Our last two days, we spent more time at the different organizations we had visited earlier in the week. Wednesday morning, we began at REACH. The first day we were there, the building had flooded. Today everything was cleaned up so the children could be inside. We were only there for games in the morning, so we didn't get to see how the rest of Drug Awareness Week went. Next, we went to Tshepo. This time, we were able to teach the children using educational toys. I taught my group of kids parts of the body using a puzzle. They were so excited! The volunteer told us that they don't get to use these toys often since there aren't enough workers to take only a few kids at a time. That day, they were also handing out soup to the community, so there was a huge line of mothers and their children outside the gate to the daycare. This service will continue throughout winter, but this was the very first. Finally, we ended the day at Lebone. Again, we played with the children before serving them lunch and putting them to bed.
Thursday, we spent the entire day at Lebone. We sang with them for hours. They absolutely loved it! After feeding them a morning snack, we went outside to play games and get warmed up. The children were very sweet and made us a banner with all of their handprints and names on it to bring back home with us. After feeding them lunch, they took a nap and we said goodbye.
Friday, I left South Africa after a wonderful 6 weeks there! I not only learned a ton about medicine and the health issues the country is facing, but I learned about the country's history, culture, nature, and people. We also made connections with people here that we can maintain from back home. The relationships and knowledge I gained through my time abroad will certainly shape how I view health issues in the States when I return.
Clinical Education in South Africa
Monday, July 2, 2012
Tuesday, June 26, 2012
Community Engagement
This week, now that the medical students are on holiday, we
are back to doing community engagement. This involves visiting various NGOs
around Bloemfontein and helping out however we can. On Monday, we went to
Tshepo Foundation’s daycare and crèche in a township of Bloemfontein. It was
founded in 2000, and it is a Christian-based organization. It has grown a ton
since it began, and now it even has a wellness center. A local doctor
volunteers her time to screen the children and refer them to another doctor if
necessary. This prevents them from having to wait days at the clinic to be seen
by a sister, who may not even catch that there is something wrong. She says she
has found TB as well as HIV/AIDS in the kids. They hope to expand the program by
getting more doctors to volunteer time. This way they can also reach other
parts of the community. We visited all of the classrooms to see the different
age groups. The children were extremely well-behaved and excited to see us. One
group sang us a song about HIV/AIDS and how it affects their community. It was
amazing to see how much these young children know about this disease, since it
is a part of their daily life. Later, we had a chance to play with the children
on their playground. They were very excited to speak whatever English they
knew, teach us games, play with our hair, and just be held. It was a fantastic
experience, and we couldn’t wait to go back! Later, we went to Lebone village
again. We were only there an hour, so we played with the orphans a little, then
helped feed them lunch. Afterward, we put them to sleep for naptime.
The children at Tshepo Foundation |
Tuesday, we spent the morning at REACH. We had gone there
the first week we were in Bloemfontein, but the children were not there since
it is only an afterschool program. Now, it is their school holiday, so they are
there all day. This week is Drug Awareness Week, and the children are doing
various programs all week to learn more about drugs and their effect on the
community. They were divided into four teams, with names like “The Drug
Chasers” and “No High.” Yesterday, they performed skits to earn points for
their team. Today, they had to create a poster showing the negative effects of
drugs. At the end of the week, the winning team will get a prize. While there,
we also played several games with them and had a short prayer, since it is also
a Christian-based organization. The woman working there told us that many of
the children are victims of abuse, so they have a social worker there that
helps advocate for the children.
While we did not want to leave REACH, we were beyond excited
to go back to Tshepo today. We went on a walk around the township to see what
life is like there. We saw all of the shacks, as well as the RDP homes that are
built for families by the government. We also stopped by a shop that sold
vetkoeks (fat cakes), which were basically sweet, fried balls of dough. When we
returned to the crèche, the children were finishing their snacks, and we played
with them again.
Finally, we made our last stop for the day at New Horizons.
