Week 1: Surgical Department at King Edward Hospital
Today marked the end of my first week on rotation here in Durban. My roommate Subu and I were both assigned to the surgical ward this week following around a team of doctors, residents, and medical students led by Dr. Sing. My first impression of the whole experience is that I feel very behind compared to the people around me. I would try to explain that I am a “pre-med”, but many of the doctors or residents didn’t quite understand what that means. In South Africa, Medical School starts right after high school, so the concept of “undergraduate” does not make much sense to them. Medical school is 5 years here, followed by a 2 year “internship” (residency is what we call it in America) and 1 year of mandatory community service to become a general practitioner. To compare that to America, we have 4 years of undergrad, 4 years of medical school, and 3 years of residency. So you can become a doctor in 8 years here in South Africa while it takes 11 in the states. If the doctor wants to specialize at all (surgery, cardiology, radiology, etc.), then they have more years of “internship” to do, the length of which vary depending on the specialty. Anyway, I felt like I was behind because I haven’t had any clinical medicine training, whereas the medical students who were only 1 or 2 years older than me were expected to be able to answer Dr. Sing’s grueling questions throughout (I did know one answer that they didn’t though so that felt good). I am still learning a lot while I am here, but I just wish that I had taken one class in basic terminology used in medicine before my trip because I think that I would be able to get a little bit more out of the experience.
King Edward Hospital
As for the rotations themselves, I learned that every day is different for the surgery team. On Tuesday, they are in theatre (the O.R.). Being thrown right into theatre on my first day was intimidating, but as the day went on I felt more comfortable asking questions. The first surgery that we saw was a laparoscopic gall bladder removal. I have actually seen this procedure done once before in the states, so it was cool to know what I was looking at and knowing what the next steps were. The difference here is that it took almost 2 hours, whereas it was only a 45 minute procedure back home. I am not exactly sure why it took twice as long here, but I think the surgeon was just being more careful when separating the gall bladder from the liver and stapling off the arteries involved. The surgery team I was following used the same operating room for the entire day so we had about 45 minutes after the surgery to prep for the next surgery, a lumbar sypathectomy and toe amputation, as well as take a much needed seat. The next surgery was very interesting because there were 4 surgeons involved, 3 of them learning from a new surgeon that specialized in the neurological system. Basically, what the surgery was doing was removing the feeling from the patient’s leg because she had been having a lot of pain due to her mostly blocked arteries in that leg and foot, which is a relatively common complication associated with HIV. Her toe had turned a dark black from lack of blood flow so they had to remove that as well. The surgery team was very accommodating and made it very easy for me and the other students to see the surgery every step of the way. The team had to spread multiple layers of muscle and cut through others in order to get to these tiny ganglions of the nerves which were responsible for sensing pain in that leg, so they had to show us one at a time what we were looking at with each new layer that they came to since the incision was only about 4 inches across. We leave every day at 1:00 so those were the only two surgeries that I got to see, but they were very cool nonetheless.
Inside my home for the next 5 weeks
On Wednesday, the team does endoscopies, which is medical jargon for putting a camera attached to a tube down the esophagus and into the stomach. The team is looking for ulcers, systs, polyps, tumors, or anything else that may be causing problems for the patients. When the team finds something, they take a biopsy and send it to the lab. After the endoscopies, we did rounds on the surgical floor and I learned to do a CVP, which checks the pressure in the right atrium of the heart and tells the doctors whether the patient needs more or less fluids. The doctors couldn’t believe I didn’t know how to do one, but I once again had to explain what “pre-med” actually meant.
Looks like Seattle, huh?
Thursday is clinic day and was probably the most eye opening day for me on rotation. The clinic was absolutely packed and I was told that the average wait time to see a doctor in the clinic is 24 hours. 24 HOURS!! The clinics are free here in South Africa for patients so they don’t have enough doctors to see the high volume of patients. I split off with 2 medical students, one from South Africa and another studying here from Germany, and started seeing patients. After the first two patients, the students looked at me and said it was my turn to take the history and do the examination. Even something as simple as taking a medical history was really cool for me because I actually got to DO something instead of just observing the whole time. After taking the history on my patient, I (“we” since I had no idea what I was doing) did the exam and ordered an ultrasound. About an hour later, my patient came back with the ultrasound results showing that he had a hernia. I won’t describe what I saw during the examination but it was pretty obvious that the problem was a hernia and I don’t even know how this guy sat down. After consulting the doctor, the patient was booked for surgery to repair his hernia, and I actually felt like I contributed a little bit to the healthcare system here. I was on a high when I got home and couldn’t wait to go back into work today for another shift, only to be a little disappointed.
An “Africa Tree” in my neighborhood
Fridays are rounds and lots of grilling from Dr. Sing. Our group grew today to 15 people all going around the ward and talking to and about each patient. Most of the conversations went over my head, but Dr. Sing did give some good advice about seeing the patient’s family as well as the patients themselves. As the day went on, the distance between Dr. Sing and the rest of us kept increasing because no one wanted to be embarrassed by him and his probing questions. By now, everyone has started to figure out that I don’t know anything so I was off the hook from Dr. Sing today. I made friends with one of the other doctors (who grew up in the Umlaze Township described in my last post) and basically asked him to fill me in on all the medical speak being used and in plain English what is wrong with the patient and how we are planning on fixing that.
I enjoyed my time on rotation with surgery but I really don’t know if I could be a surgeon in the future. As one med student described it to me you are like a chef and all you can do is follow a recipe. Once you find out what is wrong with a patient, you have to follow each step during surgery to fix them “without even thinking.” I have quite a while before I decide what I want to specialize in but this has given me a real insight on both surgery and medicine abroad. Next week: Pediatrics.
I’m having some fun on the side here as well and am really looking forward to going to the Durban Sharks Rugby match on Saturday. That’s all for now, wish me luck at the local casino tonight!