Jeremy is about to take off from Atlanta on the marathon 18 hours of being on the same plane. I am so excited to see him tomorrow night! Just a half day at Bara tomorrow, then it's time for traveling!
Here's our basic itinerary:
Feb 27-28: Hanging out at a B&B and around Jo'burg
March 1-3: Kruger Park doing a safari
March 4-9: Cape Town
March 10: Get home!
Hope everyone is wonderful!
Cheers.
Showing posts with label South Africa. Show all posts
Showing posts with label South Africa. Show all posts
February 26, 2009
February 25, 2009
Finishing up
As I only have 1.5 more days at Bara, I am starting to reflect a bit on what I have seen. It is so hard to express into words the experiences that I have had here. I have been trying to tell enough without telling too much to invade patient privacy and not gross you all out. Bara is a place with many things that need improvement. Today we were discussing the differences between private hospitals and public hospitals here in South Africa. Although I have not been to a private hospital here, it sounds and looks (from the outside) that they are much like the hospitals we have in the US. They have many of the ammenities that are available to us, unlike those which are not available at Bara. The divide between the private and public sector is astronamical. The more you can pay, the nicer facilities that you get to stay in when you are at the hospital, the less time you have to wait, and the more staff attend you.
I am sure that I will have much to write once I get home and think on these experiences some more. Hope you all are well!
Cheers.
I am sure that I will have much to write once I get home and think on these experiences some more. Hope you all are well!
Cheers.
February 24, 2009
Shock value
As I am finishing up my time at Chris Hani Baragawanth Hospital, I am realizing how used to the conditions that I have become.
Someone will go down the street with 2 different crutches, mothers will carry their infants tied to their backs (I have yet to see a stroller), and a patient who can barely walk will climb the stairs since the elevator is broken. The hospital runs out of prednisone for weeks, we search high and low for IV starting equipment, and patients wait for hours for a clinic appointment. Patients carry around their x-rays and their medical records so they won't get lost, patients go to the ward to check themselves into the hospital, and patients stay in the hospital for weeks, if not months.
I have only been around for 3.5 weeks, yet I am already getting used to the things that shocked me in the beginning. Doctors struggle everyday to fight the system, our consultant calls in favors frequently, and the registrars do as much as possible on their own in order to provide their patients with the best care possible. It is so encouraging that they care so much, but to not become burned out in a system like this would be so difficult.
Another general medicine ward rounds tomorrow, so should see many new things!
Cheers.
Someone will go down the street with 2 different crutches, mothers will carry their infants tied to their backs (I have yet to see a stroller), and a patient who can barely walk will climb the stairs since the elevator is broken. The hospital runs out of prednisone for weeks, we search high and low for IV starting equipment, and patients wait for hours for a clinic appointment. Patients carry around their x-rays and their medical records so they won't get lost, patients go to the ward to check themselves into the hospital, and patients stay in the hospital for weeks, if not months.
I have only been around for 3.5 weeks, yet I am already getting used to the things that shocked me in the beginning. Doctors struggle everyday to fight the system, our consultant calls in favors frequently, and the registrars do as much as possible on their own in order to provide their patients with the best care possible. It is so encouraging that they care so much, but to not become burned out in a system like this would be so difficult.
Another general medicine ward rounds tomorrow, so should see many new things!
Cheers.
February 23, 2009
Names
All of the patients in the hospital have 2 first names. One is a name that they were given by their parents when they were born, the other is the name that was given to them when they entered school by the officials, who said that their African names were to difficult to speak.
Example:
Nelson Mandela was born Rolihlahla, but was given the name Nelson by his teacher when he started school.
Example:
Nelson Mandela was born Rolihlahla, but was given the name Nelson by his teacher when he started school.
February 22, 2009
Pilanesburg Game Reserve
After having a great day on Saturday, including eating at Moyo and going out with some registrars from the hospital, we went on a game reserve drive today.
We saw:
Zebras, elephants, giraffes, monkeys, hippos, tons of birds, impalas, wildebeasts, warthogs, and so much more!
It was a great weekend! Now I'm just excited that Jeremy is coming on Friday!