This is an organization that provides nursing care for patients that are
homebound in Heidedal. It was founded by a nurse who had lupus and saw the need
for such a service when she wa unable to take care of the people in her
neighborhood due to her illness. We went with the nurses to three different
houses. The first man we saw had epilepsy. The nurses basically made sure he
had taken his medication for the day and that he knew when he had to go to the
hospital for follow-up appointments. The second patient was a woman who had a
stroke and could not move. She lives alone with her two children, but is unable
to take proper care of them. She can’t leave the bed, so her bed is always wet.
However, these nurses are working with such limited supplies, time, and
funding, that they cannot wash the bedding for her. They could only bathe her.
It was very difficult to see. The last patient was a woman recently diagnosed
with AIDS. The nurses wanted to make sure she was taking her ARV medication,
since many patients stop taking them due to the extremely uncomfortable side
effects. It was nice to see that there are people to check on these sick patients
every day, but hard to accept that they can’t do very much with the lack of
resources available.
Sunday, June 24, 2012
Obstetrics and Gynecology
Brief Overview
This past week I switched from surgery to the obstetrics and
gynecology rotation. I was able to see some of the smaller clinics, as well as
large hospitals. This gave me a better understanding of how the health system
works here in South Africa, as well as the different services offered at each
level of care. In addition, I learned more about the role of sisters in
antenatal care specifically. I went on call one night, and only one baby was
born the entire night! It was amazing to be able to watch the C-section.
Lecture topics this week included biology of aging, anemia, adrenal gland
physiology, mitral valve disease, biological effects of radiation, statistics,
neonatal endocrine and metabolic abnormalities, trauma surgery, physiology of
the eye, the district health system, and diagnostic imaging. There was also a
guest speaker from the UK presenting “101 Things to Do While On Call.”
Clinical Rounds
My first day of rounds was at Pelonomi Hospital’s prenatal
ward. In South Africa, pregnant women first go to their local clinic to be
treated. When there is a complication, they must go to a more specialized
institution, such as a hospital. Therefore, all of these women had some kind of
complication or risk factor for which they were referred. The first thing I
learned about OBGYN was the structure of the H-10 form. This is a form that all
South African medical facilities use when treating a pregnant woman. The woman
then keeps the form with her throughout her pregnancy, so that any medical
provider can know everything important about the woman’s history. It includes
demographic data, information about previous pregnancies, social situation,
family history of diseases, blood work, past operations, current medications,
plan for contraception after delivery, and the estimated date of delivery
(EDD). The EDD is determined by a combination of the following: calculation of
40 weeks past the start of the last known menstrual cycle, sonar imaging, and
SF measurement. It was actually quite complicated—especially when there was
discrepancy among the different types of measurements. The doctor was very
stern when the fourth years presented their cases, making sure they knew what
each part of the H-10 form meant, what all lab results signified, what the
diagnosis was, and what treatment was necessary. She was so thorough that it
took two hours for one patient!
The next morning, I was at Heidedal’s prenatal clinic. We
learned how to take patient history on the H-10 card, and were even able to
practice on a patient! We learned specifics about the blood work that is done
on each patient. They test each mother’s HIV status, hemoglobin, Rh factor, and
for syphilis. We also observed a full physical examination on several women,
and learned how to take the SF measurement that is used to determine gestation.
Finally, we were able to locate and listen to the fetal heartbeat. A sister
typically does all of this. The sister we were shadowing was very helpful and
patient, even though the clinic was extremely busy, so we learned a lot.
Wednesday morning, we were assigned to observe sonar at
National Hospital. However, the woman there would not let students watch her.
This was a problem, since the students have to see a certain number of
different procedures during their rotation, and sonar was included. We ended up
going to Universitas to observe. This ward was for extremely complicated
pregnancies and was very modern looking and sterile. It looked just like an
ultrasound room in the US. We saw three sonars. The first case had a baby that
was not growing properly. The woman was 24 weeks pregnant, but the baby was
only the size of 20 weeks. The physician had to explain to her that she would
most likely lose the baby, which was tough to watch. The second mother had a
mitral valve replacement (which we had already learned about in lecture), so
she was taking warfarin for that. The problem is that this drug causes defects.
The doctor was checking to make sure the baby was still growing properly, and
it was. The final sonar was a 4D scan, which was very cool. It was to check for
defects due to a genetic trisomy condition. It was interesting to see how much
could be determined from an ultrasound. We listened to the fetal heartbeat and
determined gestation by measuring the length of the femur.
