Work Time!

We started work today at a hospital called G.F Jooste. It’s only about five minutes away from my home stay. The conditions are much better than in Durban even though it’s still only a government hospital. I think it’s because the conditions of Cape Town are as a whole much better. We started the week in Infectious Disease. We met the doctors that work in ID, and I went off to do exams with a young doctor from Australia named Kevin Lee. He was so great to work with! Before the patients came in he would grab their file and review it all with me, making sure I understood everything and didn’t have any questions. Then he would invite the patient in, ask them questions, do an examination, and then order further tests, prescribe medication, and give diagnoses. He was very gentle and kind with his patients and made sure they understood everything that was going on as well. He was awesome and I’m so excited that I get to work with him this whole week. ID was basically full of HIV/AIDS patients that normally had secondary infections, which was most commonly TB. There was nothing too varied that stuck out to me; every patient was pretty similar. One thing that is very common here is defaulting on ARV’s though. ARV’s are anti-retrovirals; HIV/AIDS medication. If you don’t take this medication every single day at the exact same time, your body becomes quickly resistant to the medication and it will stop helping—you will pretty much get sick because your body will become weaker again instead of increasingly stronger. This is a HUGE issue. When one defaults, they have to take the second line of treatment, which is a lot more expensive and has a heavier pill burden. If they default off of THIS, then they usually have MDR, or multi-drug resistance and it becomes really hard to do anything for the patient, especially if they are non-compliant. Supplies are so limited here that when they are wasted by patients not taking their medication, doctors are often hesitant to give patients the new treatment if they aren’t sure that they will be persistent in taking it. It’s a difficult thing to deal with, and it often leads to other very complicated illnesses, like IRIS—a drug resistance that develops when MDR-HIV and TB infection coexist. There are so many things that doctors deal with on a daily basis that doctors in the states will never encounter in their whole career. It’s incredible.

Later in the afternoon we did rounds with a team of doctors, and saw quite a few cases presented. They were all very Ill patients and needed a lot of medical attention. All of them were HIV positive, some of them even being in the advanced stages of AIDS. And, all of them had HIV-related illnesses. One had cryptococcal meningitis and TB, another had TB and peripheral neuropathy and intense leg swelling that left her unable to walk, another had TB and a stroke (At the age of 28), another with TB, meningitis of the brain, seizures and psychosis, another with TB, pneumonia and MDR who was put into isolation, as well as a few other patients. It was interesting to hear all of the different ideas from all of the doctors, and to see how great a collaboration they made in terms of determining diagnoses and treatment. I definitely think group or team work in the medical field is a great idea.

Later that evening we went to Gregg’s house. Gregg is a friend of Anella’s who lives here in Cape Town. She made us acquaintances before I arrived so that I would know somebody who could be friends with us and take us around to do fun things during our stay. He came to pick us all up for something to do. Anella had told me before I arrived that he had an amazing house up on the mountain that overlooked Camps Bay and the rest of the ocean, with a pool and pretty much everything entertainment you could imagine. She was definitely right. We played pool and cards (he had a HUGE poker/card table), and had lots of fun. It was shame that it was so foggy the night we came, because we couldn’t see the view of the ocean or the city. Maybe next time (: