one REALLY long post

Hi family and friends!


It is the end of the fourth week for me in Durban. I leave to Cape Town in a week and half, which is the halfway point of my trip. Time is flying by so fast. Everyday has been busy and I am sorry for my lack of updates. Therefore, this will be a long blog and it definitely will not cover everything I have to say. Luckily, Chris leant me his laptop for the night so I can type it up and save time at the computer lab tomorrow at the university. Posting pictures has been difficult since public computers have privacy settings. I do have wonderful pictures and I am sure it is better than my descriptions.


S.A. Medical Education

Last time I left you with my experience at St. Mary’s Hospitals. Since then, I have been to three other hospitals. Week 2 was at District 2 hospital in Durban. It is adjacent to the medical school we are enrolled in as temporary international student. Since it is a teaching hospital, the doctors are more willing to teach as well as numerous registrars and post-graduates willing to take the time to teach. Education for medical students in South Africa consists of 6 six years of medical schools after grade 12, then two intern year and a required year of community service in a rural area. From then, they are considered a general practitioner (GP) and allowed to practice as a medical officer in a hospital or open a private practice. One can also continue their education and specialize, which lasts around 3 years depending on the specialty and consists of 2 exams. The residents are referred to as registrars. Everybody is a little confused by the pre-med concept and many equate an US pre-med student to a South African medical student. By the third year of med school, many of the students place chest drains, perform lumbar punctures and in their rural rotation are on call to assist in C-sections. When Molly, another OSU student, went to observe a C-section, she initially thought it was nice that they scrubbed her in. When the surgery began, the GP tried handing her the scalpel and told her to make the incision. Between the mask, face shield and accent it was hard to persuade the GP that she was not qualified to perform the surgery. The mentality in South Africa is one learns by hands-on experience. I was asked to assist in surgery at King Edwards, I had to explain how pre-med/med students are not typically allowed to assist in surgery. The head surgeons do take responsibility of those allowed to assist and will not let those they do not feel qualified. By the morals and ethics of the U.S., I still veer on the more cautious side to provide the best care to the patient. HIPPA and litigation is also near non-existent.


King Edward Hospital

Durban, South Africa

The pathology I have seen is only what I have read about in textbooks. The first day at King Edwards I went on teaching rounds in the immediate care unit in pediatrics. It mainly consist of malnutrition, diarrhea, dehydration, tuberculosis, meningitis, HIV associated immuno complications, such as minor symptoms of thrush to stage four AIDS of lactoacidosis. For those with lactoacidosis, those pt did not last the week and passed before I left. A topic that comes up often is how to combat HIV. Testing is voluntary and mandatory would be a breach of freedom of choice. Then again, watching babies and children die everyday at the hospital desires a change in legislation. To give nevirapine (which decreases transmission of HIV to upwards in the 90th percentile) to mothers before birth would require testing of mothers and mandatory testing after birth is hard to control since 6 weeks must pass. Children that are born in hospital may never return until near death and even if they were tested, ARV can only prolong life for approx. 12 years.

Tuesday I spent time in theatre, where I observed two surgeries. Both were plating of the mandible after gun shot wounds to the neck. Wednesday I spent the day in ultrasound. I initially had difficulty orienting and locating organs and structures on the screen. We performed many abdominal screens for gall stones, abdominal TB, lumps in breasts. Thursday was a short day in pediatrics and then our weekly meeting with the medical director.


Hluhluhwe Game Reserve/St. Lucia

We took Friday off to Hluhluhwe game reserve in St. Lucia. It was a beautiful sunny weekend after two weeks of rain in Durban. Friday we arrived to our hostel, spotted crocs and hippos on a boat tour, dinner and campfire. Saturday was an early start at 5 am for our day safari where we spotted, elephants, giraffes, rhinos, buffalos, monkeys, wildebeest, warthogs and many more. We had a braai (bbq) for lunch. That night, we also went on a night safari with rhinos, wildebeests, frogs and chameleons (yes! I held it.) Sunday we headed back only to have the tour bus we used, the Baz Bus, slow to 20 km/hour and died every 10 minutes. Since our driver did not know anything about cars, we diagnosed it as the alternator dead since after a ½ hour the battery light went on. In the end, we called mutiny, got off the bus at a hostel with a brewery. Baz bus refused to send a new bus until the bus broke down on the side of the freeway. Since it was getting to dusk and crime is a huge issue, we stayed at the hostel and paid a cab to take us back to Durban, a 1.5 hr trip. Besides the ending, it was an amazing weekend.


