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To Durban and Back: A Family Medicine Adventure

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Punam Ajay Raval and Grace Vugutsa Magada, medical students at Kenyatta University, Kenya who completed an elective exchange in Family Medicine at the University of KwaZulu-Natal School of Nursing and Public Health (South Africa) through the GEMx-AFREHealth Regional Exchange Partnership.

Our four-week elective at Wentworth Hospital, Durban remains one of the most clinically and culturally-enriching experiences we have had.  From exploring our interests in Family Medicine; a specialty well-established in South Africa, to learning essential clinical skills under highly experienced health professionals; and forging invaluable personal and professional ties, all while relishing the beauty that is the golden coastline of Durban – ‘fulfilling’ might be an understatement!

The Beginning

Our arrival in South Africa was marked by a warm welcome by our host, Vivienne Venter, and her family. In our planning, the resourceful GEMx regional team had provided a list of accommodation options and Viv’s was the most cost-friendly, trusted and reliable. She had hosted several other groups of GEMx elective students and was well-versed with the program. The premises were, admittedly, a bit of a distance from Wentworth, but we were soon acquainted to the public transport system – kumbi, minibus taxis that are much like the Kenyan matatu.

With our home school, Kenyatta University (KU), University of KwaZulu-Natal (UKZN) and the regional GEMx teams having fully guided us through the application process, travel logistics and clinical placements, we were well-prepared for the program that awaited us. We would be rotating within the different departments of Family Medicine at the Wentworth Hospital in eThekwini health district for a four week span. Each week would have its clearly-outlined set of practical objectives, Continuous Medical Education (CME) sessions, ward work and clinical assessments.

Orientation at Wentworth Hospital

Wentworth Hospital, founded in 1943, is a district hospital that is part of primary healthcare provision in the eThekwini health district, which serves a number of patient catchment areas. The hospital focuses on provision of services that not only restore health, but also facilitate wellbeing of the person and community in its Family Medicine practice. As such, students from the Nelson R Mandela School of Medicine (University of KwaZulu-Natal) benefit from the hospital during their Family Medicine block. It also has Physiotherapy, Psychiatry, Psychology, Social Work, Dietetics and Occupational Therapy departments among several other community health outreach projects. Additionally, the Accident and Emergency Department receives and handles acute emergencies from the nearby areas. This setting served to expose us to an undeniably holistic system of patient care.

With the South African-Cuban exchange students at a teleconference session

With the South African-Cuban exchange students at a teleconference session

Our elective began with a comprehensive orientation by Professor Mergan Naidoo, the GEMx Elective Coordinator at UKZN and Dr. Mukhinindi, a Family Medicine registrar at Wentworth Hospital. They gave us a detailed brief of the respective clinical areas, our schedule and objectives as well as the running of the South African health system.  This understanding would be crucial in our set activities for the next month.

We received a comprehensive logbook that included rotation sites for every week, meetings and bedside tutorials to participate in. On our list of tasks was the formulation and presentation of a Quality Improvement Project (QIP) on the topic of care of Chronic Obstructive Pulmonary Disease (COPD) patients.  In an interesting and fun twist, we were also tasked with bingo cards with several objectives to be completed in different departments and programs of the hospital. This was organized in a bid to gain understanding on the importance of a multidisciplinary approach in the healthcare setting.  With plenty of tasks at hand and learning to do, we were ready to hit the ground running in all things Family Medicine for the next month!

The Clinical Experience

For a week each, we rotated in the Outpatient Department (OPD) & Procedure Rooms, the Acute Medical Ward & High Care Ward, the HIV Masibambisane clinics as well as the Accident and Emergency department. We assisted the interns in drawing blood, inserting intravenous lines, doing lumbar punctures, ascitic taps, incision and drainage, suturing and removal of sutures. As a result, we gained confidence in these essential clinical skills. We clerked patients with a variety of conditions and were assessed by the medical officers in our data gathering, diagnosis, therapy and counselling in several Mini-Clinical Evaluation Exercises (mini-CEX) that kept us on our toes. Indeed, we were sharpening our skillset all through.

In the medical wards, we attended two ward rounds each day, one with a Family Medicine physician and another with a specialist, Medical Officer or Registrar. During the ward rounds we would discuss the aspects of history, presentation, clinical exam, diagnosis and management of different patients. After the rounds we would assist the interns and nurses in procedures like ECG placement and interpretation, peak expiratory flow measurement as well as drawing blood. In addition to the highly beneficial teaching rounds, we had several individual and group tutorials by the Family Medicine Registrars on commonly-occurring conditions. At this point in time, we had been joined by a second group of elective students from Zimbabwe as well as the South African-Cuban exchange students. This made for very lively learning and discussions, with input on different countries’ clinical spectrum of illnesses.

