There is another visiting student here for a few weeks, and she and I are planning a day hike up Table Mountain this weekend. Hopefully I will be able to report back with some nice photos.
I've mostly stayed in the Southern suburbs, where I am living and working, but I was able to wander around the city bowl a bit on Sunday -- it was pretty quiet, but provided a good chance for me to get oriented to the area. I'm very excited to explore a bit further.
Wednesday, June 10, 2009
A visit to St Luke's
Yesterday I went with some med students to a satellite branch St Luke’s Hospice, opened to address the AIDS epidemic. They have inpatient beds, as well as an outpatient program where you can come in, see the doctor, speak to a social worker, have a meal, and attend support groups with other AIDS patients from the community.
We spent the first few hours in lecture and PBL(!), in which we were actually given resources and left alone to solve the case. We then presented our findings as a group in an informal setting. Is it strange that this was the best PBL I had all year?
(Note to non-medical students: PBL, or problem-based learning, is a much-maligned supplement to our lectures. In the first session, we are presented with a case and create relevant assignments. In the second session, we present our assignments—usually in PowerPoint—and hope to get out early. It could really be so much better.)
Then it was off to patient interviews. I was assigned to a cachexic (wasted) twentysomething man who was sitting wrapped in blankets on the patio. He was newly diagnosed with AIDS and TB, although he wasn’t convinced that he had AIDS. Interestingly, he knew his CD4 count, a marker of HIV.
The palliative care physician we heard from earlier in the morning was careful to note that this was not a place of death, but rather a place of life: “the patients here are close to the end of their breathing life, but they are living.” And yet the patient I interviewed was in hospice for another chance at life, specifically to start a course of anti-retroviral therapy (ARV). It is entirely possible that if he is able to receive the support necessary for ARV adherence—government grants (akin to SSI in the States), nutritional counseling, symptom control, family support, housing, and transport to medical care—he will do quite well for the foreseeable future. In a more rural area in 2009, he would indeed be close to the end of his breathing life; a few years ago in Cape Town and over 13 years ago in the States this would also be true.
It’s also worth noting that palliative care in South Africa is ideally begun at diagnosis, aiming to manage symptoms, improve adherence, and care for the family. It’s actually the first model of palliative care that I was exposed to (more on that later), but is fairly unusual in the States, where palliative medicine takes over at the end of disease-modifying therapies. There is a movement afoot, however, to integrate the two—it should be interesting to see if and how our super-specialized medical system accommodates this.
Oh yeah, and in a hospice where everyone was dealing with TB: negative pressure rooms? No. N-95 masks? No.
We spent the first few hours in lecture and PBL(!), in which we were actually given resources and left alone to solve the case. We then presented our findings as a group in an informal setting. Is it strange that this was the best PBL I had all year?
(Note to non-medical students: PBL, or problem-based learning, is a much-maligned supplement to our lectures. In the first session, we are presented with a case and create relevant assignments. In the second session, we present our assignments—usually in PowerPoint—and hope to get out early. It could really be so much better.)
Then it was off to patient interviews. I was assigned to a cachexic (wasted) twentysomething man who was sitting wrapped in blankets on the patio. He was newly diagnosed with AIDS and TB, although he wasn’t convinced that he had AIDS. Interestingly, he knew his CD4 count, a marker of HIV.
The palliative care physician we heard from earlier in the morning was careful to note that this was not a place of death, but rather a place of life: “the patients here are close to the end of their breathing life, but they are living.” And yet the patient I interviewed was in hospice for another chance at life, specifically to start a course of anti-retroviral therapy (ARV). It is entirely possible that if he is able to receive the support necessary for ARV adherence—government grants (akin to SSI in the States), nutritional counseling, symptom control, family support, housing, and transport to medical care—he will do quite well for the foreseeable future. In a more rural area in 2009, he would indeed be close to the end of his breathing life; a few years ago in Cape Town and over 13 years ago in the States this would also be true.