GJ Crooks Hospital

Scottsburgh, South Africa


Week 3 we traveled 45 min. south of Durban to a small coastal town as our rural rotation. We stayed in a bed and breakfast with a five minute walk to the ocean, which I did have the privilege of taking a run on the beach during the week. A district one hospital, it was amazing. I spent two days traveling to surround community clinics. By sending doctors out every two weeks to the clinics drastically reduces the number of pts travelling to the hospital. At the Ifume clinic, many scripts and referrals were written. Pathology included cerebral palsy, CHF, hypertension and diabetes. At the Mgai clinic (2 hours from the hospital, including the time spent being towed out of poor road conditions), we saw an epilepsy endemic area. Government grants are given to those on ARV, teen preg, epilepsy, STI and rheumatoid arthritis. Since epilepsy is taken by word of pt and maybe a family member, the grant is always given. All by one pt complained of seizures. The grants are never refused. In the end, to the doctors, a grant of 900 Rands ($100 US) is nothing for pts living without running water or electricity. Resources at clinics are limited. The doctor took blood for HIV testing without gloves.


The other days were spent in causality. Causality at GJ Crooks is the epitomy of understaff/lack of resources in the health field. It consists of one open room with three semi-private consultation rooms. Pts literally line three sides of the walls and pts lay side by side on roll away stretchers or wheelchairs in the center. It is usually only manned by one doctor and a team of nurses. Ventilation is poor. The typical ailments of South Africa was seen of dehydration, stage four HIV in children and adults and TB. I also saw wet/dry gangrene of the leg. I can think of nothing worse than the smell of rotting flesh.


On the last day, I sat in on psychiatric consultations. It was extremely education as the doctor went over physical indications of lack of well-being which include temporal lob fat indicates infection, dull skin, protruding clavicles, holding hands (temperature/sweating, nervousness, clubbing), and specific South African cultural indications such as potential brain damage indicated by scars from a tradition of stick fighting in Zulu culture and pride in shiny shoes. Pathology discussed included HIV dementia and Kern icterus.


My time in Scottsburgh was really enjoyable. I was really sad to leave. We made friends with a young married couple who shared their home with us as well as their opinion of medicine and the role of doctors in S.A.


Drakensberg/Lesotho




Our weekend trip consisted of traveling to Underberg. There we hiked a bit of Drakensberg, horse backed ride, had bombfires, roasted marshmallows and made s’mores. The log cabin we stayed at was amazing. Sunday, we had our passport stamped as we visited Lesotho, an inland country surrounded by S.A. I believe it is the highest point in the southern hemisphere. We drank and lunched at the highest pub in Africa. In Lesotho, we visited a local Basotho village. The living condition was even poorer than S.A. and many of the villagers sat poised in traditional garments where a picture could be taken for a token of thanks. The students donated money, but did not take pictures. It was sad to the people surrounded by foreigners and posing with large tour buses surround the area only to jet off to the pub afterwards. It was a long trip and the road to Lesotho consists of large boulders and rocks up the steep mountain. They call it the African massage.


King Edwards Hospital

Durban, South Africa


We are all back at King Edwards Hospital! This week has been amazing. I spent Monday and Tuesday in theatre where I witnessed debridgement of the right foot in a 8 year old male due to spinal bifidus, elongation of the Achilles tendon in a 4 year old male, removal of a rush rod from the femur in a 12 year old male, left breast mastectomy and level one axially node removal in a 66 yro female, trigen tibial nail and bone graft and rotomy in male adults.


Wednesday I went back to ultrasound and CT. Reviewing the ultrasound the second time really helps reiterate the structures I saw the first time. The screens included for cholecystistic, TB adominal, UTI, pyelonephritis and hydrocepitsis in newborns. Similar to surgery, the radiologist believed in learning by doing and let me have a go at the probe.