We saw:
Zebras, elephants, giraffes, monkeys, hippos, tons of birds, impalas, wildebeasts, warthogs, and so much more!
It was a great weekend! Now I'm just excited that Jeremy is coming on Friday!
February 20, 2009
Community
Unlike most hospitals in the US, our haematology patients are often stuck in the hospital (with an occasional weekend pass) for as much as a month or two. This is due to many reasons, but especially because many of the patients are from too far away to come back and forth so regulary to receive their chemotherapy. They also need blood tests several times a week. At home, there are many outpatient centers that allow you to receive your chemotherapy as outpatient as long as it is not too strong.
These patients stay in rooms of 1 or 2 people (unlike the rest of the hospital, which is more like a giant room of 70 people) next to each other. Because they are in the hospital so long, as well as not having as much privacy as we are used to in the US, the patients all get to know each other. They move from room to room, keeping each other company and watching tv together (because the only rooms with tv are the ones where the patient brought their own).
The women in the upstairs unit watch their soap opera, "Sunset Beach," everyday when we come in the room to see how they are doing and take the bloods. The men were at lunch together at the cafeteria together when we tried to go by and round on them today. They all know about the other's conditions, therapies, and complaints. Often we will go into one patient's room and they will talk about how another patient is not feeling well.
Yes, they have much less privacy here than they do at home, but they also have support of people who have often been stuck in the hospital as much as themselves and who are suffering similar illnesses. They provide amazing support for each other, which many times they could not get at home because no one else understands as well as those who are going through it.
Cheers.
This weekend agenda: awesome, fancy African restaurant, the mall (seems to be a main weekend thing around here), and Palanesburg Game Reserve. Should be fun!
These patients stay in rooms of 1 or 2 people (unlike the rest of the hospital, which is more like a giant room of 70 people) next to each other. Because they are in the hospital so long, as well as not having as much privacy as we are used to in the US, the patients all get to know each other. They move from room to room, keeping each other company and watching tv together (because the only rooms with tv are the ones where the patient brought their own).
The women in the upstairs unit watch their soap opera, "Sunset Beach," everyday when we come in the room to see how they are doing and take the bloods. The men were at lunch together at the cafeteria together when we tried to go by and round on them today. They all know about the other's conditions, therapies, and complaints. Often we will go into one patient's room and they will talk about how another patient is not feeling well.
Yes, they have much less privacy here than they do at home, but they also have support of people who have often been stuck in the hospital as much as themselves and who are suffering similar illnesses. They provide amazing support for each other, which many times they could not get at home because no one else understands as well as those who are going through it.
Cheers.
This weekend agenda: awesome, fancy African restaurant, the mall (seems to be a main weekend thing around here), and Palanesburg Game Reserve. Should be fun!
February 19, 2009
Autonomy
The other day we attended an ethics lecture (by a lawyer, so a lot was really a law lecture), which made me realize how many laws/ethics are exactly the same as they are at home. By law, doctors have to receive informed consent before doing a procedure or else it can be considered an assault. Doctors have to do what any other "reasonable" physician would do in their situation. We talked about the basics of ethics: autonomy, beneficence, non-maleficence, and justice. Same as at home. No real differences. Except this is theory, and in practice they tend to not emphasize autonomy in the same way as we do in the US.
Patients are scolded, literally, whenever they do something that is not in the best interest of their health. The doctors here tell them that they need to lose weight, that they need to know their medications, that they never should skip an appointment, and so much more. They are all very caring, but often do not sugar coat things in order to make it more palatable. The doctors just tell it how it is. No worrying about being sued or hurting the patient's feelings. Just telling them what is in the best interest of their help. Never cruelly or offensively, but matter of fact.
At home we seem to tip toe around tough issues, worrying that we may somehow offend them. Who is really doing what is in the best interest of the patient?
Patients are scolded, literally, whenever they do something that is not in the best interest of their health. The doctors here tell them that they need to lose weight, that they need to know their medications, that they never should skip an appointment, and so much more. They are all very caring, but often do not sugar coat things in order to make it more palatable. The doctors just tell it how it is. No worrying about being sued or hurting the patient's feelings. Just telling them what is in the best interest of their help. Never cruelly or offensively, but matter of fact.
