and rainy but we were able to make the best of it.  In the morning, we zip lined through the canopy of a gorgeous forest.  There were 10 zip lines and they were all positioned pretty high off the ground, which allowed us to start mentally preparing for what came next…

Our next stop was the Bloukrans Bridge, the world’s highest bungy bridge at 216 meters.  The bridge and its surroundings are absolutely stunning.  The bridge is situated in the mountains and there is a stream that runs underneath and out into the ocean.  Walking up to the bridge definitely took my breath away and made me regret eating lunch prior.  Before this trip, I always thought that I had no interest in bungee jumping.  I mean why would I want to fling myself off a bridge and rely on only a giant rubberband attached to my ankles to keep me from plummeting to my death??  I always thought it sounded crazy, but I just couldn’t resist and I am so glad that I did it.  It was the most unbelievable experience of my life.  The feeling of free falling and being completely weightless is unlike any other.  The walk onto the bridge was absolutely nauseating.  As I walked I could see the stream below which seemed like miles away and it was terrifying, but once we got up to the platform area my mood completely changed.  The atmosphere was amazing.  They had the music blaring, everyone was dancing, and every person that worked there was so much fun and so upbeat that all the fear and anxiety disappeared.  By the time it was my turn to walk up to the edge of the platform, I willingly flung myself off the bridge and would do it again in a heartbeat!!!

Post Bungee!!

We finished off the day relaxing at the Knysna Elephant Park.  We first got the chance to feed the elephants, and then we were able to walk up and take pictures with them.  The elephants were so friendly and so domesticated.  They were in no way fearful of us and they wanted so much attention.  They would walk right up to a group of us and we got to take pictures while actually touching the elephants!

On Sunday, we ended our weekend at the Botlierskop Game Reserve.  The reverse is breathtaking and situated in the mountains.  We took a three hour game drive and got to see rhinos, giraffes, zebras, lions, elephants, wildebeests, antelopes, and more.  There really is no way to put into words the beauty of the drive so the pictures below can help to sum up our day!!  

Game Drive

Alright... So I finally have a car and finally have access to the Internet!!  I posted a few entries that I wrote last week and am in the process of writing a couple more.  Hopefully within the next few days I will be able to post a few more entries, but until then, I will leave you with a few pictures from this past weekend on the Garden Route!!

 

Bungee jumping off the world's highest bungy bridge!! 

 

Pictures from our game drive!

Riding the ostrich!  This one's for you Shan! 

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!  

A History of Cape Town and South Africa

June 6, 2013

So… I kind of wrote a book on this entry but there was a lot to take in today on our tour of Cape Town. 

Today we took a day off from the clinics and spent the day touring Cape Town and learning about its history and culture.  One of the best parts about the CFHI program is that they provide this tour for us, which gives us the ability to really understand the background of the city we are working in and the people we are helping at the clinics. 

Most people know a little bit about the Apartheid era in South Africa but it is impossible to fully grasp its effects without seeing them first-hand.  With the implementation of Apartheid, all South Africans were classified into various racial groups, which dictated the rights and privileges that people had.  Apartheid led to a complete segregation.  There were different hospitals, schools, buses, etc… for the different racial groups.  Also, the non-white racial groups, like the blacks and coloreds, were kicked out of their homes and sent to live in the townships.

Most of CFHI’s home-stay families and coordinators grew up in an area called District 6, which we got the opportunity to visit.  District 6 was a vibrant, multi-racial district in the city of Cape Town and upon implementation of Apartheid, the residents were evicted from their homes, the homes were demolished, and an enormous amount of people were sent to live in the Cape Flats (where I currently live and work in).  People’s entire lives were completely uprooted during this time and it was amazing to hear the stories first-hand from those that were affected. 

Our day ended with a tour of some of the townships in the Cape Town area, where many families were forced to move to during the Apartheid era.  The townships are still heavily populated today, which just shows the many struggles that many South Africans still face.  The visit to the townships was the most sobering and humbling experience of my life, and to be honest, I had a hard time facing the reality of it all.  Within the townships, there are hundreds of little aluminum shacks piled back-to-back and they are not much bigger than my bathroom or closet at home.  Their bathrooms consist of a porta-potty or two on every other block and the water source comes from a tap on every other block.  At one point during the tour, we met a woman who runs a community kitchen to ensure that the children are able to eat because many of the children do not have enough food at home to get by.  The best part of the day by far was getting to interact with the children in the townships.  They were so happy and energetic and they stuck to us like glue.  They wanted hugs, they wanted to be held, and they really loved posing for the camera.  They all wanted to have their picture taken and all their faces lit up when they got to see pictures of themselves on the camera.

It was a truly incredible day and a day that I will never forget.  Many of the people in South Africa face so many struggles and challenges, especially those that live in the townships, but they are all so full of life.  I no longer whine about not having heat in my home-stay, because many of the people we visited today have so little and yet seem so happy… it definitely put things into perspective.  

Children from a Cape Town township.

This sunflower was made out of scrap metal by a man named Golden in one of the townships.  The children collect the metal and sell it to Golden who then creates these amazing flowers and sells them to the tourists and members of the community.  The money he earns helps to support the township he lives in.