The BurgS

The original South African itinerary did not include Johannesburg, but because we had Friday free from clinic and had to get there by Sunday to meet our safari transfer, we improvised and here we are… in Jozi!

BazBus is a recommended, affordable method of transport for backpackers and tourists in South Africa; and to that end, they conveniently had a route from Durban to Jo’Burg. We spent ten hours in total on a bus, but the route took us through the Drakensburg, which was a scenic way to go. We also had good sightings of Soweto (the largest township in South Africa) and the Jo’Burg skyline.

Jo’Burg does not have a high record on safety, in fact all of our tour books adamantly advised against going anywhere on foot. So to err on the side of caution and appease worried parents, we stayed near our lodging and only ventured to a flea market (South Africa’s largest, at that), where we bargained for some final souvenirs.

Week Eight

Our final week in Durban started at Malagasi Clinic, which is located in the township, Umlazi. At this clinic we had a new experience: participating in child immunizations and planning visits. All children in South Africa have a “Road to Health” card, which outlines when they need to be seen at a clinic for check-ups and immunizations. When the child is brought in we collected their weight and measurements to plot on the card. Then we would see what visit they were there for and if immunizations were needed, we would prepare and administer the drops/shots. Similarly, women from the township come to the clinic with their “Family Planning” card. Like the “Road to Health” card, this card keeps track of what method of birth control they are using and when they are due for the next injection or set of pills (We also prepared and administered the shots for these women). The card system may seem primitive, but in this setting where patients do not necessarily have a PCP, it is effective in recording the patient’s pertinent history and also a record that the patient keeps to remind them of important health details.

After the immunization and family planning visits, the clinic switched back to regular primary care. The clinic is entirely run by Sisters (nurses) and so they were relieved to have our help for the day. As a result, we were allowed to assist the Sisters and serve a more active role in the visits – often biting our tongue and remembering to be respectful of cultural differences.

Unfortunately, the rest of the week unfolded as a frustrating series of events at our clinic sites – so I’m not even going to blog about it! But in the end, we completed the program on Thursday and enjoyed that evening with our host family, who put together a braai (BBQ) for our last night.

Learners' WeekEND

The red trumpet looking thing is a vuvuzela - it is especially popular with the World Cup just around the corner!

The highlight of this weekend was visiting the primary school where our host mom, Zodwa, is the principal.  The school is located about 40minutes drive from the Durban suburbs, in a more rural area.  It accommodates grades R (kindergarten) to grade 3 and there are over 1100 learners who attend her school!  Oh, “learner” is the term that is used in South Africa for “student.”

On Saturday, Zodwa and some other administrators had organized an optional fun day for the students, including football (soccer-boys) and netball (basketball –girls) against another primary school.  When we arrived at the school before 09h00 (on a Saturday, mind you!) the learners were already waiting for us, in their uniforms and with their vuvuzelas.  There was lots of singing, hooting of the vuvuzelas, and general enthusiasm about the special day.  Not all of the students were able to participate in the sports, but Zodwa explained that one reason they came was for the free meal that is provided; often students will stash some of it to take home to help feed their families.

In general though, the learners demonstrated a spirit of resilience and hope: they played hard, cheered for their teammates and indulged me with hugs & smiles!

Week Seven

Special surgical scrubs again, this time I felt like Kermit the frog... 

"It's not easy being green!"

Another week at King Edward Hospital, and another rotation in theater!  Surgery at King Edward is much different than GF Jooste because it has seven theaters versus only two.  That means that there are a handful of surgical teams that get slated for specific days of the week and there is always a variety of things to see.  Here's the short list of the most memorable things we saw:

Total Abdominal Hysterectomy (Gyn.)

Zygomatic Lift & Debridement (ENT)

Pediatric Cleft Foot Repair & Soft Tissue Release (Ortho)

Genital Warts Cauterization (Gyn.)

Scapular Open Reduction Internal Fixation (Ortho)

Femoral Open Reduction Internal Fixation (Ortho)

Mastectomy (Gen.Surg.)

Emergency Laporatomy & Thoracotomy (Gen.Surg.)

Because we weren't attached to any particular surgical team, we had the opportunity to interact and learn from them all.  Most of the surgeons and anesthetists were extremely communicative and made sure we understood the procedure; talking through each step and quizzing us along the way. This was our last week at King Edward and it was certainly an exciting way to make our exit!

A Tisket a Tasket, a WeekEND and Some Baskets!

The weekend kicked-off with a Friday night movie at home with our host family.  They wanted us to see Sarafina! which is a musical film adapted from a theater production about student-led resistance to Apartheid.  It was a great movie and even better to have watched it with our Zulu family.