Albert Luthuli Central Hospital

Durban, South Africa

While at King Edwards Hospital, we met an outpt doctor who introduced us to many different departments. In addition, he arranged for us to visit Inokosi Albert Luthuli Central Hospital. St. Mary was mission funded and GJ Crooks and King Edwards are government hospital. Luthuli is the only private/public hospital. They are supported by several partners, including Siemens. It is stated all government receive equal funding. The various government hospital mirrors the social economical gap between the people of South Africa. While King Edwards has had buildings torn down and all by two building deemed as hazards, Luthuli is a brand-new hospital built in the late 1990s and comparable to first class hospitals in the States. A specialist hospital, a referral is needed to be admitted for clinic, which includes oncology, hematology, neurology, dermatology, ophthalmology, pathology, radiology, vascular and plastic. Theatre consists of 16 operating room. Despite a trauma unit prepared for red codes and a burn unit for severe burns, the wards for these departments were empty. After the pt is stabilized, pts are

transferred to their neighborhood hospital despite being understaffed and less resources. It was astonishing to walk around the hospital. It had wards with 8 beds per room and actual space between the beds. Consultation rooms were actual rooms instead of the corner of the waiting room sectioned off by curtains. It had a library and work-out room for staff. The disparities between the hospitals are unaccountable for and when inquired, people just shrug and say it is politics. I think you can justify the hospital by stating that as government, everybody benefits. To have a problem to be referred to a hospital, one has to be well-off. Twenty people per day receive chemotherapy. With TB, AIDS, and even malnutrition, few live long enough for cell to mutate. It was nice to visit and to make comparisons, but I will be glad to be back in clinics and King Edwards Hospital.


I spent the day with a cardiothoracic surgeon in clinic following up on patients. It is the only cardiothoracic department in a public hospital. We reviewed many chest x-rays and CT of the lungs and heart. Embolism, fluid in the lungs with drains, fistulas and carcinoma invading the ribs were all pathology seen in pt. We visited the wards for post-ops of valve replacements and coronary bypasses. We were invited back for clinic and theatre next week. I’ll keep you updated! (Oh, the hospital also has the only paperless charting system in the Southern hemisphere).


Today I spent in dermatology. I learned a lot. In general, one sees skin problems just walking about the hospital. Q few weeks ago I met a woman with leprosy. The skin lesions were each 2 inches in diameter and covered/distorted her entire face. Today I was able to examine dermatomyocitis (sp?), allophisa (sp?) (destruction of hair follicles), atrophy and a genetic disorder in a three day newborn. The baby had blisters at pressure points. The disorder causes a lack of adhesion between the basal membranes. Prognosis can be good if the child survives to teenage year.


I know this as long and I hope it was interesting. I will try my hardest at posting pictures, but I do not honestly see that happening very soon. I miss you all!


Leanna

St. Mary's Hospital

Sanibonani! (Hello in Zulu, the language commonly spoken in Durban besides English.)

Everything in South Africa is going wonderful. I haven't have much time to blog or get Internet access, but I thought I'll share a little bit of the week with you.

The first hospital we have been attending is St. Mary's Hospital. It is a primary care hospital, which is called district one here. It contains 200 beds, but sees approximately 6000 births, 48,000 in outpatient, and 15000 in inpatients and unknown # in their HIV/AIDS clinic.

Day One- My first day was in pediatrics. Since we had to register at the University of Kwazula-Natal, I only spent 2 hours in the ward. The children are happy and excited for visitors. Kids are so helpless and the most optimistic of all the pt I meet. I continually visited them over the week. I can't wait to post the pictures for you to meet them.

Day Two- "I'm young and feel great. I've never been sick a day of my life."

Chris and I spent the day in the iThemba clinic, an HIV/AIDS clinic. Each day, the waiting rooms and halls are packed with pt waiting for vitals to be taken, pills counted, pick up monthly meds, or see 1 of the 2 doctors or 2 nurses if they are sick.

We spent the morning taking vitals. It was humbling to meet all the pt. They were all friendly and helpful. 200 people are seen everyday. In the afternoon, I sat counseling for the different medication regimens. Generally, most pt are compliant and the clinic's strict pill counting and home follow-ups ensures compliance. During one counsel, a young man in his last year of university resisted treatment. "I'm young and feel great. I've never been sick a day of my life" was his response. He is right. Looking around, I would never have guessed these pt were HIV+ and that every pt I talked to were positive. This is a problem ingrained in the symptoms of HIV. PT are asymptomatic until it is too late. Therefore, pt never get tested until opportunistic infections occur.

Day Three- "I have a dream.."

Today was my day out in the community. Everyday, cars with counselors go out for home visits to check on ARV compliance or pt with limited support or resources. Our car today checked on children for proper care, support and treatment. The counselor work hard to educate parents as there is no system to remove children from their parents due to limited funds.

The trip provided the opportunity for me to view the living situation in South Africa. Houses speckled the green rolling countryside in densely packed areas with a few feet between each house with garbage covering the ground. Homes ranged from 5 x 5 mud square or mud huts. Most homes do not have running water or electricity. Garbage is piled everywhere. Currently, rubbish workers are on strike as are bus drivers due to low pay. In over six hours, we saw 4 families and visited 5 empty homes. As houses are scattered wherever there is free space, we drove up and down hills looking for families and only spent 5-10 minutes with the families we found.

