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 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
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 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
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.