Our participation in the HIV clinics and perhaps our favorite part of the clinical rotations was nothing short of enlightening. With more than thirty years of the HIV epidemic, despite no cure or effective vaccine, there have been major advances in its treatment. South Africa carries a large proportion of the global HIV burden, but with the availability of antiretroviral therapy, what was initially a fatal disease has been transformed to a manageable condition. Dr. R. Ryan, the experienced Medical Officer in charge of the clinics guided us through the initiation of HIV positive patients on antiretroviral therapy, the treatment of common opportunistic infections in these patients as well as the country’s approach to their care. In this light, we were also honored to meet Professor Thumbi Ndung’u, key player within the Africa Health Research Institute (AHRI) at the UKZN Main Campus, to discuss his progress in cutting-edge HIV research. In addition, we attended an informative lecture on the role of dolutegravir in antiretroviral therapy by Dr. Richard Lessels, infectious diseases specialist and group leader at the KwaZulu-Natal Research Innovation and Sequencing Pattern (KRISP) at UKZN.

For our fourth and last week at Wentworth, we were placed in the Accident and Emergency department.  It was here that we perfected our triaging skills and got to fully understand, respect and participate in the management of emergency cases. All through this period, we received excellent guidance from the nurses, interns, registrars and physicians who were always willing to pass down their knowledge and take us under their able wings. We remain indebted to them for their time and kindness.

Durban, the Gem by the Sea

Blessed with seemingly endless golden beaches, wonderful warm weather and a uniquely multicultural heritage, Durban offered us quite the amazing experience for our weekends away from the hospital.

The Young Christian Surfers’ Group

The Young Christian Surfers’ Group

With our hosts, and dear friends made along the course of our electives, we were able to happily make a dent in our to-do list of tourist fun!  We walked along the Golden Mile, a beautiful beachside promenade lined with restaurants, curio shops and the iconic Moses Mabhida stadium. Along this stretch is also the uShaka Marine World, an aquarium set on replicas of four shipwrecks. Getting up close to the marine life through the impressive underground viewing galleries was surreal!

A favourite was our visit to the oldest surviving garden in Africa – the Durban Botanic Garden, as well as the walk along the Umhlanga pier and nature reserve with medical interns from Wentworth. It was after this that we experienced one of the traditional Indian delicacies that Durban is famous for: Bunny Chow. Often referred to simply as a bunny, this a South African fast food dish consisting of a hollowed-out loaf of white bread filled with curry. Warning: the levels of spice in this are not for the faint-hearted!

Our host was part of a volunteer group, the Young Christian Surfers, and we enjoyed spending some Sundays helping out with the great work they are doing in taking care of the less fortunate as well as teaching young children to surf along the town beach.

Lastly, one of our most enjoyable and uniquely Durban experiences was our ride on the Rickshaw tour-bus, a visitor’s lovely three-hour introduction to city centre and its surrounding suburbs. It was an excellent way to get insight into the city’s rich history and culture.

 

The uShaka Marine World        

The uShaka Marine World

The Ethiopian Experience

On our journey to and back from South Africa, we were fortunate enough to have nearly day-long layovers in Addis Ababa, Ethiopia – a country which is a cultural revelation in itself. We explored the National Museum, complete with the history of man’s origins, visited the Addis Ababa University and even had traditionally brewed coffee with injera and sirowat. Very special thanks go to Dr. Tehetena, family medicine physician at the Tikur Anbessa Specialized Hospital, for being a lovely host and companion during our day’s adventures.

Siyabonga… Thank you!

Our heartfelt gratitude goes out to everyone who worked diligently to make this opportunity possible for us. The GEMx global and regional teams; Justin Seeling, Eunice Kamami, Faith Nawagi and Phionah Kinwa efficiently guided us through the application process, addressing all our concerns at each step of the journey.

A Day in Ethiopia with Dr. Tehetena

A Day in Ethiopia with Dr. Tehetena

The Kenyatta University management and Dean, School of Medicine ensured that our application process was smooth and travel logistics were well in order before our departure. We thank Dr. Titus Kahiga and Dr. Ongecha as our home GEMx team, who ensured that we gain the most out of the experience. They as well as Mr. Vincent Maganga and Ms. Dorothy Nyapil, through the Projects Office, supported us and assisted in the processing of required documents both for visa application and the exchange process. They served as a link between us and the UKZN team. For this, we are very grateful.

On the UKZN front, we thank Professor Mergan Naidoo, an excellent mentor and supervisor right from the planning phase to the end of our exchange. He and the warm student teams, interns, medical officers, registrars and departmental staff at Wentworth made our elective an exceptional learning experience.

From Nairobi, to Addis, to Durban and back, we appreciate all the wonderful individuals who went out of their way to make us feel at home. As we duly learnt, Ukuhamba kukubona. (Xhosa)

Travelling opens a window to the world.

