Week Two

I have spent the last three days continuing to observe in the See & Treat and Casualty departments. A new physician in See & Treat has educated Molly and I a great deal about the process of diagnosis, what steps he takes to narrow down possibilities, and plenty of other useful tips. I got to observe the infectious disease ward rounds on Tuesday afternoon. An infectious disease consultant from the big tertiary hospital Groote Schur came to analyze the particularly challenging cases. Some individuals have HIV, TB, and other drug interaction complications. It is difficult to treat such complex cases, therefore it has been an informative experience for me to learn how they deal with these patients complications. Essentially TB treatment medications often have uncomfortable side effects or drug interactions with anti-retro virals. In the case where patients are responsible for taking their medications they often become non-compliant and stop taking some of their meds because the side effects are so difficult to live with. It often creates a vicious cycle of dealing with both diseases. I also observed a few femoral artery blood draws, did an ear examination, saw quite a few Deep Vein Thromboses, and a variety of other cases. A slightly disturbing situation occurred on Wednesday morning. During rounds in Casualty the doctors go around to each patient and briefly discuss their case so that the doctors for the new day know what has gone on over night. Some patients are passed over because their new or are being discharged for example. We passed by a middle-aged man on a wheelchair who looked asleep. About 5 minutes later one of the nurses quickly called over one of the doctors. The man had passed away in the wheelchair. It was an unfortunate circumstance because he had imminent liver failure from hyperglycemia related complications but he should've had a bed. This is a great example of the kind of patient load they are dealing with in their casualty department, the volume of patients is overwhelming and often there are simply not enough beds. I am learning a lot about the many healthcare challenges faced here in South Africa. This weekend we are going on the Garden Route trip with Avril and Marion our coordinators. It should be great fun and plenty of pictures will be up on Monday.