Thursday 5 December 2013

Arrival in Cape Town

(Written one week ago, finally posted today!)

I'm getting a late start to blogging my trip, so I'm trying to sum up my first 10 days in Cape Town in this one post. I arrived late last Saturday after 24 hours of travel from Toronto with a layover in Amsterdam. 

I am in my final year of medical school, and have come to South Africa for the last four weeks of my fourth year electives period. This year is structured so that we have 16 weeks to do electives in any type of medicine, wherever we want provided we are willing to set it up! In Cape Town, I'll be doing Emergency Medicine and Trauma at Tygerberg Academic Hospital, which is associated with the medical school at Stellenbosch University.  With my plans to go into Family Medicine with ER, this is the perfect opportunity to gain a practical approach to trauma.  Furthermore, this elective will allow me to see the provision of health care in South Africa, and see firsthand challenges and considerations not present in North America.  It will also be an opportunity to experience the South African culture, learn about the history, and immerse myself in the natural beauty of South Africa.

Tygerberg is a ~1400 bed hospital located in a suburb of Cape Town. Where I'm working primarily is within the Trauma unit. Unlike at home, where both medical emergencies (such as sepsis, stroke, MI) and trauma cases both come through the Emergency Department, here at Tygerberg the Trauma unit is separate from the medical ER. The unit sees a very high volume of trauma, as it is the referral centre for trauma coming from much of the Western Cape province, and sees about 22500 trauma cases per year. Stepping into the hallways, the volume is obvious!

Photo of Tygerberg Hospital from http://www.westerncape.gov.za/your_gov/153

I have now been here a week and am still getting used to the hospital, but it is exciting from a medical point of view. My consultant gave me a tour of the trauma unit as part of my orientation and "wow" is about the best I can describe it.  The hallway was lined with patients in chairs and stretchers, most sporting one or more of bloody bandages, eye patches, arm slings, and bags of IV fluids held in their hands.  Several young men walking the halls together carried chest tube drainage systems filled with their own blood draining from their chests as casually as if they were briefcases.  This prompted my my attending to tell me how they manage the hemo-pneumothorax patients in the trauma unit, without admitting them to the wards.  She then showed me the room with 12 reclining chairs where patients, mostly gentlemen, with chest tubes stay until their 24 hour drainage is sufficiently low so the tube can be pulled and they can be discharged.

After my tour, the other attending physician in trauma said "welcome... Want to do some suturing?", and directed me towards a young woman who had been stabbed in the back.  I have previously seen only one stabbing in London, and this was to be the first of about 20 who I saw in the first week alone.  This is alongside multiple gun shot wound victims - I have now seen two patients with 9... Yes 9... Gun shot wounds, and still living! To round it out, I have also seen many victims of motor vehicle collisions, severe orthopaedic injuries, and head trauma in my short time here so far. In the last two shifts I have been here, I have put in about 100 sutures!  As far as hands on experience, I've sutured a ton, pulled many chest tubes out, started a central line... And otherwise am gaining a much more concise approach to trauma, the ABCDE algorithm, which is exactly what I'd been hoping to learn from a medical point of view. Overall the doctors here have been very welcoming, very friendly, and very willing to teach and get me involved!

As for living, I am staying in the International Students' Lodge which is on the university campus, right next to the hospital, so very convenient for getting to work! Unfortunately it is somewhat isolated thirty minutes out if Cape Town, but have rented a car for the month along with another student. Learning to drive manual transmission AND on the left side of the road are two new challenges.  As the name of the lodge suggests, I'm living with medical students from around the world, all of whom are also doing electives.

My thoughts so far? Within the hospital, it has been eye-opening and overwhelming but exciting! Outside of the hospital, I have found Cape Town beautiful, but not so overwhelming from a cultural point of view, as I have seen a very limited and sheltered segment of Cape Town and South African culture so far. I have felt nowhere near the sense of culture shock I felt upon arriving in India last summer! Aside from the fact that it's thirty degrees and sunny here, this university campus feels like a Canadian university campus.  The highways are well maintained, the mall where we did grocery shopping was bright and clean with many stores one would expect in a mall, the grocery store felt just like a store at home, and the restaurant we ate at in Cape Town was clean and upscale. Yet this was a very sheltered view and partly what I expected, having been told of the massive disparity of wealth in South Africa, with many exceedingly wealthy people, but many more exceedingly poor people.  It is in the hospital where I have seen more of this difference.

Camp's Bay 

Outside of the hospital, I've had the chance to do some exploring in and around Cape Town - Friday I went to the beautiful Clifton Beach in Cape Town, with beautiful white sand and turquoise water that was lovely yet leg-numbingly cold to get into! We had dinner in the affluent suburb of Camp's Bay, lovely yet a reminder of the disparity in Cape Town.  Saturday spent the morning gorging on food at the market at the Old Biscuit Mill, a famous Saturday morning location in Cape Town, and spent the afternoon exploring the mountains and ocean at the Cape of Good Hope outside Cape Town.  Sunday was spent with a great group of fellow students doing the hike up Cape Town's Table Mountain. Although on most days I have seen the top of the mountain obscured with clouds - the so-called table cloth - on this day, the air was hot and the sky was perfectly clear! We hiked up one side and down the other, 6 hours in total. The hike was completely worthwhile on its own, but the views of Cape Town and the surrounding waters were absolutely stunning and made it all the more worthwhile!

That sums up most of my first ten days here in Cape Town! With that, I hope to now post shorter stories more frequently as updates from my time here!

En route to Cape Point

Cape Point

Cape Town from Table Mountain (Robben Island in the distance)

Atop Table Mountain