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Group Reflections on a GEMx Family Medicine Exchange from University of Zimbabwe to University of Kwazulu-Natal

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nyasha Manyeruke, Leslie Mashayahanya, and Talent Munjombi, medical students at University of Zimbabwe College of Health Sciences who completed a elective exchange at University of Kwazulu-Natal School of Nursing and Public Health (South Africa) through the GEMx-AFREHealth Regional Exchange Partnership.

 

Students selfie in Durban

INTRODUCTION

When we signed up for the GEMx Elective experience in South Africa, we hoped to experience and gain better understanding of the clinical setup in a neighbouring African country and improve our overall clinical skills in preparation for our final year of medical school. We happily report, that the experience exceeded our expectation and broadened our knowledge overally.
Under the supervised guidance of Proffessor Mergan Naidoo, we had an opportunity to rotate in different wards at the hospital, that is- High Care Unit, Out Patients Department, HIV clinic and Accident And Emergency Department. We had multiple opportunities throughout our elective to interact with Family Medicine constultants and Registrars for “one on one” tutorials as well as group tutorials. We also interacted with other members of the clinical team including interns, counsellors and nurses, who taught us and encouraged us to perform certain procedures, such as, drawing blood for investigations, inserting urinary catheters, suturing and so forth. Outside clinical activities at the hospital, we also explored Durban –visiting the beach, shopping malls, indulging in local delicacies, and interacting with fellow Zimbabweans living in South Africa, as well as the other locals we encountered in our day to day activities. We gained a greater appreciation of the multicultural and diverse society that makes up South Africa, Durban in particular, and how this correlates to patient management in the hospital setup.
In this report, we have summarized our elective experience into experiential sections and attached pictures accordingly.

Hospital Clinical Experience
1. Out-Patients Department
We each spent a week attached to the outpatients department, participating in local procedures and guidelines. In our logbooks we had clear learning objectives and subjective measures to assess our progress throughout our elective. We enjoyed ourselves thoroughly, and below in Figure 1.1, the picture illustrates Leslie clerking patients seated on the bench waiting to be served at the Out-patients Department.

MD student looking at papers

2. High Care Unit
We each spent a week attached to the high care unit. We mainly learnt ward management of patients and ward conduct as well as protocol. Besides knowledge learnt on commn ailments in our setting, such as, HIV, TB and Myorcadial infarctions, from the various ward rounds and tutorials,we also assisted the interns in performing their daily ward duties, such as, taking blood, performing lumbar punctures, inserting chest drains and so on, as well as interpreting lab results for investigations. Figure 1.2 below illustrates Talent taking blood from a newly admitted patient, with the assistance of one the nurses.

Students taking care of patient

3.HIV clinic
We each were attached to the HIV clinic for one week, and we mainly participated in patient adherence counselling, reviews, as well as initiation of patients on Antiretroviral medication. We learnt about the importance of the multi disciplinary team and we often assisted the nurses at nearby clinic( gateway clinic) in using the referral system tool effectively in ensuring patients receive the best care. Figure 1.3, is a picture showing Nyasha, standing at the entrance for Gateway clinic.
Student in front of hospital sign

4.Accident and Emergency
We each spent one week at this department. This was a very busy department, it was very interesting learning about the triage system at this hospital and the acute management of patients. We learnt about the importance of time and sharing tasks amongst members of the clinical team in order to manage patients adequately. In figure 1.4, the picture below illustrates Leslie, preparing bloods to be sent to the laboratory for investigation.

5. Other Hospital Related Activities

Talent and Leslie reviewing clinical magazines for updates on recent research findings, new additions to clinical guidelines and for Continuing Medical learning(CME) in the doctor’s tea lounge during some of our lunch breaks.

Students Reviewing Journals

Talent(female) and Leslie, standing in front of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marveled at the architecture

Talent(female) and Leslie, standing infront of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marvelled at the architecture

A selfie taken after our GEMx end of elective exercise and discussion with us and Professor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

A selfie taken after our GEMx end of elective exercise and discussion with us and Proffessor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

As we come to the conclusion of our elective experience, we would like to thank all the people who made this elective experience possible, we thank you for impacting our careers in our fruitful and adventure filled manner. We hope you continue your great work.