Of the 4 families, the first was a HIV mother and baby who are both compliant to the meds, but the mother used the gov. grant money for baby formula on rent. Every situation is a catch-22. The choice is between hunger or shelter.

The second family we met was a 17 year old teenager with a previously malnourished baby living with her grandmother. She is one of many females in the country. Teen preg is very common and S. Africa is working on education and changing a whole society's beliefs. Condom use is not widely accepted and when the campaign initially began, more than 50% of the condoms were defective. For girls, protection or the choice to have sex is not an option. Many are raped and those that are not physically assaulted agree because they are supported by men. The government system also grants 220 Rand/month to teen moms, which is only $25 US a month. It is not enough to support a child, but to females with no money, it seems like an easy option.

Upon a hilltop, I met Innocent, whose Grandma is n ARV and sister on TB treatment. During our discussion, Innocent took me aside to ask me to help him with his problem. Outside, he told me he had this dream. It is to come to the US for job opportunities. He explains how he studies and reads the newspaper. Do I know of any sponsorships? Of all the people I met, he is the only one that specifically asked me for monetary support. Generally, the questions ranged from how long will I be here and when will I return. With no support from the govn., many look for foreigners for help. As an American, there is a sort of celebrity status. Children wave, cars honk and stop, people stare and favors are granted. In the end, there is so many problems to be solved and so many people to help. It is disheartening to know it is a long time before S.A. can rebuild so all can have even basic living conditions.

The next family was a short visit. Twin brothers walking on the sidewalk were hit by a car. One died instantaneously while the other one was badly hurt. Driving in S. Africa is madness. Right of way for pedestrians does not exist and people have to run to avoid being hit by cars. The sight of children do not even slow down cars. I saw 2 year old barely able to walk themselves grab younger siblings barely smaller them themselves hauling them out of the road as fast as possible

Day 4/5: Labor/Delivery

In the spring, I spent 10 weeks precetoring with an OB/GYN and it was one of the best medical experiences I had. I enjoyed the clinical and surgical aspects of the field. Seeing the labor/delivery ward in S.A. was such a contrast. When asked by our medical directors the biggest comparison between the states and S.A., it would not be the quality of care, but the lack of resources. Therefore, nurses and doctors offer the best care and pt pick up the rest of the slack. Those lucky enough to go to the hospital labor until they dilate 8 in the waiting room in wooden chairs, receive morphine and mandatory episiotomy without any lidocaine. There is no team of nurses, midwives, family and doctor. Nobody holds your hand or legs. The women scoot down the metal table by themselves. After the birth, the women literally pick up their belongings and move to the ward to spend maybe one night. There is no customer care.

I also witness 2 C-section. Very similar except the cut is made vertically instead of a horizontal cut as well as limited supplies. Everything is reuseable.

I hope this is specific enough. I have so much to say and so little time. Pictures are hard to take due to crime, but I tried to take as much as possible. In the future, most of my blogs might just be documented in pictures. Here is a link to my day in the community and Heidelbeg. Peds, labor/delivery, HIV/AIDS clinic to come.

I miss you all!

Community: http://www.facebook.com/photo.php?pid=34542033&l=15ebb&id=19712952

Heidelberg: http://www.facebook.com/album.php?aid=2149965&l=a51c6&id=19712952

Hello! I'm in S. Africa! This will be short. The flight was long, but good. The one thing I have truely enjoyed is meeting various people from all over the world. Everybody has been friendly and helpful. After my first 10 hour flight, I had a 12 hour flight in Germany. I went to Heidelberg, which is 55 miles from Frankfurt...Leanna-style. I got lost, but I found my way. Little mishap, I took the train 45 min in the wrong direction. It was worth the extra energy and money though. Heidelberg has the oldest university in Germany. It was old town wonder with a castle, coffee shops on cobblestone streets and historic buildings. I added a few pictures. I had yet to take pics here in S.A. It is a little bit more difficult.

My host family is wonderful. The mother definitely mothers me and the daughters are sweet, funny and helpful. I have yet to meet the other students. My driver gave me a small tour of Durban and I saw a few townships. One impression I have is all the tour books did not do justice in stating how poverish some areas are. I will state more on my impressions later.

Pre-Departure

Hello Family and Friends!