At home we seem to tip toe around tough issues, worrying that we may somehow offend them. Who is really doing what is in the best interest of the patient?
February 18, 2009
Essentials
One of the essential supplies that all of the doctors have in their coats at Bara are staplers. Yes, to staple papers together. The charting system is very unlike our 1/2 paper and 1/2 computer charting at home. Whenever more medication sheets, progress notes, and other forms need to be added to the chart, they are just stapled to the notes that are already present. The inpatient charts often end up looking like a wad of crumpled up paper, which has been separated and restapled many times because parts of the chart are sent to different places like the pharmacy. Due to all of this stapling and restapling, parts of the chart often go missing, and sometimes we do not even know if the patient has received all of the medication that they need.
Although their charting may still be mostly paper, at least they don't use pagers. Unlike at home, doctors carry cell phones, where they receive texts and calls. This would be so much easier than the 3-4 pagers the resident on call has to carry.
Although their charting may still be mostly paper, at least they don't use pagers. Unlike at home, doctors carry cell phones, where they receive texts and calls. This would be so much easier than the 3-4 pagers the resident on call has to carry.
February 17, 2009
Nemesis: HIV
The amount of human tragedy here in Jo'burg secondary to HIV is astronomical. I cannot even describe the devastation that this disease causes in this country. On the bus today, we (Ashley, Tina, and I -- all American students) were discussing how it is like our heart failure, diabetes, cardiovascular disease, and COPD all rolled into one, except instead of having the average age in 60-70s, these people are usually in their 30s.
HIV (or RVD--retroviral disease) status is treated like a vital sign. During a presentation of a patient's illness, it must be stated whether someone is HIV+, whether they are on ARVs (antiretrovirals), how long they have been diagnosed, and what their CD4 count is (a marker for their level of immunosuppression). My attending told us today that unlike the justice system where you are innocent until proven guilty, in South Africa "you are positive until you can prove that you are negative" in the hospital.
Today, Ashley and I went on general medicine intake rounds (which covers all of the patients who were admitted to the hospital overnight). The intern that we were working with told us that 1 of every 11 people in South Africa has HIV/AIDS (I have personally read numbers as high has 2/10), and that about 90% of the medicine admissions are HIV+. HIV is part of the basic testing that is done whenever a patient enters the hospital.
Although people seem educated regarding the prevalence of HIV, as well as the need to get tested, many people have not been tested, lie about their testing, or are not taking ARVs although they know they are positive. A patient we talked to today who is 4 months pregnant kept stating that she had never been positive, but after some more interrogation by our consultant, we discovered that she had tested positive 1 time, but never returned to have a confirmatory test. My perspective of the reason why people refuse to get tested, to not believe their test results, and why they do not take ARVs may not be completely true, but I have given it much thought:
People do not want to have HIV (obvious, sorry), so they deny it in every method possible. They do not want to acknowledge the fact that they may have hurt their loved one(s). They do not want to accept that they may become very ill themselves. They do not want to be looked down upon by those who surround them. By not taking meds and not getting tested, people are able to deny the fact that they have HIV/AIDS, so they do not have to take responsibility for their condition.
Today, I saw at least 10 patients with HIV. I saw tuberculosis, Non-Hodgkin's Lymphoma, cryptococcal meningitis, a lung abscess, aspiration pneumonia, aplastic anemia, polyarthralgia, and pure red cell aplasia all compounded with HIV. These diseases are so difficult to treat without the added burden of an immune system that is entirely depressed by HIV.
So therefore, I call HIV a frightful nemesis.
HIV (or RVD--retroviral disease) status is treated like a vital sign. During a presentation of a patient's illness, it must be stated whether someone is HIV+, whether they are on ARVs (antiretrovirals), how long they have been diagnosed, and what their CD4 count is (a marker for their level of immunosuppression). My attending told us today that unlike the justice system where you are innocent until proven guilty, in South Africa "you are positive until you can prove that you are negative" in the hospital.
Today, Ashley and I went on general medicine intake rounds (which covers all of the patients who were admitted to the hospital overnight). The intern that we were working with told us that 1 of every 11 people in South Africa has HIV/AIDS (I have personally read numbers as high has 2/10), and that about 90% of the medicine admissions are HIV+. HIV is part of the basic testing that is done whenever a patient enters the hospital.
