Today I started my internship at Victoria Hospital in neighborhood called Wynberg just within the boarder of Cape Town. It’ s a public hospital that serves about 1,000,000 people – most patients only living on less than $1 a day. Among the black population, HIV and Tuberculosis (TB) is significantly high Cape Town compared to the US. However it has some of the lowest rates in all of South Africa. I even saw a patient who had HIV, TB, hypertension, type 1 diabetes, and renal failure. Surprisingly a chart like this is not uncommon here.
In South Africa there is a private and a public health care system. 80% of the population is served under the public health care system (mostly black bantu) and 20% are served under the private (mostly white Afrikaans).
I had an interesting conversation with one of the doctors I shadowed on the first day. Apparently, South Africa spends 10% of its GDP on health care (quite staggering). 60% of the funds goes to the private health care system. The other 40% of the budget serves 80% of the population.
The gap between rich and poor here is astounding and not just socioeconomically, but racial level as well.
Anywho, my first day at Victoria Hospital was crazy for a lack of a better world. In the morning we joined a group of last year med students, interns, and residents in the ICU where the doctor probed them for answers on how to treat each patient that was there. He challenged them which different drugs and possible syndromes. I really didn't know what they were talking about, but it made me excited. I could imagine myself a few years from now in their shoes answering similar questions.
Later that day, I shadowed a register (medical resident in the states) on his rounds. I was really taken aback by how caring he was. It was obvious he was wealthy (by the patients standards) and probably never experienced poverty quite like some of his patients. He took his time to explain their conditions and what was happening without being condescending or pretentious. Which was quite heartening to see.
Later that day I shadowed another doctor in the ICU. This is where the day got crazy. There was a patient in an isolation room who had viral pneumonia and chicken pox (which can be extremely deadly in adults). His lungs were in extremely poor shape and a few of the participants and I suited up in our gear and observed in the room.
One of us also got to shock the patient after he started experiencing heart failure. The patient woke from the intense shock and began tearing out his IVs -- which was intense and scary. But later had another cardiac arrest. Myself and two other volunteers were allowed to participate in two cycles of chest compressions and his heart did start again. However the patient eventually died and I had witnessed the whole thing and participated in the attempt to save his life.
I'll admit I am a really sensitive person. I cry during the animal abuse commercials with Sarah Mclachlan (LOL) so seeing someone die in front of me was really scary.
I have never experienced the limbo between life and death this personally before, and I’m grateful for this experience. It confirmed for me that I really DO want to be a doctor. But I have decided emergency medicine is definitely NOT for me.