On Saturday we woke to grey skies, and as we were waiting for the bus downtown, the clouds broke and we got poured on with rain!  As it showed no signs of stopping, we resorted to Plan B: exploring "the Pavillion", a giant (indoor) shopping center. I think it's safe to say we covered every corner of the complex, including the movie theater where we caught a showing of the new Robin Hood with Russell Crowe.

Fortunately, Durban weather pattern is predictably tropical; so although it rained all day Saturday, sunshine and hot temperatures resumed the next morning.  We fulfilled our original weekend plan by taking a minibus taxi downtown to Victoria Street Market, and then settling on the beachfront to soak up some sun.  The purpose in going to the market was to bargain for some Zulu baskets, which are both traditional and beautiful. With baskets in tow, we navigated our way back to the suburbs on the minibus taxi.  As our host brother MakaB says, riding the minibus taxis is traveling "African style!"  The taxis are basically 15 seat vans (full to capacity+), and using a series of hand signals and names of stops you can take them downtown and practically everywhere else for a fraction of the cost of other transportation.  Our round trip adventure cost us 12 ZAR per person or about $1.50 USD.   Weekend is over, but mission accomplished!

Our newly acquired collection of Zulu baskets!

Week Six

This week we began new placements at another district hospital, King Edward VIII Hospital.  Shanley & I were both on the pediatric rotation which was a nice change of patients and exposure to a lot of new things medically.  At King Edward there is a Pediatric Outpatient Department (POPD), a Pediatric Resuscitation Unit (critical care, PRU), a Neonatal Unit ("Nursery"), two inpatient wards, and an entire unit of pediatric gastroenteritis.

Monday through Wednesday we stayed pretty close to the PRU, learning from the department chief Dr. Ramji, who spent anywhere from 2 to 3 hours doing rounds with us!  King Edward is a teaching hospital and is linked to the University of Kwazulu-Natal's Nelson Mandela Medical School.  There are 4 interns and 1 resident on his service in the unit and they invited us to go to a lecture on Newborn Assessment/Physical Exams and the weekly M&M (morbidity & mortality) meeting, which was also pretty cool.  For the rest of the week we worked in the outpatient department doing measurements for neonates, as well as experiencing the nursery with its high volume and insufficient resources.

In nursery there is a constant flow of babies needing intensive care and only 3 respirators for the whole department. As such we witnessed some very difficult decisions being made about which babies had the best prognosis and social support to continue receiving care, versus those who didn't and would be taken off ventilation in order to make it available for another child in need.  On the other hand, we saw some pretty unique life-saving procedures like placing a central line through the umbilicus, which provides both venous and arterial access.

When we had some spare time we would go into the inpatient wards and play with/comfort the kids.  The inpatient wards are chaotic, with the kids roaming in hospital gowns doing anything to keep themselves entertained.  What was most difficult about the week was working with the kids that have conditions as a result of being a victim of their environment.  One little girl in particular, aged 10, presented with severe dehydration and headaches.  She has AIDS and had a recent admission of cryptococcal meningitis - which was the readmitting diagnosis this time.  She weighs only 17kgs, which classifies her a marasmus patient and stage IV AIDS.  Despite her physical condition, she kept bright eyes and a diligent smile which made reflect on why I love medicine: work is love made visible.

30 Days 'til Kick Off

.... which means I will be home in less than one month:

enjoying the World Cup with the comforts of home,
leaving the madness right here in South Africa.
You can be sure, however, that I will be returning donned in official FIFA gear.

Go Bafana Bafana!

Bunny in My Belly

This is a "bunny" (also called "bunny chow"):

It is a loaf of bread (or in this case, 1/4 loaf), hallowed out and filled with curry.  We read about bunny chow in all of our tour books, and have waited until Durban to indulge because Durban is known for having the best curries.  It was well worth the wait, and a perfect start to our WeekEND!

On Saturday, as is customary with the start of a new program, we were given a tour of the townships. As in Cape Town, the townships are primarily areas of very impoverished living.  However, in Durban the dwellings are less compacted together and there are more modern homes mixed in.  Umlazi is the second largest township in South Africa, and even after driving through it for two hours, we hadn't seen it all.  Still, after all these weeks, the scale and severity of these communities with people struggling to meet basic needs for survival is truly humbling.

The later part of the weekend we spent time with one of our host brothers, MakaB (age 13), at the Durban beach front and uShaka Marine World. The climate here is such that I suspect we may be spending more of our free time at the beach!

Week Five

The beginning of our stay in Durban has been clipping along with something new almost everyday.  On Monday we visited the University of KwaZulu-Natal, where we got registered as international students at the Nelson Mandela Medical School.  Our driver gave us a brief orientation of Durban city center and beach front, before we spent most of the afternoon viewing the new football stadium.  The rest of the week was back to work!