Thursday morning, I was at the prenatal clinic at MUCPP,
located in the township. The consultation rooms were very crowded because there
were nursing students there observing as well. Even though it was a little
hectic, we were able to do some physical exams on a few patients. The medical
student I was with said that the observations and rotations they do during
their third years are important for them to understand what the health
professionals do. For instance, sisters perform physical exams on patients;
these students will not do that as a doctor. It’s important, however, that they
are able to know what the sisters did and understand their notes when a patient
is referred to them. It was very inspiring to hear of this dedication to
collaboration in the workplace.
On Call
I was on call all night on Wednesday at Pelonomi labor ward.
When we got there, two twins had just been delivered, so we were able to see
them. Then, we were in the theater for a C-section. It was such an amazing
thing to watch, and it was interesting that the mother only had a localized
anesthetic so she knew what was going on during her operation. I was also
impressed by how many people were needed to deliver the baby. There were
doctors for both the mother and the newborn, as well as students or nurses to
assist. After that, I couldn’t wait to see more, but it was a very slow night.
We actually did not see anything else, so we got a good night’s rest in the on
call room.
Lectures
The biology of aging lecturer did a fantastic job of
highlighting the importance of gerontology. He gave statistics about the
elderly in the Free State and around the world, showing that the elderly
population is growing rapidly. This signifies a growing need for providers for
this patient population. He also gave a general overview of aging, showing the
difference in life expectancy for different organisms (ex: flies live 18 days,
sea turtles live 380 years, and trees live thousands of years). He also showed
how the human life expectancy has changed throughout the years, dating back to
the life expectancy of Bible patriarchs. It was interesting to me to see the
frequency with which religion is included as a part of the lectures. He
concluded that diet and exercise are the most effective ways to age in a
healthy way.
The anemia lecture was very informal, with the professor
introducing himself by his first name only. He stressed the importance of
looking for the cause of anemia, rather than simply diagnosing and treating the
anemia. He also pointed out specific things to ask when taking history. For
example, he wants the students to ask separately if the patient is taking any
over-the-counter medications, since patients often do not report this when
asked if they are taking any medications. In addition, he showed the importance
of knowing the cultural and social qualities of the patient. He gave the
example that families who drink a lot of tea are often anemic, since tea
inhibits iron absorption and that alcoholics have lower folate levels. The
following lecture on adrenal glands was presented through a case study of a
real patient with Addison’s disease. She also reviewed a few concepts from the
previous endocrine lecture. The final lecture on mitral valve disease was
interesting because he talked about how mitral regurgitation has different
causes in South Africa than in Europe. In South Africa, it is typically due to
rheumatic endocarditis, which requires a valve replacement rather than repair.
This lecture overlapped a lot with the aortic valve lecture the previous week.
The medical physics lecture was on the biological effects of
radiation and radiation protection. She provided guidance on safe doses of
radiation by comparing the amount of radiation one receives in different ways,
such as smoking, cooking with natural gas, living near a nuclear plant, and
getting an X-ray. She specifically argued that medical radiation is an
acceptable risk if it is used cautiously, since smoking can shorten your life
by seven years while medical radiation only shortens it by about 49 days. She
then taught how to protect the patient from unnecessary radiation and
precautions to take during pregnancy.
The statistics lecture was extremely interesting. He argued
the importance of statistics as having the ability to identify a problem or
public health issue, so that action can be taken to solve it. He used an
interactive computer model to show various health statistics for South Africa
and countries around the world. For example, he showed that the most global
child deaths occur in sub-Saharan Africa. Through these statistics, WHO has
gotten involved to implement programs to save newborns, such as tetanus
vaccines, malaria prevention, kangaroo mother care, and breastfeeding.
The trauma surgery was a continuation from the one last
week. Therefore, it was taught in a similar fashion, using situations to teach
different emergency medicine procedures. After this, a guest lecturer from the
UK came and presented “101 Things to Do On Call.” The students liked to see the
similarities and differences between their system of education and clinical
practice and that of the UK. We were also able to practice some when we were on
call that week.