As most of you know, I am leaving for South Africa tomorrow! I do intend to keep a blog while I am away as a way to keep in contact and share my experience with you. I hate making promises I never intend to keep, but I will try my best to keep this updated. If you received an e-mail this link, I have put you on list that I will send when I updated this site. Honestly, I couldn’t figure out how to let people subscribe to the site, so the e-mail list seemed like the next best option. If you would like me to add or take you off the list, please just let me know. No hard feelings at all ;)

Before I start rambling on about my adventures and experiences in South Africa, I figured my first entry would be a compilation of some of the questions I have been asked.

First off, where and when are you going?

I am heading to South Africa, located in the southern tip of Africa, on the 24^th of September. I will spend 5 weeks in Durban and then 5 weeks in Cape Town. Durban is a large city of approximately 3.2 million people located on the east coast next to the Indian Ocean. It deems mild weather. Durban is the home to the Zulu nation, which are descendants of indentured laborers from India and British settlers. The population mainly consists of Black Africans followed by Indians.

Cape Town is the second largest city with a population of 3.5 million people. Bordered by the Atlantic Ocean and Table Mountain, Cape Town boasts of its picturesque scenery. It also contrasts huge economic disparity with the city center and surrounding townships called Cape Flats. South Africa has 12 official languages , including English.

Before heading back into the States on the 11^th of December, I’ll fly into Paris and spend a week in Europe.

Are you going someone? Where will you stay/amenities available/transportation?

That always seems to be the next question. Thank you for your concern for my safety…but yes. I’ll travel to S.A. alone, but there will be 3 other students from my school as well as other students from the Northwest.

Part of my program is to grasp a greater understanding of the culture as well as immerse myself in the culture. Therefore, in both cities, in both cities, I will stay with South African families that have dealt with difficulties from disadvantaged socio-economic status. Breakfast and dinner will be provided. For those who want to send mail, my address for the first 5 weeks is

10 Carolina Crescent
Woodlands, 4004

I will also be provided with a cell phone and I will post the number as soon as I find out. Transportation to and from the clinic is provided. All other transportation is on my own.

Now the important stuff, what are you doing?

The medical internship program I am participating is through the international department at my university, Oregon State, in conjunction with a nonprofit organization called Child Family Health International (CHFI) based out of San Francisco. www.chfi.org CHFI places students in global health education practices at 17 different sites in 6 countries, as well as recover medical supplies and equipments. In addition to 12 credits, I will rotate through various hospitals, clinics and wards in various specialties.

Why a medical internship and South Africa?

I choose to go on this medical internship and specifically to South Africa for many reasons. In winter 2007, I became interested in social justice work. It actually made me pause and reconsider my career choice of medicine. At first, I did not think the two fields could be combined without leaving a pursuit of a MD to a Master of Public Health. It seemed insurance companies limited the provider’s ability provide the best care. After researching many clinics and practices, it became evident that social work and a M.D. can be combined and are entwined. I am still researching different specialties, but I have seen examples of providing healthcare to disadvantaged individuals whether practicing as a primary care physician, volunteering of working in federally or nonprofit clinics or accepting CareOregon or Oregon Health Plan.

South Africa was then my destination of choice for its history of colonial and apartheid turmoil, struggle for racial equality and diversity of people. In correlation to medicine, health care is limited to inadequate funding and few medical professionals. Health care challenges include public health issues as well as the increasing prevalence rates of HIV/AIDS. Both of which I feel are critical problems in the United States. In Durban, the focus will be in hospices, AIDS care and treatment clinics, public hospitals and a rural rotation located 150 kms from the city. In Cape Town, rotations through three hospitals, including the teaching hospital of the University of Cape Town, include, but not limited to general surgery, trauma/emergency, urology, plastic surgery, orthopedics, pediatrics, gynecology.

Why Long Walk to South Africa?

My blog is named after Nelson Mandela’s autobiography, Long Walk to Freedom. My research included reading the history of S.A., which included Mandela’s work. Mandela amazed and inspired me with his strong conviction and fight against apartheid. He chose the difficult, self-sacrificial route of imprisonment, separation of family, all for dreams and hopes of changing the government and the beliefs of the majority of the nation for the equality of all races. His dedication of the mind through education, body through physical pain, and heart in constant anguish in his fight is an example of how one should live their life in pursuit for the betterment for others.

Thank you to everybody who has supported me in my decision to travel overseas, especially to my family who always trust and support in all the choices I make in life. I will be in touch!