THANK YOU
Siyabonga

Ntuthuko Mkhabela’s Cardiology Elective Exchange to Uganda

Filed under: GEMx Regional Exchanges

Ntuthuko Mkhabela

Post by Ntuthuko Mkhabela, a 5th- year medical student at the University of KwaZulu- Natal in South Africa taking an elective program to Makerere University in Uganda. (Student on the left)

Introduction

My name is Ntuthuko Mkhabela, I am a 5th-year medical student at the University of KwaZulu- Natal in South Africa.

I was afforded the opportunity to do a Cardiology elective program in Makerere Univerity in Uganda at the Mulago Hospital Heart Institute from the 4th until the 23rd of June 2018 by the GEMx.

I found this to be a great learning opportunity and also a very prodigious chance to explore new places and meet new people. From when I got to Uganda I found that everyone was very friendly, though it was difficult at first to settle in and comprehend how somethings are done but within a few days, it really felt like home.

Academics

Group photo at the hospital

I had to admit that I had the best bedside teaching at the Heart Institute and they have the best grand round on Tuesdays with the best and most enthusiastic teachers I have ever had any chance to meet.

I was a great honor to get teaching from Dr. Batambuze “The Lord of the Heroes” as he refers to himself when entering the ward, he isn’t only a great consultant but also offers the best form of teaching in a very passionate and motivating way; and he also has a great sense of humor.

He was very patient with us and even though he had not come to teach undergraduate students. He made us feel welcome and were willing to assist us wherever we got lost. He would take us all the way from basic science and anatomy up to the clinical and bedside medicine and the one thing he really enforced was the importance of proper and evidence-based bedside clinical medicine and how it would assist in saving a patient’s life and for that I would like to forward my special thanks to him.

Ntuthuko Mkhabela and Lindokuhle Dlamini

We also had the best team in the ward led by Dr. Majwala who also held our hands throughout the period together with his MMed students: Dr. Ssibuliba, Dr. Were, and Dr. Herbert. They were willing to not only share their much valuable knowledge with us but also even shared some of their resources with us.

It was really a great motivation to me and if given the opportunity I would definitely love to work with them again because I think there is a lot that I could learn from them and it wouldn’t be just for me to not appreciate these great individuals. It also wouldn’t be just for me not to appreciate Dr. Lugero for his great teaching, he was the first to welcome us and he rightfully told us that he cannot welcome us with a party or whatever but he can only welcome us with academic questions and indeed his teaching remains highly appreciated. I would also like to appreciate all the other doctors I have not mentioned above who also were willingly and undoubtedly making efforts to ensure that we are trained to become great clinicians.

I also had an opportunity to spend some time in the Cath Lab to see how coronary stents are inserted and again we were welcomed with warm hands and without any objections taught us as much as they could within the little time we had in there and it was again a memorable experience.

Briefly, I would just say I the academic side of my visit had the best teaching I have ever been exposed to in my life and I remain grateful, and one would then safely say the purpose of the trip was fulfilled.

Social

Ntuthuko Mkhabela selfie

During my stay in Uganda, I had a chance to explore a number of places in the area, starting with the tour around Makerere University which we had with Clement who was a great host and was always there when we needed him. He became more than just ‘a student who was supposed to show us around’, he became a friend and a colleague who we shared a lot of great moments with and also shared knowledge.

He is a great leader and has been in the student leadership myself, we actually shared a lot in common hence we got along very easily and I sure do wish him well in the future and hope we do meet again at some point.

I also had an opportunity of watching the multicultural tribes of Uganda performing their traditional dance TWICE because for some reason I just couldn’t have enough of their dance,  jokes,  music and of course the food courtesy of Dr. Isaac.

Ntuthuko Mkhabela enjoying traditional activities

This was a great experience and it made me wish to get a chance to go live in their rural areas for at least a day so I could be part of the traditional activities and have the first-hand experience of how it actually feels to be one of them because I was already feeling like one of them even at that time. I couldn’t really tell whether this gentleman was too tall or it’s just that I am very short but I honestly had the most fun at this cultural dance event I also had an opportunity to go and watch a local rugby tournament and also meet up with other medical students from different other countries from all around the world. I made a lot of friends who I learned a lot from; we also watched a number of world cup games together and shared a lot of fun moments. With some, we even share the same accommodation which allowed us to get to know each other even more.