Thursday, the students wrote a quiz on the anatomy of the
eye. It was very short, and then we had a lecture on the physiology of the eye.
The lecturer did not make the powerpoint, so she skipped many irrelevant
slides. She did include several demonstrations and videos, however, to
illustrate the concepts.
That afternoon, we had a lecture on the district health
system. The students were presented with a project in which they must use the
National Health Act to back up a case study. The lecturer compared the
structure of South Africa’s health care system to the US, explaining that South
Africa provides health care based on geographical districts rather than who can
afford the services. He also taught about the importance of getting the
community to participate in health care service delivery. Another point he
stressed was developing a system in which people at the grassroots level can have
a voice at the top of the system in order to effect change. There was much
debate among the students, making it a more dynamic lecture than most.
The final lecture was on diagnostic imaging of the liver. I’ll
be honest and say that this lecture was more above my head than the others
because it was mostly just images of radiological scans. Since I didn’t have
the appropriate background at reading these, I found it a little confusing. The
professor did provide a lot of advice, however, about how to avoid making mistakes
when reading the scans and preparing a diagnosis.
Clinical Education Facts
The students received their final grades for their third
year of medical school this week! Those that passed are now fourth years. If
students did not pass, but were close, they have a chance to rewrite exams in a
few weeks. However, any student below the rewrite score fails the year and must
repeat the entire third year.
For the OBGYN rotation, the students have a book with a
certain number of procedures or tasks they must observe or do. When they
complete it, the doctor or sister signs it off. This, along with a report on a
case study is due for marks at the end of the rotation.
Friday, June 15, 2012
Last Days of Surgery
Brief Overview
This week we continued hospital rounds in the surgery unit.
We had one more day at Universitas Hospital, then went to Pelonomi for the
remainder of the week to get experience in a different location. These mornings
we went on rounds in the wards and then observed some clinic visits. We were
also on call at Pelonomi Thursday evening after class until 11pm. We only saw
two patients while there. One was not in a stable enough state to have his
operation, and the other was an appendectomy. Lecture topics have included
surgery, health policy and service delivery, ophthalmology, obstetrics and
gynecology, and trauma.
Clinical Rounds
Our first day of rounds, none of us knew what to expect. We
arrived and quickly began following a doctor from bed to bed. At each bed,
registrars had to present the patient’s history, diagnosis, and treatment to
the doctor. Then, the doctor would question both the registrars and the
students. There were about 4-6 patients per room, so there was little privacy.
There were some very interesting cases, however, since these patients were brought
in for the 5th year clinical exams that had just ended. We saw a 98
year old man with breast cancer, many hernia patients, breast cancer patients,
and patients with thyroid conditions. It was interesting that the doctor never
used gloves, even when undressing wounds and drawing blood. We later went to
the endocrine clinic. We sat in on a consultation about a patient’s thyroid
condition, but I was unable to understand much because they were speaking
Afrikaans.
Rounds in Pelonomi were only slightly different. We were
accompanied by some 4th year medical students and two doctors. These
doctors were much more interactive with the students. When they did not know
the answers to his questions, he would make them find the answers and report
their findings to him the following day, rather than tell them the answer. The
students say they’ve learned much better that way. When they did know answers,
he asked continually more detailed or challenging questions to really prepare
them to be doctors. The students were also very helpful with explaining things
to us. One of the fourth year students even taught me how to examine a parotid
mass on a patient. The very next day, the doctor had to use a translator to
tell this woman that the mass was cancerous and the removal of the tumor would
compromise her facial nerve, leaving one side of her face paralyzed. He wanted
the patients to see how to effectively deliver bad news, as this is a necessary
skill for all physicians. At the clinic, the doctor took about a half hour to
let the 4th year students present their “homework” from the previous
day and explain more to them about their patients. Then, we saw two
consultations. The doctor was extremely compassionate toward his patients and
addressed their concerns and desires regarding their treatments.
On Call
After class on Thursday, we went back to Pelonomi to be on
call until 11pm. It was very slow that night. We saw only two patients. The
first was a middle-aged man with AIDS. He needed a surgery for an intestinal
blockage, but the doctors could not operate due to the severity of his AIDS.
