Skip to Content
GEMx

GEMx Blog

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.

Cardiology Electives in Uganda

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Lindokuhle DIamini

Post by Lindokuhle Dlamini MBChB 5 student UKZN Nelson Mandela School of Medicine, South Africa

Preparations and Travelling to Uganda

During the time I was preparing for my trip to Uganda for my Cardiology electives for three weeks. I was not sure whether it was going to be possible for me to go to Uganda or not due to the fact that this was my first time traveling to a place that is outside of my own country. Immediately after my online application through GEMx, everything was easy for me because I received the help I needed on time and hence it was easy to get Immunizations, Visa, and other useful information about the place I was traveling to on time. Many people intervened and assisted a lot, Prof. Mergan Naidoo who is the GEMx Manager at UKZN, Professor Ncoza Dlova the dean of clinical medicine at UKZN medical school, Faith Nawagi from GEMx and Sunga Chumia helped me a lot with the whole process.

During the day of my trip to Uganda, I missed my flight from South Africa to Entebbe in Uganda, and this was due to the fact that there was a very long immigration cue at the airport and very few consultants, this was the only challenge I faced, but I did rebook the flight and the following morning I then traveled to Uganda, it was a good experience indeed.

Arrival and General Impression about Uganda

I arrived at Entebbe, and I checked in in the country after that I went to the Mugalo Hospital guest house where I was staying for my electives, I met many people in Uganda, but the common thing I noticed about every individual I met is that they were so welcoming and respecting as well, even though sometime I would not feel well because I did not fully understand their culture during the few days of my arrival in Uganda, and my fear was that maybe I will do or say something that means something bad or rude according to their culture, but their respect always kept me feeling at home. Uganda is a very good country but very expensive. I went to Shoprite just to get a few items at Acacia Mall and while comparing prices with the South African Shoprite, it was a lot more expensive. Staying at Mulago Hospital guest house was very good I met few Medical students from other countries and it was very nice to meet them, listen, and observe them as well I learned a lot from them both academically and socially.

Lindokuhle posing for the camera

My first day of Cardiology at Uganda Heart Institute, as I was still battling with the one hour difference between South Africa and Uganda, one of the Medical Students from the College of Health Sciences was sent to come and give us a tour around the Mulago Hospital, it was so useful because from then I did not struggle with directions around the entire hospital. On my first day, I met Dr. Isaac Ssinabuyla who is the manager of the GEMx at Makerere University, who is also a Cardiologist at Uganda Heart Institute, I also met Phionah Kinwa who is the Associate Coordinator for International Programs at Makerere College of Health Sciences. Dr. Isaac Ssinabulya took us and we went to the Heart Institute, we arrived the ward round had already started and he introduced us to the team. The Cardiologist who was in charge was Dr. Lugero Charles.  I learned a lot, most of the patients we saw were mixed valvular disease patients. The team I was with at the Uganda Heart Institute were so keen to teach, I learned a lot from them, not only academics but even the conduct of a Medical Doctor, being part of the team equipped me, to such an extent that I now consider Cardiology my first choice specialty. On Tuesdays, I attended major ward rounds where I met Dr. Batambuze an old Cardiologist who received his training in the United States. He taught me Cardiology, most patients presented with the mixed Valvular disease, coronary artery disease, Aortic dissection mostly caused by hypertension, and congestive Cardiac failure.

Lindokuhle and his colleagues

I clerked and presented patients to the doctors during ward rounds, and the most important thing Dr. Batambuze use to emphasize was the issue of being able to pick up clinical signs and being able to interpret them, as well as the importance of demonstrating how you elicited the clinical signs you mention. My Cardiology clinical attachment helped me a lot; it taught me to work with other people. Dr. Batambuze organized tutorials, and he uses to give both us medical students and MMed students tutorials, it is quite good to be involved in a clinical setting with many medical doctors, because you get different views and approaches as well which broadens your horizons. After the ward round, I used to study a lot, to try and cover as much work as possible. It was much discouraging to learn that Doctors are underpaid after so much hard work of their training, and the type of care they give to patients. It was also sad to see some of the patients in beds because nothing can be done but only palliation and some of them cannot afford to pay for the surgery procedures more especially the Type A Aortic dissection patients, because of limited resources at Uganda Heart Institute, and patients have to be transported to Kenya for such procedures only to find out that patients cannot afford, but I was glad because even though most patients could not afford, Doctors use to continue with medical treatment learned that there is a lot of communication in medicine, and to be a good doctor does not only require excellent academic record but it requires a lot of passion, patience, and commitment. I also learned to approach patients as a whole, not only to treat the disease but also to focus on other aspects of life, because they might be the precipitants and the cause of the disease. And now that I am at home I will make sure that I help other fellow students, and furnish them with all the information I received at Uganda Heart Institute. I really appreciate the experience I had at the Uganda Heart Institution.

Lindokuhle in his medical cap and stethoscope

Acknowledgments

I would like to thank GEMx for offering this exchange program, which made everything easy on my side as far as applications and other important information is concerned, thanking SAMA Scholarship for offering me funding. Prof Mergan Naidoo who is the manager of GEMx at the University of KwaZulu Natal(UKZN), Prof Ncoza Dlova who is the dean and head of the school of clinical medicine at UKZN who encouraged me to apply and further assisted me with finances where they were loopholes, Miss Sunga Chumia who assisted me with logistics. I would also like to thank Dr. Isaac Ssinabuyla who is the manager of GEMx at Makerere University in Uganda for the help and for hosting us as well as Phionah Kinwa.

Copyright © 2013-2022 by the Educational Commission for Foreign Medical Graduates. All rights reserved.
Terms | Privacy