Although people seem educated regarding the prevalence of HIV, as well as the need to get tested, many people have not been tested, lie about their testing, or are not taking ARVs although they know they are positive. A patient we talked to today who is 4 months pregnant kept stating that she had never been positive, but after some more interrogation by our consultant, we discovered that she had tested positive 1 time, but never returned to have a confirmatory test. My perspective of the reason why people refuse to get tested, to not believe their test results, and why they do not take ARVs may not be completely true, but I have given it much thought:
People do not want to have HIV (obvious, sorry), so they deny it in every method possible. They do not want to acknowledge the fact that they may have hurt their loved one(s). They do not want to accept that they may become very ill themselves. They do not want to be looked down upon by those who surround them. By not taking meds and not getting tested, people are able to deny the fact that they have HIV/AIDS, so they do not have to take responsibility for their condition.
Today, I saw at least 10 patients with HIV. I saw tuberculosis, Non-Hodgkin's Lymphoma, cryptococcal meningitis, a lung abscess, aspiration pneumonia, aplastic anemia, polyarthralgia, and pure red cell aplasia all compounded with HIV. These diseases are so difficult to treat without the added burden of an immune system that is entirely depressed by HIV.
So therefore, I call HIV a frightful nemesis.
February 11, 2009
Saving Soweto
We are not allowed to take pictures at the hospital, but I have taken a few from http://www.lefthandfilms.co.za/gallery/P16/, which are exactly where I walk around every day at the hospital. I thought you all might like to see what it is like. I only included pictures of places I see daily:
Pitching = showing up
Everyday we arrive at the hospital whenever our bus decides to drop us off. We get to the bus stop at approximately 6:50 am and hope for the best. Sometimes it gets there and leaves before 7:00 am rolls around, others we wait until about 7:20 am. We have officially discovered Africa time, which according to our registrars is very common. The bus could leave early or late, we just have to pitch to the hospital whenever we can. Our "bosses" are so worried about us making the bus in the afternoons, we actually leave about 20 minutes before its scheduled departure to wait for it. Needless to say, we do a lot of waiting every day.
Yesterday I officially saw my first patient on my own. Needless to say it was a little difficult. Not only was she the first person that I have met here that did not speak a word of English, but we could not find a room in the clinic for me to talk with her. After conquering these obstacles, I came to find out that she has had a deep cavitating lesion on her right thigh, which has been getting worse for the past 7 MONTHS! She had just been told to dress it, and eventually someone took a biopsy, which demonstrated lymphoma. She was unconcerned about it due to the fact that it was not painful for quite some time.
Another patient that I saw yesterday had 3 masses, which were visible from across the room, under his chin. He stated that he was unconcerned about the masses because, once again, they were not painful. My attending physician told me that this is extremely common here, especially in those who are uneducated and do not know that even and especially non-painful masses are something to go to the physician for.
So Ashley and I pitched (yes, that means showed up) to a "tut" (aka tutorial) today with the other South African medical students. We often feel significantly stupid in these sessions because everyone here seems to know so much more about physical diagnosis than in the US. At home, when we suspect something, we order the tests to discover what is wrong with the patients. Here, they narrow down the diagnosis much quicker and more efficiently just with their physical exam skills. They often discuss signs and symptoms that we have never heard before. It is amazing how much clinical teaching the students and the residents receive here. Several times a week, if not daily, an attending physician (consultant) takes time to teach a case including all of the physical diagnosis signs, which there are a LOT more abnormal findings here than in the US. It has been an amazing learning experience.
Cheers.
Yesterday I officially saw my first patient on my own. Needless to say it was a little difficult. Not only was she the first person that I have met here that did not speak a word of English, but we could not find a room in the clinic for me to talk with her. After conquering these obstacles, I came to find out that she has had a deep cavitating lesion on her right thigh, which has been getting worse for the past 7 MONTHS! She had just been told to dress it, and eventually someone took a biopsy, which demonstrated lymphoma. She was unconcerned about it due to the fact that it was not painful for quite some time.