The students said this is quite normal, since most of their patients are HIV
positive (very different from the US). They’ve been taught to assume all
patients are HIV positive until proven otherwise. If a doctor or student gets
pricked, they are started on immediate ARV treatment for one month. We later
saw a patient that presented with abdominal pain. It was fascinating to be
there for the entire process of trying to make a diagnosis. It first began with
eliminating ectopic pregnancy. We were told to assume every woman is pregnant
until proven otherwise, and that every pregnancy is ectopic unless proven
otherwise. We learned a lot about the different blood, urine, and radiological
tests that are done. Even with all of the tests, it was unsure what her problem
was, so they had to do an exploratory abdominal surgery. It ended up that she
had appendicitis, so they simply had to remove it. We saw her the next morning,
and she was recovering well.
Lectures
The surgery lecturer handed out an outline of everything
that is most important in each chapter to help guide the students. He is 83
years old and was the first trauma surgeon in SA, so it was very interesting to
hear his advice and opinions. He highlighted the power of observation,
listening to the patient, managing time, and asking open questions. He also
spoke much about how different each individual patient is and the danger of
making generalizations. Finally, he taught about establishing a trusting and
respectful relationship with the patient by touching their hand before
continuing with the rest of the examination.
The ophthalmology lecturer was substituting for the normal
lecturer. She mainly read off of the slides and finished very quickly. The
health policy and service delivery lecture was fantastic (probably because I’m
more interested in public health than most of the medical students). He was
very funny and interactive. He probed the students to think beyond the
principles that seemed like common sense upon first glance. For example, he
made them define the term “healthcare system.” At the end, he reviewed health
legislature in the past decade in SA, but he went through it very quickly. The
main things were the ability of children to consent to abortion at age 12, the
implementation of a national health insurance plan, ARV roll out plans, and the
role of the government in sustaining the private health care sector in SA. The obstetrics and gynecology lecture was
very interesting, especially since I’ll be in that department for clinical
rounds next week. She was very effective because she showed the logic behind
all the changes that happen during pregnancy.
The trauma lecture was two hours long. He began with a
history of trauma, starting with Cain and Abel in the Bible, the Aztecs,
ancient Chinese medicine, early ambulances, all the way to the current state of
emergency medicine and trauma. He also mentioned ethics, specifically regarding
prolonging one’s life and whether the patient will still have dignity once they
recover. He included law as well, by teaching about prevention. For example,
laws against drinking and driving help prevent motor vehicle accident trauma. This
lecture also included some physics, treatment techniques, and information about
providing psychological support for patients and their families. At the end, he
predicted that in the future, more trauma will be due to terrorism, and
biological or nuclear agents, as well as natural disasters. Additionally, he
commented on the importance of technology, as the hospitals are now moving away
from paper charts and toward electronic systems.
Clinical Education Facts
- The entrance exam is a general test covering math, reading, science, and writing; it takes a total of six hours.
- The students take OSCE exams, in which they see a picture of a condition. They must describe what they see, diagnose the condition, tell what other causes are possible, and outline what types of treatments may be used.
- UFS has an anatomy and pathology museum for students to utilize when studying. It was amazing to see how many different specimens they had--including embryos from every stage of pregnancy.
- The students joke that 3rd years are "medical spies," because they don't know anything and are just looking around, taking in information. The 4th years are "medical tourists," because they are observing everything. The 5th years are "medical slaves," because now they are expected to do everything they've learned and seen the past two years.
Tuesday, June 12, 2012
Initial Days as a Medical Student
Short Summary
This week we started our internship with the medical program
here at UFS. We essentially are shadowing a medical student and doing
everything a medical student at UFS would do. In the mornings, we have clinical
rotations. This week I am in surgery rotation. So far, we’ve spent a day in
gastroscopy and a day in the operating “theater.” In the afternoons, we attend
lectures, which have varied in topics from hematology and cardiovascular
abnormalities to radiology and pediatrics. A few nights we will be on call
overnight at different clinics around Bloemfontein. It’s busy, but I’m learning
so much and making many new friends!
Clinical Rounds
Our first morning of rounds was in gastroscopy. The first
patient we saw had dysphasia and had to have a permanent feeding tube inserted.
