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!!"#$%&'()!"!"#$%&'()*+,! Maeve Hume-Nixon Email me at Maeve.HumeNixon@gmail.com with any questions! 27/02/12 30/03/12 Internal Medicine Ms Mariska April International Students Coordinator, +27 21 938 9549, maa@sun.ac.za Tygerberg hospital, Cape Town, South Africa MRSA testing availability unknown!"#$%&$%#'()*+,-./'

!"#$%&'$( ' Do you want to do your elective in a stunning location? A place with a huge variety of activities ranging from winetasting, to lazing the day away at beautiful beaches, to climbing mountains for the spectacular views? A hospital placement with fascinating diseases, and opportunity for lots of practical experience? Do you want an elective that will be a life changing experience? ' Then my elective at Tygerberg Hospital in Cape Town, South Africa is for you! Tygerberg Hospital is a teaching hospital affiliated with The University of Stellenbosch, located about a 30 minutes drive from the centre of Cape Town. I did Internal Medicine, in which I saw a myriad of exotic diseases that I d only read about in textbooks; the majority of which were manifestations of HIV/AIDS or TB. I admitted acute medical patients, dramatically improved my phlebotomy skills, did lots of ABGs, and drained 2L of fluid from a patient s lung. I stayed on-campus at the International Students Lodge with 50 other medical students. Over five weeks we did so many great activities including going swimming with seals, climbing Table Mountain, relaxing at gorgeous beaches, and attending fabulous concerts. I cannot recommend this destination for an elective enough. Cape Town stole my heart, and I desperately want to return! 0'1,$2')3'-4$'5).*-'6'3%)7'8,)9:*'($.;<'=.+$'!)29'

)*+(,-#./$&0( Tygerberg Hospital is a teaching hospital for the Faculty of Health Sciences; University of Stellenbosch, and its campus is adjacent to the hospital. It is the largest hospital in the Western Cape and the 2 nd largest hospital in South Africa. Overseas medical electives are big business here and you will find you become one of around 50 foreign elective students during the busiest times.' >9-$%9.-,)9./'?-@;$9-*:'8);#$' I stayed at on-campus at the International Students Lodge with mostly other medical students, as well a few research and dietetics students. The majority of these students were from Germany, Holland, or Belgium; in fact during most of my stay I was literally the only native English speaker, and the only person not from Europe. In retrospect this was an incredible opportunity to develop friendships with people throughout Europe, however initially the language barrier felt a bit intimidating as the German and Dutch cohort tended to speak to one another other in their native languages. The hospital was 30min-40 minutes away from central Cape Town, and it was a 5-10 minute drive to the nearest shopping centre where there was a supermarket. This was an important destination given the accommodation was self-catering! Most people agreed that it was too dangerous to walk to this supermarket, and so you were stranded at the campus unless you had a car, or paid for a taxi. Thus, most students hired a car during the duration of their time at the lodge, which is what I did, paying ~ 800 NZ$ for 5 weeks. This was no Ferrari; the name of the car hire company was Rent A Cheapie, which gives you an idea of the quality of the car. 1-%2 On my first day I was shocked when I was introduced to my 11+ person team. There was one house officer, two A"'%))7'B,-'2.*'-,;,$%',9,-,.//"CD' S.Is (South African 6th year medical students), four 5th year students, and another four 3rd years. They were all standing around this woman who was getting a lumbar puncture with the curtains around her bed thrown open. The house officer asked me to rummage in his bag, in which he had appeared to put the whole stolen contents of the medical supply closet, for an LP needle. As I found out, each ward had its own budget, and so there were variable amounts of LP kits, needles, and sometimes

even gloves. You had to occasionally go wandering through several wards to accumulate all the supplies you needed for a specific procedure. The structure of the week was similar to New Zealand. We had ward rounds at 8am that would go for around 4 hours, and then jobs would be assigned to EVERYONE. There were no phlebotomists at Tygerberg Hospital so a key role of the medical students was to take blood. In addition due to the prevalence of HIV and TB amongst patients there were very frequently pleural taps or lumbar punctures to be done, so on occasion these jobs would fall to the medical students also. I was surprised and impressed that the SIs did uncomplicated pleural taps and LPs unsupervised. There were 4 firms: Monday, Tuesday, Wednesday, and Thursday. There were two teams to each firm, one who did day acutes from 8am - 6:30pm, and then one who did night duty. The teams would alternate weekly between day duty and night duty. Fortunately students were only expected to stay until 11pm when their firm was on night duty. Acutes were like in New Zealand where a student or house officer would go and see a patient and then a registrar would review them. I would describe these acutes as chaotic. There was no orderly list of patients to be seen, so I would wander the passage of F1; the medical acute ward, and ask patients (many of whom were often lying on stretchers in the corridor) if a doctor had seen them. Having ten other students also trying to see patients added to the difficulty of this task! Any patient you admitted you became responsible for. This involved chasing test results and writing them in the patient s file, and assessing the patient in the morning prior to ward rounds to see if their condition was improving, or if they had any new complaints. You were also expected to write a management plan which would be reviewed on ward rounds by the registrar. I found this whole process very valuable both in terms of learning and also gaining the trust and respect of my team. Developing a good relationship with the house officer and registrar was key to enable you to attempt practical procedures such as lumbar punctures and pleural taps; experiences which I found really valuable. 3&456&5+(7&%4/45( Everyone at Tygerberg hospital speaks English, however the University and hospital is very 'Afrikaans' and for many of the students Afrikaans was their first language. Ward rounds were officially conducted in English, but students and the registrar would often start conversing in Afrikaans, so I would often have to repeatedly ask for them to revert to English. Most of the patients spoke at least some English, and the team assigned me English-speaking patients. )*+(8+9/'/4+( As an aspiring infectious disease consultant, I found the medicine in South Africa truly fascinating. Diseases that were briefly skimmed over during the course of my medical education in NZ were the bread and butter of the doctors here. These included Echinococcal lung disease, tuberculosis in every body system; renal, GI,