Passion to Practice: Nzeeke Herbert’s Path to a Transformative Elective Exchange

Filed under: GEMx Regional Exchanges GEMx Student Reflections

By: Nzeeke Herbert, fourth-year medical student from Kabale University School of Medicine, Uganda

Herbert Standing Outside
My name is Nzeeke Herbert, a fourth-year medical student from Kabale University School of Medicine found in south-west Uganda bordering Rwanda. It is one of the nine Universities in Uganda that offers a degree in Medicine and surgery. I am privileged to be one of the pioneers of this medical school and one of those who had the first chance to participate in this elective program through GEMX.

 Growing up, I used to admire health workers putting on white coats. I then started getting the passion for medicine seeing how the health workers were caring for the sick and especially whenever there would be an emergency with everyone running up and down in a bid to help. Watching my father and mother die before I achieved my passion was another painful moment for me, but this didn’t stop my hopes of pursuing a medical course.

I joined a clinical school for my diploma in clinical medicine and community health in 2002 to 2005. I developed a positive attitude of doing my best whenever I handled the sick/suffering without segregation. I had no hopes of joining the university for the degree because I was supposed to look after my siblings since I was the first-born child. However still with my passion for medicine, I didn’t lose hope and through Prayer God made a way in 2016 when I was finally admitted to Kabale University to pursue this noble course.

Pioneering

The GEMx program gave me another rare opportunity to have an experience in Kenya where I didn’t have any hopes of traveling during my undergraduate studies. It started with a simple announcement at the University notice board calling for students to apply and participate in the exchange program with a deadline. I thought it was not serious and kept busying myself until the deadline date when I finally submitted my application. To my surprise three of us, we were called to the office of the dean of the school of medicine where we were told that we were selected by the faculty among ten applications to participate in the GEMx program.

It was such a joy. I wondered how best I could handle this as to be one of the first people at my medical school and a pioneer of the program. However, I had to be with hope and wanted to experience how other countries carry out their training of medical students in their medical schools.

Safari to Kenya

We traveled by road from Kabale, Uganda to Nairobi Kenya via Busia border, a journey that took me twenty-one hours. This was the first time I had ever traveled such a long distance. But it was rather an adventurous journey as I viewed the beautiful scenery of Africa; the landscape, parks, different animals, and valleys provided such a good tourist view.

Acclimatizing to Kenya

I found that Kenyans were welcoming and friendly. Swahili was the main language of communication and initially, it was challenging but some locals tried English, which made me learn more Swahili so I would be able to communicate. Their main meal was “Ugali” (posho in the simplest terms) with greens (sukuma wiki). It was not easy to cope up with the diet as I was used to Matooke and Irish potatoes. I had to adjust to fit within the local dishes.

The Elective Begins!

At Kenyatta University the coordinator GEMx welcomed us and introduced us to the different head of departments including the dean School of Medicine. This made me feel at home. A time table was drawn that helped me go through the expected objectives smoothly. The teaching hospital-Kiambu level 5 Hospital in Kiambu county was located approximately 30Km away from the university. This called for waking up early morning to catch the bus that would transport students to and from the hospital daily. The University had a six-year degree program for medicine and surgery compared to our Ugandan program of five years.

Forensic Medicine   

In forensic medicine, I was able to attend a few lectures and five autopsies with lots of learning and getting expertise from the experienced government pathologists. The pathologists were such good people who made me learn when, why, and how to do an autopsy. I had the chance to visit the biggest government chemists’ laboratory where samples are taken for analysis concerning forensics and the law. This improved my knowledge in forensic medicine and skills in carrying out autopsies which will help me become a good medical officer in the future.

Mental Health

In mental health at Mathari Hospital, I gained skills in clerking mental cases and attended rehabilitation sessions in a private rehabilitation center for substance abuse clients at Blessed Talbot. This gave me great experience in understanding the relationship between drug addiction and mental health and the team approach in handling such clients.

Surgery

The experience in surgery rotation was such an amazing one especially the radiological investigations in managing surgical cases for example; MRI, MRCP, CT scan in addition to other routine investigations were readily available within reach and patients would go for them when requested. The surgeons were such good people as they made me learn a lot with their good advice and teaching.

This was such an interesting experience as it contributed to my knowledge that will help me go through medical school smoothly and use it in the future during my practice so I can become a good professional medical worker with the relevant skills. On the social aspect, I made friends, interacted with many students and visited many malls around Nairobi and markets. It was very interesting staying in Nairobi. Would wish given another opportunity to go back. Traveled back Kabale-Uganda by road and had a safe journey. All my travels and welfare were fully facilitated by GEMx. LONG LIVE GEMx LONG LIVE KABALE UNIVERSITY.

 

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