We could not understand everything going on because the sisters (nurses) and
the doctor were not speaking English. The medical students tried to tell us
what was going on when they could though, which was nice. I thought it was
interesting that the patient only had local anesthesia, because it looked so
painful. I also noted that the sister touched some materials that had been
autoclaved without gloves.
Next, we watched a colonoscopy. This time, there were two
doctors present, so one was available to focus on explaining things to us and
questioning the medical students about the symptoms, procedure, and possible
treatment options. It is amazing how much these students know since they are
the same age as us. He also gave them
the tip to classify their future patients into the following groups: healthy,
curable, palliative, or about to die. That way, they can determine the best
method of treatment to maximize the comfort of the patient as well as efficient
allocation of resources.
Tuesday, we were in the surgical theater (operating room).
We learned the proper way to scrub in. It was interesting to notice that they
even have a different protocol for washing hands than we use. The scrub sister
was very funny and helpful. Even though we had to watch the operation from the
observation room above, two of the students were able to scrub in and do some
stitches! They were very excited and nervous since it was their first time on
an actual patient! We watched a venisection called a “fem-pop.” It was above my
understanding, honestly, but they removed a large vein running the length of
the leg, attached it to the femoral artery, then to somewhere else to divert
blood away from a clot. Overall, the operating room looked just like on in the
US, and they were very cognizant of sterile technique. The only difference I
noticed was the use of fabric scrub gowns rather than disposable ones.
Lecture
The students have lectures every afternoon, from
approximately 12-5, with a lunch break. However, there is a new lecturer every
1-2 hours, so it really isn’t too bad. A sign-in sheet is passed around at the
beginning of each separate lecture, and the students must attend 80% of
lectures to be eligible to write exams. Most lecturers have a PowerPoint
presentation, and the students have a massive bound book with all of the
printouts of the slides in it. The style of lecture is very different depending
on the professor or doctor speaking.
Our first lecture was on myeloproliferative neoplasias,
which are cancers of the bone marrow. This lecturer was very interactive and
used simple metaphors to clarify the concepts he was teaching. He also found it
very important to relate research to clinical practice. He explained how
research has increased the knowledge about these diseases so much so that
current medical students often understand them much more than the older
generation doctors. He also explained the problem that the drugs to treat this
disease are extremely expensive since it isn’t very common. He then highlighted
a nonprofit organization called Max Foundation, that provides these medications
to anyone in need who cannot afford it. He even had specific numbers regarding
how many people in Bloem benefit from that organization.
The next lecture was on pituitary function. This lecturer
was more formal, and he had each disorder categorized into symptomology,
screening, diagnosis, treatment, and follow-up.
He also included mnemonic devices and tips for the students as they
study for their exams.
The final lecture for Monday was on aortic stenosis, a
cardiovascular condition. This professor reviewed basic anatomy and physiology
of the heart. He also went through a logical progression to help the students
understand how the disorder affects the patient to determine the potential outcomes.
His powerpoint was more of an outline, however, so the students had to pay
close attention to take good notes.
Tuesday, the first lecture was on radiology. She specifically
spoke about efficiency and accuracy. She highlighted the importance of
requesting the correct test and providing the radiology department with ample
and sufficient information to know exactly what is necessary. This protects the
patient from unnecessary radiation, but also saves money (this is especially
important in a public health system). Her advice was to always ask the
question, “Am I going to act upon the results of this test?” If not, the test
is unnecessary and should not be requested. One interesting thing she said was
that they have patients keep their radiology films and bring them back for
follow-up appointments rather than keeping them at the hospital.
The rest of the day was pediatrics lectures. One was on
thermal regulation in neonates, and the other was on fetal development. They
were both very interesting because they deal with such a unique and special
patient population. The first lecturer taught without a PowerPoint by just
asking the students questions and guiding them toward the answers. The second
lecturer was very funny and passionate about the topic. One interesting thing
she pointed out was the difference between the public and private systems. For
example, there is more extensive screening of neonates for medical conditions
in the private sector than the public. She also shared personal experiences,
such as a time when she failed to diagnose hypothyroidism in a baby.
Clinical Education
At UFS, there are two classes for medicine—Afrikaans and
English. Both admit 80 students each year. However, the group of third year
students we are currently shadowing has 50 English and 72 Afrikaans. This is
due to students either failing or dropping out. If the students fail, they are
allowed to repeat twice. The same year cannot be repeated twice though. During
the second year, the students study anatomy, and most perform a clinical
research study. For example, one group of students studied children who were
admitted to hospitals and clinics around Bloem after car accidents to see what
percentage was wearing seatbelts, since it is now a law for children to wear
them. The entire medical education is five years, followed by a two-year
internship and a year of community service. If they want to specialize, it can
take another five years. At this point, they are called registrars.
The past two days, the fifth year students have been taking
their final exams. They have both long and short exams. In the short ones, the
examiner tells the student the patient’s complaint or an area of the body that
has an abnormality. Then, the student must examine the patient and make a
diagnosis in fifteen minutes. For the long exam, they must take a complete
patient history and do a physical exam to make a diagnosis in thirty minutes.
All of the students looked so stressed! The hospital was also very busy as
there were examiners from all over the country there to administer the exams.
Friday, June 8, 2012
Community Engagement!
We started our community engagement program yesterday and
were able to see various nonprofit organizations and clinics around
Bloemfontein. Our first stop was MUCPP, which stands for Manguang University
Community Partnership. This clinic is in the township and was set up by the
Health Department, the University of Free State, and the Manguang community.
When we walked inside, there were patients everywhere. The waiting room was
full, and there were lines of people outside each department. While they send
patients with very serious ailments to another institution, the clinic can
provide most services. They even deliver babies there and have a physiotherapy
center. All of the services are free, just like all public healthcare
facilities in South Africa. Another interesting program offered is called
LoveLife. Youth from the township come into the clinic when they have free time
to be trained in HIV/AIDS prevention education. Then they go into their
community to educate others. Not only does this program increase awareness
about HIV/AIDS, it also gives these youth something to do with their free time
rather than getting into trouble or involved in crime.
We returned to Lebone village to get a better understanding
of what they do. They house 42 orphans who are affected or infected by
HIV/AIDS. They transport the kids to school each day and provides nutritious meals
for them. After school, they offer afternoon classes and homework help. The
village even has a computer lab to ensure the children develop necessary skills
to secure a job. Lebone village also has a large farm of vegetables, a chicken
farm, and a greenhouse of flowers. They use this food to feed the children, feed
other poor families in the area, and then sell for a small income. We stayed
for a long time to just play with the small children who were not yet old
enough to go to school. They were so cute and brought us so much joy!
Next we went to Heidedal, a colored area of Bloemfontein. We
toured the facilities of a program called REACH. They offer life skills
training, such as computer skills and hygiene classes. In addition, they
provide HIV counseling and an afterschool program and nutritious meals to
children ages 7-18. On the way home, we
passed Palonomi hospital in Heidedal. It was interesting to see that the public
hospital was right beside the private one. It was clear that the private one
was much nicer and newer than the public one.
Today, we visited Free State Care in Action. This
organization provides a daycare three days a week. In addition, they have a
soup kitchen on Wednesdays and Fridays. Pick n Pay, a supermarket here, donates
produce to the organization. Therefore, they are able to provide fresh foods to
the poor families. The kitchen staff there packs parcels of basic foods for 80
people and their families each week. They also take clothing donations from the
community and distribute them to the families that come in daily. Finally,
there are social workers on staff to help families apply for grants to help with
the financial burdens they face.
Wednesday, June 6, 2012
Welcome to Bloemfontein
I arrived to Bloemfontein on Sunday afternoon after two weeks of traveling around South Africa. We were welcomed by Louise Steyn, from the International Office at UFS. She showed us to our hostel (dorm), which she had stocked with food and other essentials. We quickly unpacked and headed to dinner with the other ASU students, UFS students, and some professors from both universities. I sat with the four UFS medical students that were there. They were all third years and preparing to take their final exam. Here in South Africa, students begin clinical rotations after this exam, so they were all very excited and ready to start seeing patients and doing rounds at the hospital! The girls seemed very nice, and I am looking forward to spending more time with them when we start shadowing them next week.
The rest of this week, we have been getting adjusted to living in Bloem. Monday, we were given a campus tour and went to the Mimosa Mall to get cell phones, buy some food for the week, and do a little fun shopping. Tuesday we went to the Waterfront, which is another large shopping center. We tried rum and raisin gelato, which we've been told is a very popular flavor here.
Wednesday, we went on a city tour! We began at the Anglo Boer War Museum. Unfortunately, the exhibits were closed for rennovations, but we were able to see various memorials outside and watch a documentary on the war. There was a specific memorial dedicated to women and children who died in concentration camps during the war. We even learned about Emily Hobhouse, the woman for whom our dorm is named. She was an Englishwoman who came to South Africa to expose what was happening in these concentration camps and is buried a the memorial. Our tour guide then told us about the relationship between the Anglo Boer War and apartheid. He argued that the homelands and townships were similar to concentration camps. Therefore, it is important to learn about history so we don't repeat the same mistakes. It was an interesting parallel that I would not have considered on my own.
After that, we drove through a township nearby. In some places, there were homes built for the people living there by the government. However, there were still shacks next door. The families living in the homes rent these shacks out to immigrants or refugees from other countries in Africa, since there are 8-9 million immigrants in South Africa. From the township, we drove into a historically colored part of Bloemfontein. This is an artificial race classification for those not distinctly black or white. During the years of apartheid, various tests were used to determine the race of these people. One specific example is the pencil test, in which a pencil was placed in the hair of the person. If the pencil fell out, the person was considered white. If it did not, the person was considered black. This often separated children from parents who looked different.
We also visited an art museum that had many unique sculptures, an exhibit on African music, and paintings ranging from very traditional to abstract. Later, we drove to Naval Hill. We saw zebras, ostriches, giraffes, antelope, and a wildebeest. Finally, we visited Lebone Village, an orphanage for children who are infected with HIV or affected by it in some way. The village also has its own woodworking shop, bakery, and textiles shop. These both raise money for the children and provide a skill for the children to use later in life. We will be volunteering there toward the end of our internship, and we are all very excited to go back!
The rest of this week, we have been getting adjusted to living in Bloem. Monday, we were given a campus tour and went to the Mimosa Mall to get cell phones, buy some food for the week, and do a little fun shopping. Tuesday we went to the Waterfront, which is another large shopping center. We tried rum and raisin gelato, which we've been told is a very popular flavor here.
Wednesday, we went on a city tour! We began at the Anglo Boer War Museum. Unfortunately, the exhibits were closed for rennovations, but we were able to see various memorials outside and watch a documentary on the war. There was a specific memorial dedicated to women and children who died in concentration camps during the war. We even learned about Emily Hobhouse, the woman for whom our dorm is named. She was an Englishwoman who came to South Africa to expose what was happening in these concentration camps and is buried a the memorial. Our tour guide then told us about the relationship between the Anglo Boer War and apartheid. He argued that the homelands and townships were similar to concentration camps. Therefore, it is important to learn about history so we don't repeat the same mistakes. It was an interesting parallel that I would not have considered on my own.
After that, we drove through a township nearby. In some places, there were homes built for the people living there by the government. However, there were still shacks next door. The families living in the homes rent these shacks out to immigrants or refugees from other countries in Africa, since there are 8-9 million immigrants in South Africa. From the township, we drove into a historically colored part of Bloemfontein. This is an artificial race classification for those not distinctly black or white. During the years of apartheid, various tests were used to determine the race of these people. One specific example is the pencil test, in which a pencil was placed in the hair of the person. If the pencil fell out, the person was considered white. If it did not, the person was considered black. This often separated children from parents who looked different.
We also visited an art museum that had many unique sculptures, an exhibit on African music, and paintings ranging from very traditional to abstract. Later, we drove to Naval Hill. We saw zebras, ostriches, giraffes, antelope, and a wildebeest. Finally, we visited Lebone Village, an orphanage for children who are infected with HIV or affected by it in some way. The village also has its own woodworking shop, bakery, and textiles shop. These both raise money for the children and provide a skill for the children to use later in life. We will be volunteering there toward the end of our internship, and we are all very excited to go back!
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