Unfortunately, I didn’t get to go to the Safari and to Lake Victoria with them, which I really think it would have been really great adventure given the fact that it was in the home of the Nile Rivers its self.

Ntuthuko Mkhabela enjoying his stay in Uganda

Conclusion

Even though the trip started off on a very frustrating note from missing our flight and having to spend a night in Johannesburg to serious financial constraints but in the end, all the efforts were worth it and I definitely would relive every moment of it if given the chance again. I appreciate the opportunity that was afforded to me and would like to thank everyone who put their efforts into ensuring that this trip became a success.

Smiling with my new friends

I think this GEMx initiative is a great one and really I would like to see more people from our school taking part in it.

Thank You

 

 

 

 

Get to know Mercy Muhadia Okova

Filed under: GEMx Regional Exchanges

Post by Mercy Muhadia Okova, a 5th-year medical student at Jomo Kenyatta University of Agriculture and Technology. 

I spent most of my childhood days in the rural area, the western part of Kenya and my high school and college days in the capital city Nairobi. I have a taste of both rural and urban life which makes life easier for me because I know how to deal with people from both sides.

When I was young I would sing the common song of many children that when I grow up I would like to be a doctor. However, that dream made sense when my dad fell critically ill and I wanted to understand what was happening to him and help where I can. I was also motivated by a young lady: a medical doctor who was in her second year of residency in Neurosurgery. That made me believe young ladies can also excel in the field of medicine. I excelled in my final high school examination and got admitted to study medicine.

Unfortunately, my dad passed away while I was in my first year of study before I could barely understand what made him unwell. Later on, I understood and this fueled my passion to fight Non-communicable diseases(NCDs) by creating awareness on healthy lifestyle practices for prevention of Non-communicable diseases. I write articles concerning NCDs on my blog mercyokovaonncds.wordpress.com

I learned of the GEMx electives through my classmate and we met the coordinator in my school who guided me in applying for an elective at University of KwaZulu-Natal, South Africa and got accepted to rotate in the Department of Family Medicine. I am glad to have met a very pleasant team lead by Professor Mergan Naidoo. The program is quite busy already learning a lot in the first week. I hope to share more experiences as the elective goes on.

GEMx Exchange to UKZN

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Nancy Binsari and Tendwa George, 5th year medical students from Kenyatta University who’ve completed an exchange at University of KwaZulu Natal (UKZN).

Tendwa and Nancy smiling

Tendwa and Nancy ready to go on their exchange

Introduction:

This elective is an opportunity to find out more about yourself and what you want to do in the future. The elective allows you to explore a particular area of medicine or something different, such as research or teaching.

The two of us were selected to participate in the elective term through the GEMx program. Our home school, Kenyatta University was enrolled into this program through the regional platform in Africa for the first time in 2017. Being the pilot group, we were privileged to get a chance to participate in our elective at our host school UKZN (University of KwaZulu Natal) at Wentworth Hospital. Two of our other colleagues also participated in the GEMx program, and were sent to Makerere University in Kampala, Uganda to the cardiology centre.

We had 4 weeks of rotation in the department of Family Medicine in Wentworth hospital, one of the hospitals for UKZN clinical rotations. Family medicine, formerly “Family Practice” is a specialty devoted to providing comprehensive health care for patients. Family medicine is a three-dimensional specialty, incorporating knowledge, skill and process.

Dr. Mergan Naidoo, the head of department of family medicine at UKZN was our contact person and took us through the orientation at the hospital as well as our clinical rotations in our various sections. With the aid of a well-put logbook, Dr. Mergan Naidoo took us through our objectives for the clinical rotations and also guided us on a quality improvement project that we undertook during our stay at the hospital.

4 people standing and smiling at the Department of Family Medicine

Tendwa, Nancy, Dr. Naidoo and Kenneth at the Department of Family Medicine

Week 1: Out Patient Department (OPD)

Our first week was in the outpatient department (OPD) which is divided into the chronic and acute sections. In the acute section, we clerked patients and presented to the senior doctor in charge, Dr. Oyebola who guided us and corrected us accordingly. We had an opportunity to familiarize ourselves with the South African guidelines on management of common conditions of patients in the OPD. We were able to experience a variety of conditions and were tasked to identify or at least make out the differential diagnosis of the presenting complaints.