T

The New Group: Patricia & Chris from Univ. of Michigan, both undergrads

Tuesday and Wednesday we worked at the Marianhill Clinic, which is a private clinic run by the Islamic Medical Association and is located in a very rural township area.  On any given day, the clinic has one or two Sisters (nurses) who conduct the patient visits and administer treatment, as well as a counselor for HIV testing.  This is the only primary healthcare clinic in proximity to the rural community, so the volume of patients ranges between 140 and 160 people per day!  Because of the huge patient load, the Sisters move through the patients very quickly, taking only a few minutes to assess, diagnose and prescribe treatment.  Medications are dispensed and administered in the same visit, but this is delegated to a nursing assistant so that the Sister take the next patient.  Patients who present with an STI or signs of a viral infection (ie. shingles) are directly referred to the HIV counselor for testing. Although the pace of this sort of healthcare would be unheard of in the States, it is extremely efficient in this setting.   Because the clinic is private and in no way subsidized by the government, every patient that is seen must pay 40ZAR (about 6USD); this includes the visit and any medications that are given; however, HIV testing and counseling is free.

During our days at the clinic, the HIV counselor was kind enough to take us to see a sangoma, who is a traditional healer in the South African culture.  An overwhelming 80% of people in South Africa have sought treatment from a sangoma at one time or another.  The sangoma that we met was a 97 year old woman, who showed us her collection of herbs and mixtures for treating different ailments.  People must pay the sangoma for her services and sometimes this can be several hundred Rand.  Our sangoma was very patient with all of our questions and wide-eyed observations, and even did a good luck burning ritual while we were there.

T

The Sangoma with her herbs and mixtures

Thursday and Friday we moved on to Chatsworth Hospice, where we became acquainted with the hospice system in South Africa and went on home visits with the Sisters.  Chatsworth is a dominantly Indian community in Durban, in a suburban-like setting; during Apartheid it was where Indians were allowed to live, and have since stayed.

Hospice in South Africa is a non-governmental organization and is comprised of inpatient and home-based care.  Chatsworth only has ten inpatient beds and so most patients received care at home (which is the majority preference anyway).  The Sisters keep logs of patients who have terminal diagnosis as well as patients who are in remission.  During the home visits they assess the patient’s needs and will either make a referral for them to be admitted to the inpatient facility or they will just provide education and social support to the families.   Hospice Sisters and the few doctors that make rounds on the inpatients, work on a primarily volunteer basis which is truly impressive considering the workload.  Each geographic region/district has a hospice that serves its respective community, but again, it receives no support from the government.  Hospice in South Africa is more widely accepted and carries less of a stigma than in the US; it was a humbling way to end the week, working alongside the dedicated Sisters.

An Epidemic of Mass Proportion

This past weekend Shanley and I arrived in Durban, South Africa to begin the second leg of our internship. Durban is on the East Coast of the country and is very lush with scenery; although the climate is much hotter and more humid than Cape Town. The focus of this part of the internship is directed to the HIV/AIDS epidemic in South Africa; it is so widespread in a sense that it can be difficult to imagine for those living elsewhere. To help give perspective, here are some of the hard facts:

-In South Africa, one in five adults are infected with HIV

-Half of all deaths, and 71% of deaths among those aged between 15 and 49, are caused by AIDS

-In 2005, there were 1.2 million children orphaned by AIDS

-The average life expectancy in South Africa is 54 years; without AIDS it is estimated to be 64 years.

-In 1990 the first national antenatal survey to test for HIV found that 0.8% of pregnant women were HIV positive. By 2005 the rate had increased to 30.2%.

You may be reading and asking yourself, "Why did South Africa's AIDS epidemic go unchecked for so long?" From what I've learned so far, it's a problem that can be traced back to leadership, even in the last few years there have been mixed messages from the government on this issue:

-The most rapid increase of HIV prevelance took place between 1993 - 2000, during which time the country underwent major political changes with the disembarkment of Apartheid and so the problem was not given adequate attention.

-In 2000 at the International AIDS Conference in Durban, President Mbeki gave a speech conveying his belif that poverty, not HIV, was the root cause of AIDS.

-In 2006, then deputy president Jacob Zuma was on trial for allegedly raping an HIV positive woman. He attracted further controversy when he stated that he showered after sex in belief that this reduced his chances of becoming infected with HIV.

-In 2006, the health minister of South Africa spoke at the International AIDS Conference and promoted nutrition (specifically beetroot juice) rather than antiretrovirals (ARVs) for the treatment of HIV.

In response to the epidemic there have been mass campaigns throughout the country.  Evidence of this can be seen all over, especially in healthcare environments, with posters and other propaganda pertaining to the HIV/AIDS epidemic.  Here's just a sampling: