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