It’s also worth noting that palliative care in South Africa is ideally begun at diagnosis, aiming to manage symptoms, improve adherence, and care for the family. It’s actually the first model of palliative care that I was exposed to (more on that later), but is fairly unusual in the States, where palliative medicine takes over at the end of disease-modifying therapies. There is a movement afoot, however, to integrate the two—it should be interesting to see if and how our super-specialized medical system accommodates this.
Oh yeah, and in a hospice where everyone was dealing with TB: negative pressure rooms? No. N-95 masks? No.
Friday, June 5, 2009
Thoughts at the end of week one
Tuesday: Greeted by a marching band
The first thing I saw when I made it through customs (and sadly gave up my Emirates Airlines cheddar cheese) was a throng of paparazzi and a marching band. A local rugby team had just won the World Cup and was on my flight. I’m on the lookout for a celebratory parade in the next few days.
And I got one additional piece of advice: no walking alone after dark, not even to the store down the block. Clearly I'm not in Squirrel Hill anymore . . .
Wednesday-Friday: Working & a little bit more about what I do
Things are off to a good start here. I met the professor yesterday, and I think we will work well together. She was glad to hear that my apartment was across the way, because she had set up a 7:30 a.m. teleconference for me on Monday. She will be out of town, so I will be introducing the study to our nine(!) research assistants, one in each province. The purpose will be to give them instruction on how to administer the survey and to set goals for each area. It’s kind of intimidating, the idea that I will be taking the lead on this and supervising nine people around the country.
So far, work has mostly consisted of a literature review – a largely disheartening look at how difficult it is for AIDS patients in developing nations to access essential medicines. One study noted that 4% of AIDS patients in urban South Africa received anti-retrovirals (what we think of as standard AIDS care in the States), with perhaps 30% receiving adequate relief for their most common and debilitating symptom: pain.
There are a few bright spots in the literature, though, mostly borne of activism on the part of health care providers. Uganda, for example, passed a law in 2004 allowing certified palliative care nurses to prescribe morphine, bringing pain relief to rural areas in particular. This came about in part because of the serious physician shortage there: 1 doctor for every 50,000 Ugandans. For comparison, there is 1 doctor for every 400 Americans.
There are many components to increasing access to palliative care here, but the Ugandan system provides a good starting point.
In other news, Tuesday I will go with the fourth-year medical students* on their hospice rotation to St Luke’s. I’m not sure what this entails exactly, but I know that I am not cleared to do anything clinically—nor should I be! I am certain that it will be a valuable experience, and it will be nice to spend the day with some peers.
*Theirs is a six-year program, so we are at nearly equivalent points in our education.
The first thing I saw when I made it through customs (and sadly gave up my Emirates Airlines cheddar cheese) was a throng of paparazzi and a marching band. A local rugby team had just won the World Cup and was on my flight. I’m on the lookout for a celebratory parade in the next few days.
And I got one additional piece of advice: no walking alone after dark, not even to the store down the block. Clearly I'm not in Squirrel Hill anymore . . .
Wednesday-Friday: Working & a little bit more about what I do
Things are off to a good start here. I met the professor yesterday, and I think we will work well together. She was glad to hear that my apartment was across the way, because she had set up a 7:30 a.m. teleconference for me on Monday. She will be out of town, so I will be introducing the study to our nine(!) research assistants, one in each province. The purpose will be to give them instruction on how to administer the survey and to set goals for each area. It’s kind of intimidating, the idea that I will be taking the lead on this and supervising nine people around the country.
So far, work has mostly consisted of a literature review – a largely disheartening look at how difficult it is for AIDS patients in developing nations to access essential medicines. One study noted that 4% of AIDS patients in urban South Africa received anti-retrovirals (what we think of as standard AIDS care in the States), with perhaps 30% receiving adequate relief for their most common and debilitating symptom: pain.
There are a few bright spots in the literature, though, mostly borne of activism on the part of health care providers. Uganda, for example, passed a law in 2004 allowing certified palliative care nurses to prescribe morphine, bringing pain relief to rural areas in particular. This came about in part because of the serious physician shortage there: 1 doctor for every 50,000 Ugandans. For comparison, there is 1 doctor for every 400 Americans.