TB meningitis, and of coarse HIV/AIDS. I saw patients with opportunistic infections that I d only ever read about in textbooks; CMV retinitis, Cryptococcal meningitis, grade 4 Kaposi's sarcoma leading to destructive lymphangitis. The experience was eye opening for me. I have always had a passion for global health, but until my placement in South Africa I didn't really understand the devastating spread of HIV. WHO estimates the HIV prevalence there is 18% between the ages of 18 and 49; nearly 1 in 5 1. My experiences however suggested that within the hospital population the prevalence of HIV was between one third to one half, and 1/5 had TB. The patient who will live on in my mind was a 38 year-old woman who presented with Burkitt s lymphoma and virological failure (Burkitt s lymphoma is one of the malignancies associated with HIV/AIDs). She had this huge abdominal tumour protruding from her tiny frame, and couldn't breathe due to bilateral pleural effusions?+)-'-4$'wx.-$%/,/"y'*,#9'6' +.-4)#9)7)9,5',7.#,9#'3,9;,9#'3)%' 4";.-,;'/@9#';,*$.*$' up to the 2nd rib. She required therapeutic pleural taps everyday because she was so dyspnoeic. I performed my first pleural tap on her, and she asked me to hold her hand as we watched almost 2L of fluid drain from her left lung. She was 38 years old and palliative because of AIDs. :0&;( I simply fell in love with Cape Town. It is a city with so much natural beauty, history, cultural diversity, and simply perfect weather. During my stay I saw Cape Town in all it's scenic glory; visiting Cape reserve, climbing up table mountain (the mountain which defines Cape Town's skyline), and climbing up lion's head to see 360 degree views of the city. And did I mention the beaches? The glorious weather allowed you to spend the afternoon drifting into evening lazing upon golden sands, although the freezing artic ocean meant that swimming tended to be an unpleasant activity. I saw historic sites such Robben Island where Nelson Mandela was imprisoned, the slave museum, and District 9 Museum; a symbol of the time of apartheid. U9$')3'=.+$'!)29:*'&$.54$*<' 3.7)@*'3)%',-:*'5)/)@%3@/'*4.5V*' '''''''''''''''''''''''''''''''''''''''''''''''''''''''' E 'FG>=HIJ'?)@-4'03%,5.'6'?-.-,*-,5*'K>9-$%9$-LJ''MNNO'I$&'MN'K5,-$;'MNEM'P@9'MQLJ'01.,/.&/$'3%)7R' 4--+RSS222J@9,5$3J)%#S,93)&"5)@9-%"S*)@-4.3%,5.T*-.-,*-,5*J4-7/'

Enjoy wine and food? There is Long Street lined with fantastic bars and restaurants. Then of course there is wine country; Stellenbosch and Constantia, beautiful regions who produce delicious and affordable wine. Another passion of mine is music, and I was lucky enough to attend concerts of great South African bands in the most stunning settings like Kirstenbosch; the botanical gardens. )/.#($-($*+(<6$6%+($%&=+00+%($-(>$+00+4"-#'*(( Car rentals I would recommend organizing a car rental before arrival. Otherwise you may end up stranded at Tygerberg campus for daysweeks as during peak times the cheaper rental companies may not have cars readily available for hire. U@%'1,$2'24,/*-'2,9$-.*-,9#',9' =)9*-.9-,.Z')9$')3'=.+$'!)29:*'7.9"' 3.7)@*'2,9$'%$#,)9*' Go in a pair - I am an outgoing friendly person, and initially I found it quite difficult and isolating being the only native English speaker! A lot of Dutch and Belgium elective students come from the same universities because their home universities are exchange partners with The University of Stellenbosch. I would recommend doing this elective in a pair, which would also be helpful in regards to costs as you could share a car and have a double room, which was cheaper. Apply early There are two major universities that offer medicine in Cape Town; The University of Stellenbosch, and the more prestigious University of Cape Town. I applied approximately 8 months before my elective, at this time all placements at the University of Cape Town affiliated hospital Groote Schuur (where the first heart transplant was performed) and Somerset Hospital were filled. If you are interested in these placements they recommend applying 12-18 months in advance. My final piece words of wisdom are that your elective at Tygerberg hospital is what you make of it. Take initiative; offer to take bloods, fill in radiology forms, and attend acutes. These simple tasks demonstrate that you are capable and builds a trusting relationship with your team, thus they will be more likely to allow you to perform more sophisticated procedures. I loved Cape Town so much that I have already vowed to return. For me, it had everything; beautiful weather and scenery, vibrant city life, and fascinating medicine. Working in South Africa revealed to me the human cost of HIV/AIDs and TB, and has strengthened my passion and commitment to working in these areas; both in a clinical setting and also in a research capacity. I cannot recommend Cape Town as an elective destination enough. It is a fantastic place to go if you have an interest in tropical medicine but want supervision, and outside the hospital it has something for everyone.'