Meeting Healthcare in South Africa: First Impressions
By Julie Hugunin, Biology, 2017
Just as we begin to poke the woman with a needle the power goes out — again. “Are you sure we shouldn’t be worried?” my unsteady voice asks, clearly naïve and inexperienced to life in a South African township. “Yes, electricity is always a problem here, can you just shine your cell phone for me?” the fifth year medical school student responds in a casual tone.
We are in Langa, the first planned township in South Africa during apartheid. Most of our patients here speak only Xhosa and broken English. As the medical student obtains the necessary blood for a rapid HIV test, I can see under the dim light of my cheap phone that he isn’t wearing gloves. I soon find out they’re rare in the small mobile clinic — as is hand sanitizer. I smile at the woman on the table and make a quick joke about the irony — Langa means sun in Xhosa, but here we are in the pitch black.
As the power blinks back on in the confined room, I can see two clear lines on the test strip. I know what this means, but my first ever patient does not. While my throat closes up the medical student’s gently explains the situation to the woman. Though it is positive, the test itself has a very high false positive rate. Normally, we would give her yet another test made by a different company to confirm the results; however, we have run out of these today. We give her a referral to go to the local clinic as soon as she can and then she’s gone; in walks the next patient.
While searching for the answer to the ever present question of whether medical school is right for me, I have ended up in South Africa. I have spent three months interning in the neurosurgery department with Dr. Padayachy at the Red Cross War Memorial Children’s Hospital (RXH) in Cape Town and whenever I can, I attend Students Health and Welfare Centres Organization (SHAWCO) clinics in townships surrounding Cape Town.
RXH is the only government-funded children’s hospital in South Africa. This means we see a wide range of patients, and the waiting rooms are always packed. Tuesdays and Thursdays are theater days, so on just my second day I was invited to watch a corrective surgery for an 8 month old boy with craniosynostosis.
Craniosynostosis is impaired skull formation caused by the premature fusion of one or more of the skull sutures. During the roughly six hour long surgery, the skull was removed, remodeled, and pieced back together. That quick and simple sentence makes it sound easy, so let me rephrase: in six hours the surgeons peeled back all five layers of the scalp, drilled and cut the abnormal skull pieces out of the head, gently remodeled them, put the pieces back together, and then stitched up the layers of the skin until a single scar was all that was left.
For a girl who used to pass out at the sight of blood, it was nothing short of a miracle that I held it together in front of the neurosurgeons. Not surprisingly, the surgery is considered highly invasive — the majority of complications result from major blood loss and high transfusion rates. These complications are exacerbated by children having a low blood volume and disproportionately large heads.
I have recently begun a retrospective study of craniosynostosis cases to look at ways to reduce the amount of blood loss during surgery. Hopefully, using indicators like age, weight, and length of surgery, professionals may be able to prepare for and reduce the need for blood transfusions.
We truly are the sum of all our experiences, and working in healthcare in Cape Town is unlike anything I could have experienced in Boston. In the same work day, I see world class elective surgeries such as the one described above, and I witness the lingering effects of apartheid and limited resources on patients who can barely afford to make it to the hospital. Working here has opened my eyes to medicine, and the immensity of what I learn on a day to day basis is exactly what I had hoped for. So for students still applying for co-op in the spring, it’s not too late to consider going international!