Another patient that I saw yesterday had 3 masses, which were visible from across the room, under his chin. He stated that he was unconcerned about the masses because, once again, they were not painful. My attending physician told me that this is extremely common here, especially in those who are uneducated and do not know that even and especially non-painful masses are something to go to the physician for.
So Ashley and I pitched (yes, that means showed up) to a "tut" (aka tutorial) today with the other South African medical students. We often feel significantly stupid in these sessions because everyone here seems to know so much more about physical diagnosis than in the US. At home, when we suspect something, we order the tests to discover what is wrong with the patients. Here, they narrow down the diagnosis much quicker and more efficiently just with their physical exam skills. They often discuss signs and symptoms that we have never heard before. It is amazing how much clinical teaching the students and the residents receive here. Several times a week, if not daily, an attending physician (consultant) takes time to teach a case including all of the physical diagnosis signs, which there are a LOT more abnormal findings here than in the US. It has been an amazing learning experience.
Cheers.
February 9, 2009
Shame (said in 2 syllables: shay-m) = that stinks
One of the most difficult, frustrating things about Bara is the lack of resources. The doctors are every bit at educated and well read as any doctors at home, but they are very short on the number of sisters (nurses), as well as medications and other medical supplies. The doctors are persistant to get the best possible care for their patients.
Example 1:
We went to see an outlier (patient in another ward, whose primary team is general medicine), and discovered that the sisters were giving the morning medication at 1200. Hmm . . . our patient had not had her "bloods" taken for labs yet, she was dehydrated with her IV fluids stopped, and was throwing up. She had received an oral anti-emetic, but had been unable to keep it down. My registrar and I hung the fluids, mixed the Zofran (IV antinausea medicine), and took the bloods while we were there.
Example 2:
For about 4 days now, we have been trying to get an echocardiogram for one of our patients. The registrar has taken the patient to the cardiology department 3 days in a row, but they have not received the echo.
I have come to discover that persistance, as well as a well-respected attending physician can get you much more in Bara than anything else. For the lack of resources here, the difference from the US is that these patients never worry about where the funds are going to come from to pay for their care. When they need chemo, they receive the top of the line regimens that are proven in the literature. Although I have spoken with several who wished they had taken out medical aid (insurance) prior to becoming ill, they do receive the care they need without worrying about how they are going to pay for it if they get well. The also do not worry about it running out, especially since most of our patients are in the hospital for several weeks to a month. They all are also relatively young, so many of them never anticipated becoming ill in the first place. I know so many people like that in the US.
Miss you!
Example 1:
We went to see an outlier (patient in another ward, whose primary team is general medicine), and discovered that the sisters were giving the morning medication at 1200. Hmm . . . our patient had not had her "bloods" taken for labs yet, she was dehydrated with her IV fluids stopped, and was throwing up. She had received an oral anti-emetic, but had been unable to keep it down. My registrar and I hung the fluids, mixed the Zofran (IV antinausea medicine), and took the bloods while we were there.
Example 2:
For about 4 days now, we have been trying to get an echocardiogram for one of our patients. The registrar has taken the patient to the cardiology department 3 days in a row, but they have not received the echo.
I have come to discover that persistance, as well as a well-respected attending physician can get you much more in Bara than anything else. For the lack of resources here, the difference from the US is that these patients never worry about where the funds are going to come from to pay for their care. When they need chemo, they receive the top of the line regimens that are proven in the literature. Although I have spoken with several who wished they had taken out medical aid (insurance) prior to becoming ill, they do receive the care they need without worrying about how they are going to pay for it if they get well. The also do not worry about it running out, especially since most of our patients are in the hospital for several weeks to a month. They all are also relatively young, so many of them never anticipated becoming ill in the first place. I know so many people like that in the US.
Miss you!
February 5, 2009
How's it?
Hello from South Africa!
