A great week at Kwa Dabeka!

Well, despite my uncertainties, I had an amazing week at the clinic in Durban!!! As I mentioned before, it is basically a HUGE primary care centre, but they get all kinds of health care problems. The unfortunate thing (for students, that is) is that they refer all of the "interesting"
patients to a hospital right away, but fortunately, I learned so much this week and I am so happy that I was able to gain this experience. One doctor I was particularly fond of was there from Tuesday until today. He is a "generalist" but the other doctors send him all of the TB patients because he is very good at treating them. Today I was able to see cryptococcal meningitis in a patient. He could not walk and his communication was limited. Kevin and I diagnosed him with nstagmus (spelling?), which was a riot for us because the med student there looked at us like we were crazy until we did the test for it (first time I got to do one of those little clinical skills tests on a positive patient) and saw that he had dramatic nstagmus. I saw so many x rays of TB and post-TB scarring... it is like nothing I have ever seen in Canada (well as far as class examples go). The doctor encouraged me to take pictures of the x rays because he knew that I wouldn't see them again. I feel so lucky to be able to see all of the things that I have seen this week. I saw a child with CP with 2nd degree burns convering his lower body. This case was particularly touching because of the time I have spent with Cassie. Most of you know Cassie, who is so normal that it's almost hard to notice her gate! This boy on the other hand, was completely deformed. His feet had flexed into themselves and his knees were permanently flexed. This boy will never walk. The tragic thing about seeing this is the fact that if this boy had received physio and done the right exercises when he was younger, he would probably be walking. In Canada I would think that the parents had not spent enough time or energy with him, but here it is different. This clinic is in a VERY rural part of Durban, where many of the people are uneducated and unable to understand the importance of intervention. This is the same area that sees countless children die because they have been given enemas for various reasons, dying of dehydration and hepatotoxicity. Today a nurse told us that one of the most common remedies used is sunlight detergent or colgate toothpaste (up the bum!). My heart really went out to this boy, 13 years old, who will forever be dependant on others for care as simple as going to the bathroom... all because of something as simple as intervention... prevented by a problem that is too big for me to fully understand (the lack of education).
At this clinic there were 4 very young women and 3 men who were physicians for the clinic. This was a very impressive number for such a rural clinic, but there were still hundreds of patients in the waiting rooms. The unfortunate thing about this is that children with flus and other acute ailments are waiting with immunocompromised patients! Not only that, but the chronic disease patients (diabetes, hypertension, epilepsy) were waiting full days for refills on their treatments. These patients could have easily been seen by nurses or interns in a clinic elsewhere (an initiative that may one day become a reality) so that the doctors could get the other patients through faster. The reason that this is so problematic is that currently, a patient will come at 5 am to wait for the doctor, and will not see him/her until mid-afternoon. This means that the patient has not taken their medications and their condition is now acutely out of control. For example, a patient will come in with a blood pressure or sugar level through the roof and the doctor cannot do anything about the chronic problem (the reason for the follow up to get meds) because the acute changes are scewing the tests!!! This happens over and over, unfortunately.
I saw a lot of chronic diseases that were dealt with the same as they would have been in Canada. The doctors are so educated; I feel on the same level as the other medical students I have encountered, no question!!! It seems that the medical education is wonderful, but I wouldn't say the same about the nursing education. Unfortunately, many, many doctors leave to go overseas (for more money and better living conditions), leaving mostly nurses. I get so frustrated by the nurses.... they can be so apathetic that I am close to an outburst. Today we had a wrap up meeting with the whole group and one of the girls started crying at the thought of how some of the nurses treated the patients. It really is heartbreaking to see patients being treated like "dogs" as she put it. We started talking about the health care system here and what changes might make things better. One of the interesting things that was brought up, which I hadn't given much thought (and I am ashamed to say so), is the fact that never once has a doctor educated a patient about their condition. Disclaimer: there is a HUGE emphasis on education about HIV... which I believe is different because the modules are a requirement to receive treatment. I think this is great; the modules are fabulous... but there is still a huge problem with non-compliance. Despite the fact that patients still fail to comply 100% with treatment, I strongly believe that the modules make worlds of difference. I can't even imagine how awful it would be without them. Having said this, no one is counselled on diet, life-style modifications, sighn/symptoms, etc when they have other diseases like hypertention or diabetes. Maybe educating them wouldn't make everyone comply, but surely it would help!! AND I am sure that patients would be less apathetic about their own conditions if they were educated! However, it's not as simple as just spending time with each patient. The fact is that many will still fault on their treatments and failt to change lifestyle factors... and when you are looking into a hallway FILLED with faces waiting for treatment, the urge to spend an extra 10 minutes with a patient staring blankly into your eyes... well, it's just not an appealing option. The task of seeing all patients seems impossible each day... and each day some patients are not seen.
I have been talking about so many problems, but I do not mean to sound negative. I feel so lucky to gain what little bit of insight I have, and I want to share it. I've had such a great week and I feel like I have learned so much about medicine here and at home. I almost forgot... one of the most exciting parts of my day... I put a canula into Kevin's arm while we were in the RU. I hadn't done that before, so as silly as it sounds, haha, I was pumped.
Tomorrow at 6 am 4 of us leave for Cape town... we will be hiking table mountain by noon :)
Next week I will be in a MTCT clinic (mother to child transmission.... should have a P in front for prevention!), which has a clinic and a research centre. I am excited to see the research centre because I have heard good things about it.
I think that today we should pray for the horrible apathy of patients and providers. Please pray that patients and providers will put some heart into healthcare!!! Pray that doctors will see something different about that patient who might just comply with their orders, so that they will be inspired to take that 10 minutes and explain to the patient how they can take control of whatever ailment is against them!!! Thank you so much for your continued support. I love you all.