There are many components to increasing access to palliative care here, but the Ugandan system provides a good starting point.
In other news, Tuesday I will go with the fourth-year medical students* on their hospice rotation to St Luke’s. I’m not sure what this entails exactly, but I know that I am not cleared to do anything clinically—nor should I be! I am certain that it will be a valuable experience, and it will be nice to spend the day with some peers.
*Theirs is a six-year program, so we are at nearly equivalent points in our education.
Wednesday, June 3, 2009
BOS-JFK-LHR-DXB-CPT
In an attempt to stay within budget while also getting in a vacation with friends in the UK, I ended up taking a series of four flights to get to Cape Town. I don’t mind flying as much as I used to, which is to say that I no longer panic at the idea. Still, four flights over two days is no one’s definition of pleasant.
Here are the suggestions I got to make my travel easier, all worth heeding:
1. Don’t try to stay up all night to exhaust yourself into a new time zone. I would have appreciated (but likely not heeded) this advice at 15.
2. Better choice = Benadryl + eye mask + foam ear plugs.
3. Leave Heathrow if your layover is even close to long – mine was 11 hours, and I got to go into London and see a college friend with whom Facebook had reunited me. We had a lovely picnic lunch near the National Gallery, and I got to roam around Central London for a few hours. (Tip: wifi is not abundant in London the way it is in American cities. Pret A Manger is your best bet, and they’re ubiquitous.)
4. If you must connect, the Dubai airport is a pretty nice place to do so. It was like being in the States, more specifically Houston, to which it has multiple nonstop flights. I found this rather amusing. On my way back I will be in Dubai for 8 hours, but am not convinced that it’s worth it to go through customs and see the sights.
5. You probably don’t need to pack as much stuff as you think you do. You certainly need less than you want to haul around a major airport. When I went to Vietnam in 2005, my friends convinced me to bring clothes I wasn’t attached to, and leave them behind as a donation. Out of no altruism whatsoever, I am hoping to significantly lighten my load for the trip back to the States.
Other suggestions, which I will report back on:
6. Go to church, and not the white ones. If I could do this in Central PA, I think I will be able to do it in Cape Town.
7. Go to ____ National Park. As I decided against brining malaria prophylaxis, I will bypass Kruger and go somewhere without malaria.
8. Take a weekend trip to Harare.
9. Hike Table Mountain.
10. Find a braai – I think once my friend moves here I will be all set with this, as it was her advice.
Feel free to chime in with your experiences of Cape Town, South Africa, or travel in general.
Friday, May 29, 2009
Hello Goodbye
A week ago I finished my first year of medical school. The next day I packed my car and drove from Pittsburgh to Boston; on Sunday I will fly to Cape Town for the summer. Those two sentences encompass a lot of improbable journeys—leaving my hometown and 28 years worth of relationships; moving to Pittsburgh, a city whose reputation draws few; and taking a circuitous road to medical school.
As I write this, my closest friend (another ex-Bostonian) sits across from me at Darwin’s café in Cambridge. We’ve snuck in saag from Punjabi Dhaba, one of our go-to foods from our time living on this side of the river. In a few minutes I’ll walk to the yard to meet the man whose encouragement has so shaped this journey. The week here has been unusually sweet, reconnecting with friends and family and the town that I thought I would never leave. Coming back here is a reminder of how much Boston has shaped me and how fortunate I am for the relationships I forged here.
I decided to start this blog to keep in touch with people while abroad this summer. A little bit about why I’m going: we are “encouraged” to spend our first summer doing research. While some of us joke that the school would like us to pipet peptides into kidneys, I have been fully supported in my desire to pursue a different sort of project. Broadly, Cape Town presents an opportunity to look at the intersection of social justice and medicine; more specifically, I’m looking at access to palliative care in urban and rural populations there. It’s a great privilege to work on this project.
Happy reading!
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