The last 5 days have been exciting, exhausting, and totally overwhelming. Due to our limited access to the computer lab, we haven't been able to get online since we were in the states. The experience so far has been nothing short of unbelievable. I am here with two other medical students (both Ashleys), and two of us are together on a haematology (South African spelling) rotation at Chris Hani Baragwanath, which is the largest hospital in the southern hemisphere. It is unlike anything I have ever seen. There are about 100 one story buildings, which are each wards. Between the wards there are covered walkways (maybe, if not dirt trails), where you walk outside. There are about 50 patients in one large open ward in each building, where there is maybe one bathroom, and definately no air conditioning. I have to say that one of the most unusual things that I have seen is when I looked through an open window and saw someone on a ventilator. The facilities are terrible, but the people that work here are extremely knowledgable (definately more so than the US in terms of physical diagnosis on exam) and I am already learning incredible amounts beyond the culture.
We are living in a dorm on part of the university campus, which is fine since we each have our own bedroom. There isn't any air con (as they call it here), but it really isn't necessary since it only gets to about 80 during the day and in the 60s at night. It rains every afternoon, so we sometimes get a little wet between the wards when we are walking around. We haven't really ventured outside of the hospital and our dorm. We ride about 45 minutes on the facility bus each way to get to Bara hospital. It is down in Soweto, which is short for South Western Townships, which is not the best part of town.
The amount of disease here is unreal. I will try not to bore you, since I know most of you are not interested in it, but our patients are approximately 75% HIV + (or RVD+) here. We see tons of AIDS associated conditions, as well as miliary TB. I also get to do many things that I wouldn't be able to do at home. Today, I actually got to perform a bone marrow biopsy! Super pumped about that. Anyway, enough of the boring medical stuff.
Hopefully, I'll get computer access again soon, so I'll fill you all in on details if you are interested.
Miss you all!
The last 5 days have been exciting, exhausting, and totally overwhelming. Due to our limited access to the computer lab, we haven't been able to get online since we were in the states. The experience so far has been nothing short of unbelievable. I am here with two other medical students (both Ashleys), and two of us are together on a haematology (South African spelling) rotation at Chris Hani Baragwanath, which is the largest hospital in the southern hemisphere. It is unlike anything I have ever seen. There are about 100 one story buildings, which are each wards. Between the wards there are covered walkways (maybe, if not dirt trails), where you walk outside. There are about 50 patients in one large open ward in each building, where there is maybe one bathroom, and definately no air conditioning. I have to say that one of the most unusual things that I have seen is when I looked through an open window and saw someone on a ventilator. The facilities are terrible, but the people that work here are extremely knowledgable (definately more so than the US in terms of physical diagnosis on exam) and I am already learning incredible amounts beyond the culture.
We are living in a dorm on part of the university campus, which is fine since we each have our own bedroom. There isn't any air con (as they call it here), but it really isn't necessary since it only gets to about 80 during the day and in the 60s at night. It rains every afternoon, so we sometimes get a little wet between the wards when we are walking around. We haven't really ventured outside of the hospital and our dorm. We ride about 45 minutes on the facility bus each way to get to Bara hospital. It is down in Soweto, which is short for South Western Townships, which is not the best part of town.
The amount of disease here is unreal. I will try not to bore you, since I know most of you are not interested in it, but our patients are approximately 75% HIV + (or RVD+) here. We see tons of AIDS associated conditions, as well as miliary TB. I also get to do many things that I wouldn't be able to do at home. Today, I actually got to perform a bone marrow biopsy! Super pumped about that. Anyway, enough of the boring medical stuff.
Hopefully, I'll get computer access again soon, so I'll fill you all in on details if you are interested.
Miss you all!
January 28, 2009
Getting ready to go
On Saturday, I will be leaving for South Africa for 6 weeks. I am doing a hematology (or in South African English: hemaetology) rotation at Chris Hani Baragwanth Hospital in Johannesburg for the first 4 weeks, then travelling with Jeremy for the last 2 weeks.
Right now I'm trying to make sure that I am ready. I've had my shots, have prophylaxis for malaria, and am carrying some cipro for just in case. Kind of funny since I will be working in a hospital, but I am trying to be prepared.
I am going to try to keep this blog up for everyone who is interested in what I'm up to.
Right now I'm trying to make sure that I am ready. I've had my shots, have prophylaxis for malaria, and am carrying some cipro for just in case. Kind of funny since I will be working in a hospital, but I am trying to be prepared.
I am going to try to keep this blog up for everyone who is interested in what I'm up to.
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