Dissection in the Clinics?!

I am slowly beginning to realize that I have actually learned a lot during this trip. While I usually still try to keep my mouth shut during ward rounds, I have started knowing the correct answers to many of the doctor’s questions, and been able to recognize different problems and symptoms present in the patients.

Since I have not shadowed in the United States yet, I cannot compare the procedures, but I find it odd that dissections take place in the clinical office. Some patients come in complaining of stomach pain and are referred to have a gastroscopy, while others come in complaining a bullet that was left in his back after being shot and operated on. So, of course, Dr. Taylor removed the bullet right there in the clinic. It was pretty intense. The following patient had swollen lymph nodes that, with a biopsy would show either TB or lymph, so a lymph node was dissected from his chest just below the armpit.

I walked back to my room after the first class to eat lunch and when I left to return to the second class I found Reynecke tossing a rugby ball outside while several other people stood around. They were about to shoot a video promoting on-campus living and made jokes about “hey, look! I found another white person to be in our video!” So hopefully I’ll find that video on Youtube someday.

Back to the Surgical Ward!

Since my week of dermatology was over, I returned to Pelonomi with Adelle and Dani. The two general surgeons we shadow, Dr. Taylor and Dr. Rost, had patients in the trauma ward as well. One patient had been shot in the stomach as a guy hijacked his car, which happens fairly often. Another patient had been stabbed in the neck and slashed across his back, it was pretty rough. The last patient in our ward rounds was a 19 year old girl (but didn’t look a day over 15) who had a large abscess on her stomach. The rounded abscess was about 5in wide, 4in long, and protruded about an inch from the body. Dr. Taylor injected doxacome into her IV line and then sprayed a liquid (I’m not sure what) on the abscess to freeze/numb it. He made about a 1 inch incision in the middle of the bulge and out poured a pale mint green chunky fluid that filled an entire dental container. It was quite possibly the most disgusting thing I have ever seen, yet so exciting at the same time. After the majority of the abscess was drained, Dr. Taylor put his finger inside the incision and dug around the wound to loosen any remaining chunks of infection, and finished by using a syringe to wash out the wound with water. Throughout this whole process the patient was screaming and crying and calling for her “mommy,” which was pretty rough to listen to, but Dr. Taylor explained that the sedative he gave her before the seizure also causes memory loss so she will have no memory of the torture that just took place.

That afternoon, Sami and I walked to the mall to indulge in Mugg & Bean’s scrambled eggs. I’ve mentioned these eggs before, but they are worth the mention. I have ordered a side of scrambled eggs with every meal I have eaten at Mugg & Bean and their food will truly be missed. We also caught a glimpse of the “interesting” attire (my attempt at being polite) worn by some of the metric schools nearby. 

Tree life

The first uniform we've seen...how unfortunate

I obviously took this inconspicuously 

Jelly shoes? I thought only 7 yr old 90's kids were allowed to wear those.

I'm basically a pro at dorm-life food. Sliced bread, frozen chicken patty cooked in the microwave (disregarding instructions not to), and mustard, one of two condiments anyone could ever need. The other being peanut butter, of course.

A Day of Rest

I woke up mid-afternoon on Sunday, ate breakfast (aka, oatmeal and yogurt), watched Star Wars Episode III, went for a run, and then Sarah, Sami, and I went to Megan’s for our second homemade meal. We had a chicken pasta bake, homemade bread, and some type of baked squash with creamed corn and melted cheese. Delicious! After we returned home, we all took a well-deserved nap. 

I remembered to take a picture this time

And here are some pictures of campus

My room because I can't remember if I've posted one before

The Universitas Hospital

Where we have class each day

These gates are at every entrance to the campus. To enter or leave campus, the driver must show his/her student card, and upon leaving the security guard checks to make sure your keys are in the ignition and that you didn't hot-wire the car. Before the security became more lenient, you would be required to turn off and restart your car in order to leave campus because there were so many stolen cars.

Strings made with bottle caps. Thought it was neat

They are known as the UFS Kovsies, but I'm not sure what that means

Our hostile, ConLaures

These revolving doors are pretty much everywhere

An Attempt to Sokkie

I woke up early Saturday morning to schedule an attraction we planned to do that day. Unfortunately, the place of business was no longer open so we were unable to go. Instead, I went to the Vryfees for a few hours and ate lunch, and then Sami and I went again for dinner as well. We had planned to go Sokkie (an Afrikaans dance) that night, but it seemed everyone was tired, busy, or with their family. We were really upset, but at about 9:30 when we all had our pj’s on, we got a call from Reynecke saying he would be there in 10min and we’re going to the bar. Yay!

Wild Boar was a huge bar that had seating and a bar on either side of a large dance floor. People were sokkying when Reynecke, his girlfriend, Zehanca, Rory, Sarah, and I walked in, but after about 3 songs the music changed to traditional club music. It was a great time and I certainly used my American accent to my advantage, if you catch my drift.

A street performer

In South Africa, they have traditional Afrikaans names on the Coke

A giant slab of meat I found interesting

Rory...

Some guy that knew we were American and jumped in our picture

Sarah, Zehanca, and I

How Trauma(tic)!

