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Foerderer Journal Foerderer Award for International Study Foerderer Journal Foerderer Award for International Study Name: Anthony Kent Location (City, Country): Cape Town, South Africa - April 2017 Program: Divisions of General Internal Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town College: SKMC Email Address (Optional): [email protected] Updated October 2016 Foerderer Journal Foerderer Award for International Study 1. How did you prepare for your trip abroad? My 4-week clinical elective at Groote Schuur Hospital (GSH) took place in April 2017. I began applying for the elective in January 2016. However, it is currently recommended to begin applying as early as 2 years in advance. You must contact the elective student coordinator at the Faculty of Health Sciences, University of Cape Town and express your interest. They may take a long time to respond. Application instructions may be provided if there are openings available in your area of interest. Paperwork for the University of Cape Town (UCT) and the Health Professions Council of South Africa (HPCSA) must be completed and submitted via regular mail. Have an active passport that must be valid at the time you plan to return to the US. Fees must be wire transferred to UCT and the HPCSA as specified by the University of Cape Town. Request away elective approval from the respective department at Thomas Jefferson University and complete the required departmental paperwork. 2. What information should be reviewed/studied prior to going to your intentional location? Understand the occupational health risks at the hospital you intend to visit, which may be very different from your home hospital. For example, TB is endemic to Cape Town and other parts of South Africa. As a healthcare worker in South Africa you have an increased risk of exposure to TB. Review the University of Cape Town’s policies for visiting students. Schedule an appointment with Jefferson Travel Medicine. Read about the latest news in the country and city that you plan to visit. Speak to friends that have visited the region in order to learn their perspective. 3. Describe some of your biggest accomplishments in this experience. I felt accomplished in the relationships that I built with my colleagues and patients. There is an incredible diversity of backgrounds among the patients, students and staff at Groote Schuur Hospital. Multiple languages are spoken regularly during patient encounters. I was humbled to learn about the public health challenges in South Africa and the resulting impact on patients. Rheumatic heart disease, HIV, and TB are common in the patient population. Updated October 2016 Foerderer Journal Foerderer Award for International Study Patients present at younger ages (~30s) and with more advanced disease compared to what is commonly encountered in the United States. Common chronic diseases in the US, such as diabetes, hypertension, and hyperlipidemia are also present, however their effects tend to cause end- stage disease later in life. Thus, there are two major patient populations from my experience in South Africa, the young adult and older adult patient populations, which contrasts with a predominantly older patient population in the US. It was not uncommon to see patients in their 20s and 30s with mitral valve heart disease due to an episode of acute rheumatic fever during adolescence, and often in combination with other comorbidities such as HIV. As a result, young patients presented sick, which happened infrequently during my medical school training in the US. 4. Please describe a typical day in your program at your clinical site. My preceptor provided me with a roster that outlined a daily schedule for visiting students. Morning ward rounds started at 8h00. Bedside rounds were performed and tasks collected and divided among the team for post-rounds work. During the remainder of the day I assisted in clinic or with procedures. Daily academic meetings were held to review cases. The patient wards are organized into large open rooms with beds arranged along the wall with curtains for each patient bed. There are smaller two- patient rooms, however most wards are organized into an open-floor format. Paper graphs are posted next to the patient beds to track patient data. A computer system is in place, however computer resources are limited. Lab results are available on computers. Radiology scans are viewed on large monitors in the wards. Paper charts are used for everyone, not electronic medical records. Physical exam is practiced at a mastery level by residents and attendings. Tests cannot always be ordered in a resource-limited environment, so physical exam is used more frequently, and in combination with the patient history forces a greater critical thinking approach to management. Medical students and residents perform blood draws for labs and place IV lines. In the outpatient clinic medical students assist residents during patient visits. The outpatient clinic receives a high volume of patients. Encounters last on average for 30 minutes, allowing for more time with the patient, longer than practiced in a busy outpatient setting in the US. Updated October 2016 Foerderer Journal Foerderer Award for International Study 5. Describe the patient population & typical services provided. Groote Schuur Hospital is a government-affiliated hospital that provides care for patients with government issued health insurance. The patient population is comprised of a variety of cultural backgrounds. Patients rely on Groote Schuur for the majority of their inpatient and outpatient care. Groote Schuur is one of two large government-affiliated academic hospitals in Cape Town, the other being Tygerberg Hospital that is affiliated with the University of Stellenbosch. For patients who can afford private insurance there is a private hospital system. 6. What was the most rewarding part of your trip. Learning to function in a large academic government-affiliated hospital in a foreign country was rewarding from a training standpoint. This was a resource-limited environment where physicians do not have the luxury of ordering every test that they wish. As such, clinicians rely more on their interaction with the patient. Residents spend far less time on the computer and far more time with the patient. I thought that the style of medicine was more akin to what is taught in medical school and expected of a physician, with greater autonomy and richer clinical training for students and residents. 7. What was the most challenging part of your trip. It’s a long way to travel to reach South Africa. A 15-hour flight if nonstop from NYC-JFK to Johannesburg, then a 2-hour domestic flight to Cape Town. Learning clinical medicine in a resource-limited environment with less of the comforts of a home hospital made it difficult at first, however it also provided me with one of my most valuable training experiences in all of medical school. 8. Did you participate in additional language study during this trip? If yes, how much did you improve? No formal additional language study. However, you will learn about Afrikaans, Khosa, Zulu, and possibly other languages. 9. Would you recommend this program? Why or why not? I would not recommend this program to all future students because of the level of preparation required and the difficulty of working in the hospital as an individual visiting medical student. Daily transportation to and from the hospital is challenging in the Cape Town traffic as well. Occupational health Updated October 2016 Foerderer Journal Foerderer Award for International Study risk is also very high with TB. The risk of contracting TB is an accepted risk for medical students and staff in South Africa, which is a paradigm shift from working in most hospitals in the US. 10. Any suggestions on activities, food, sightseeing, etc. at this program location? Cape Town has an abundant variety of activities. Groote Schuur Hospital itself is the site of the first human heart transplant in 1967 by Dr. Christiaan Barnard and his team. The museum for the first heart transplant located at Groote Schuur is dedicated to this achievement and is highly recommended to visit. For any place of travel, stay with friends and don’t go it alone. Always plan to have a form of phone communication and mode of transportation back to your local address. 11. What (if any) additional information would you like to have known prior to participating in your program? Be aware of the level of TB exposure risk. N95 masks are standard for encounters with patients who have known TB. However, TB is endemic to Cape Town and simply being in the hospital elevates your risk of exposure and contracting TB. Updated October 2016 Foerderer Journal Foerderer Award for International Study Photo 1. Groote Schuur Hospital (GSH), Old Main Building, now houses administrative offices Photo 2. GSH, Old Main Building Updated October 2016 Foerderer Journal Foerderer Award for International Study Photo 3. GSH, New Main Building, includes all major wards and services of a large academic hospital, 893 beds Updated October 2016 Foerderer Journal Foerderer Award for International Study Photo 4. Devil’s Peak, view from Groote Schuur Hospital, Anzio Road Updated October 2016 Foerderer Journal Foerderer Award for International Study Photo 5. Upper Main Campus, University of Cape Town (UCT) Updated October 2016 .
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