Of the patients seen, a majority suffered respiratory diseases with TB and community acquired pneumonia leading. We also noted that the country had a large burden of HIV and it was therefore not a surprise that it was in the background in most of the TB infections. We were provided with masks to prevent acquisition of TB in patients. Other conditions we encountered in the OPD were hemorrhoids, gastroenteritis just to mention a few.

Week 2: Accident and Emergency  

Nancy and Tendwa standing in front of Accident/Emergency Department

Nancy and Tendwa outside the accident and emergency department.

The second week of our elective term was at the Accident and Emergency department. This was under the supervision of many doctors. Our task here was again to see patients and clerks, suggest investigations and come up with a management plan. We would then present this to the doctor on call as well as the intern doctor for approval of our approach and advice on what we missed out on. This turned out as a very good way of learning as sometimes they pointed out that we have the theoretical knowledge but need to put more practice into applying it to the patient and seeing them as a whole. We were trained to act like investigators and see beyond what the patient is saying. It was quite interesting because no matter how busy the floor got, the doctor’s would never rush us both in clerkship and in presenting to them. We got really good insight on what it means to be part of a health team and experienced what role we had as doctors.

 

Week 3: Acute Admission Ward

During our third week we rotated in the acute admissions ward. This is where all acutely ill patients admitted from Accident and Emergency department are transferred for high care and monitoring till they are stable enough to be discharged or transferred to other medical facility or surgical wards. It is during this rotation that we familiarized ourselves with the protocols and guidelines of South Africa for the management of acutely ill patients during the acute phase.

Week 4: HIV Clinic

We spent our final week in Wentworth hospital was spent in the HIV clinic. Here, we learnt under the supervision of Dr. Ryan, we saw newly diagnosed patients as well as follow ups and got to experience first-hand the countries’ way of combating the high levels of HIV infection in the area.

A thorough examination of the patient was also well covered to examine symptoms the patient brought up as well as anything they would have missed e.g. skin rashes or mouth lesions. The consultation would end with the patient understanding all the information being presented and patients were asked to come back for another visit. We had to update them with a full summary of what was discussed in terms of patient health and progression or regression of HIV.

Tendwa and Nancy have masks on their faces

Tendwa and Nancy at the HIV clinic

Challenges:

One of the challenges was the language barrier. It was difficult to communicate with some patients who could only express themselves fully in Xhosa or Zulu. To combat this challenge, the doctors and nurses went out of their way to translate whenever possible and give us English speaking patients to clerk.

Acknowledgment:

1) We would like to thank Dr. Titus Kahiga for his exemplary role in making our exchange possible. He conducted regular meetings with us, guided us every step of the way, and took great measures to ensure we gain the most out of the experience. He acted as a link between us students, the university and the GEMx program. We are not sure that if we were under anyone else our exchange would have even been possible.

2) We would also like to extend our gratitude to Dr. Faith Nawagi. She was always present to respond to questions and concerns right from the first day we began the journey. She was always efficient in communication channels and would reply to emails within a very short time. This helped us with our planning and preparations. We are positive that the program will see greater heights with her commitment and passion for the students.

3) We extend our hearty gratitude to Professor Mergan Naidoo. The professor provided very good mentorship right from the planning phase to the end of our exchange. He also made time for regular interactions to address any concerns we may have had. We would also like to extend our gratitude to Mr.Ifukho, Mr. Vincent and the projects team in Kenyatta University as well as Ms. Anitha from UKZN. They were quite helpful in the processing of required documents both for visa applications and for exchange purposes.

4) We would like to thank the individuals who stood out in our elective term. These individuals managed to take time for us students and gave us an exceptional learning experience.  The staff’s enthusiasm and warmth remains entrenched in our memories as well as their motivation to providing us with a good amount of knowledge. These people include Dr. Ayubola, Dr. David, Dr. Daniels, Dr. Mbaiza, and Dr. Ryan.

5) Our sincere gratitude to the office of the Dean at Kenyatta University school of Medicine and our Dean Prof. Agina for ensuring we had all we required during our stay at KZN, as well as selecting the two of us to represent the school for the elective program at UKZN, South Africa.

6) Lastly, we thank the nursing staff as well as the interns who helped us settle in each department and allowed us the opportunity to help wherever we could.

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