The Afrikaans students and I returned to the optometry lab on Friday morning to look at a lifesize model of the eye with interchangeable slides showing different diseases of the eye. After an hour we left to return to the National Hospital for dermatology. Unfortunately, the dermatology clinic was having a very slow day with practically no patients. Our only patient was a 65 year old man with a nodule just above his knee. The doctor asked him to remove his shirt so we could classify the “age spots” on his back based on the terms we had learned throughout the week. A sister entered the room and asked about a scar on his leg, he replied by saying he had a bypass surgery in December by Dr. Piers at Universitas. Gasp! I know him!

The doctor ushered the man into the operation room, injected an anesthetic into the nodule, and used what looked like a tiny ice cream scooper to saw/scoop of his nodule. He then burned the base of where the nodule was to kill all remaining tissue, and bandaged the wound.

After class I went back to my room to take a nap because I was on-call in the trauma ward that night from 6-11pm (or 18-23:00, if you prefer).

The first patient brought into the trauma ward that night was a 51 yr old woman who had been in a car accident. Before I saw the woman, a man walked passed me with a plastic bag of which I inspected and found it was a human arm. Holy crap. I walked over to where the woman was laying, without a right arm, and discovered that she was driving without a seat belt so when her car rolled twice, her arm was slung out the window and cut clean off. She was awake and without sedatives or anesthetics, but the amount of shock her body was experiencing kept her from feeling the pain. We found out later that her left femur was completely shattered, and she had previously suffered from a stroke which left her entire left side paralyzed. So now, as sad as it is, she has one working leg and that’s it.

The next two patients were pedestrians who had been hit by cars. The first had a broken leg just above his ankle. I was asked to remove his shoe and dear gracious me I have never smelled something so putrid in my life, and it was by far the closest I have been to passing out since I arrived. The second pedestrian accident came in about 45 min after the first and after I cut off his pants we discovered he also most likely had a broken leg, and possibly a few broken ribs as well. Nobody else was brought in before 11 so we left shortly after. I learned tonight that I can definitely handle trauma, and it doesn't bother me, but it also doesn't really spark my interest either. 

Culture Shock...Almost

I met with the Afrikaans students on Thursday as well to learn a little fundoscopy. (where you examine the retina of the eye with a light and a magnifier called an opthalmoscope) The lights in the room where off so even from far away the pupil would glow bright red if the opthalmoscope was pointed into the eye. When close up, I could see the complete inside of the eye and all of its blood vessels that met in the middle. So cool! Those with bigger pupils or blue eyes were easier to see because of a lack of pigment. 

We drove to the National Hospital for the rest of our day where we learned about wound care which was performed on an obese lady with a severe, festering leg ulcer. Apparently, she has had this ulcer for over a year watching it grow and shrink, but never completely heal. Afterwards, we watched a small growth (I'm not sure what it's called) be removed from a man's toe, and then observed a clinical appointment in which a little girl had a full body rash.

For your viewing pleasure, I found this picture on Google of what her ulcer looked like, though hers was much bigger.

Something I learned at the Vryfees that afternoon is that NOBODY says "excuse me" or "sorry" when they bump into each other, so I guess they just pretend it didn't happen. After walking around the crowd for about 30 minutes I gave up saying it as well because if any acknowledgement of my gesture was shown at all, it was usually a look of confusion. A woman literally almost knocked me to the ground and didn't even turn to look. The surprising part is that everyone I have met in Bloemfontein so far has been very friendly, caring, and polite so I assume the "excuse me" phrase isn't in their culture. 

I also learned that people get really offended if you don't greet them before speaking to them. I approached a food stand and waited for the lady to ask, "can I help you?," but instead she just stared at me with an indifferent/impatient look on her face, so I went straight to the point and asked for a grape Fanta. She practically scowled at me and replied "Hello, I'm fine, thank you." In the United States, if you walk up to a McDonald's cashier who is busy, and (as I would say) hate-facing/mean-mugging every customer that walks in, they will probably get annoyed at your effort to greet them before blurting out your order. 

Our First Braai!

Tuesday before class we met a couple Afrikaans students who said they were doing dermatology this week. I’ve been interested in shadowing a dermatologist for a while, but have never had the opportunity so I decided to continue with a group of Afrikaans students for the rest of the week. Monday and Tuesday they were in the clinic with patients learning general terms for skin lesions and spots. On Wednesday our group of 9 went to a small classroom and as a group answered multiple choice questions about pictures of skin problems to practice terminology. It was very interesting and insightful and much more interactive than the afternoon classes we usually attend.

Wednesday night we attended our first Braai, which is basically a cookout. Marius, a guy in our class, and his wife Marie hosted us at their house in Bloem. We went to a grocery store beforehand to buy our own choice of meat (I bought lamb kabobs), but when we arrived, we discovered that Marie had prepared appetizers, Afrikaans shots and drinks, and other snacks. Marius has visited the US before and spoke of an instance in which he was invited over for dinner, but he arrived, he ate, and he left, so he assumed that we were unaccustomed to the idea of going to someone’s house to socialize before and after eating dinner. Obviously, socializing was completely expected, and I absolutely loved every second of it.

I don't have any pictures of our Braai because my phone was dead, but I'll steal some pictures from Sami's facebook and post them later.