Gastroenterology is Not For Me

Week 2 marks the end of our time in the vascular department with Dr. Piers, and the beginning of our week in the gastroenterology department. We were asked to arrive at 8:30 instead of the usual 7:30, and still spent about an hour and a half waiting for the doctor to arrive. In this time before lunch, we were able to see two patients get a long scope, with a diameter slightly less than that of a penny, shoved down their throat and into their duodenum, intestines, stomach, etc. This was very unsettling to watch as the patient was gagging, coughing, and vomiting the entire time. When the doctor found little polyps on the second patient's stomach lining, she inserted a tool, comparable to tiny wire cutters, down the tube to cut off a few of the polyps for testing. It seemed like pure torture and I wanted nothing more than to yank the tube out of their throat and rip it in half, but I was trying not to be so quick to judge the subject.

Tuesday's trip to the ward did not leave as much of an impression on me. We followed our usual 5th-years around as they interviewed their assigned patients as to why they were there, their initial reason for coming to the hospital, if they have had surgery, their overall well-being, etc. The reason for this was to prepare to present the patient's story to the specialized doctor, and their thoughts regarding it. This seems like a very effective method of learning for the 5th-years about a range of different patient problems and complaints, their diagnosis, their treatment, and whether or not they were improving.

Sunday means Laundry Day

I was waiting for this day with great anticipation because our plan was to go to a tourist-like attraction called "The Cheetah Experience." I'll let you assume what that might entail. Unfortunately, Megan got sick and Devon had a personal issue so we postponed until possibly this coming weekend. With a full unplanned day ahead of us, Sarah, Sami, and I decided to take a cab to the National Museum. Not as exciting as cheetahs, but I always love a good museum. When we returned from the museum we were greeted by hoards of people with large suitcases filing into our dorm; a seemingly awesome sight, until we walked closer to discover they were half our size. Ages ranging from about 8-16ish? We were informed that they will be staying in our dorm for the week because they are competing in a table tennis tournament in Bloemfontein. Stay tuned.

On another note, at this point in my trip I was completely out of clean pants, in fact, I was completely out of clean pants on Friday (judge me), so it was time to do some laundry. Have you ever taken your dryer for granted on a cold winter day with temperatures just above freezing? I certainly have. Although, it's moments like having to hang my clothes on a clothesline in 40 degree weather while wearing running shorts that I appreciate most, because these moments force me to realize how blessed and thankful I am for the life and opportunities that my parents have provided me, and the friends that I have met along the way. So as a friendly reminder: I love all you guys! You too, Dr. Jones.

Off to the Boeremark!

After going to bed at 3:30am, Sami and I were thrilled to hear Afrikaans church-like music blasting from our neighbors room at 7am the same morning. Oh the joys of dorm life. Megan, Anna, and Devon came to pick Sami and I up at 10 to go to the Boeremark which is an Afrikaans farmer's market. It was just like a flea market, but  mainly had hand-crafted Afrikaans products, traditional food, clothing, jewelry, etc. and I absolutely loved every second of it. We purchase a couple different kinds of foods, of which none I know the name of or could possibly attempt to spell. Something I found interesting was the amount of people who spoke to me in Afrikaans. True, I was at an Afrikaans market, but I was wearing a sorority t-shirt, leggings, bean boots, and had a professional-ish camera. I might as well have had "tourist" tattooed across my forehead, but I'm glad I don't stick out like a sore thumb too much.

Minions!

Storytime: Once upon a time, my living room at home had an adorable and classic lake/boat/sailing theme because we live on the lake. My parents decided to go to Europe and bring back black and white pictures of Paris, giant framed German laws, etc, and hang them in our living room, so now it just looks silly. I saw this rhino carving and thought "ha! I should buy this and hang it in our living room to add to the chaos." Unfortunately, R800 is a little pricey for a joke. Oh well.

This didn't taste too bad, but having to look at it while eating it just made me nauseous. A local overheard our group discussing what we should try and he suggested this. After buying one, we asked him what kind of meat it's made of and he replied "it's probably best that you don't know."

This chicken on a stick was quite delicious.

This was basically pita bread with shredded cheddar cheese and apple jam. A strange combination, but still pretty good.

.Sami and I returned home and immediately went back to bed. We all planned on going to a professional rugby game that night, but Sami wasn't feeling well so it was just Sarah, Cherade, and I that attended. The game was held in a nearby stadium that actually hosted World Cup games! After watching professional rugby I can now say I am definitely a fan. For those of you not familiar with rugby, it's basically football with no pads and absolutely no rules. You could punt the ball down the field whenever you felt like, when a player hit the ground with the ball everyone would just attack him and beat it out of his hands because it was still in play, and if someone threw a pass, the other team would pick up their players like a cheerleading stunt to grab it out of the air. You never knew what was going to happen next. (Unfortunately I don't have any pictures from the game because they wouldn't allow me to take my camera inside. Not sure why.)

That night we had a repeat at Dani and Nikki's, but this time we were way less rowdy. We all made a rule that Sami and I had to attempt to speak in a South African accent and the South Africans had to speak in my accent. (Sami doesn't really have any accent. haha) Only few times in my life have I laughed that hard. We were all pretty terrible.

You Wore Bathing Suits, I Wore Bean Boots

Happy 4^th Everyone!

Unfortunately, South Africa doesn't celebrate the independence of America so we still had to get up at 7 to go to rounds. I wore an American flag shirt, cliché, I know, and kindly reminded the South Africans what day it was. Ward rounds for the vascular department are on the seventh floor of the hospital and for some reason it’s always unbearably hot. Instead of learning about each patient’s story, the doctor just went to remove dressings and make sure the wounds were being properly cared for. Healing oozing leg stubs + 80 degree rooms + weird smells = Me almost vomiting. Almost, being the key word J

Between rounds and class, Cherade took us to a Chinese toy store in the mall to look for fireworks and our hunt was successful! As his 4^th of July present to us, he bought us some biltong. Biltong is a must-have for all occasions and is a lot like beef jerky, but not as tough. After class we returned to the mall to buy groceries and drinks for the night’s festivities.

Biltong

We went to Nikita and Danielle’s flat to have pancakes, (which we would call crepes) and celebrated our Independence Day, Ross passing his rewrites, (They all take three exams at the end of each year and if you fail one you have to rewrite all three. If you fail a rewrite, you must retake that entire year.) and Adelle’s birthday. 

Giving Adelle her birthday presents.

Our night started like this...

....and ended like this. 

That's all I'll say about that. At least we are bonding. Aren't you proud, Dr. Jones??

Our lovely firework show. 

Definitely one of the most memorable Independence Days I'll ever have.

Why I'll Never Become a Smoker

We were told that today we would do more rounds with the vascular patients, but when we met with our 5th-years we learned that rounds happened at 6am this morning instead of 7:30 when we arrived. The rest of their schedule was filled with surgery so we were more than happy to accompany them. Dr. Piers was preparing for a femoral anterior tibial bypass surgery when we arrived and was stitching up the patient at 10:45 when we left for lunch, followed by class. The patient had several dead arteries in his remaining leg (as the other had already been amputated) clearly shown by his black big toe. Why did he have an amputation in the first place? SMOKING decreased his vascular function. Apparently having a leg cut off is not enough of a sign to quit smoking so he continued and now faces more surgery and more amputation. (*cough cough* Larry! aka My stepdad) Anyway, the procedure that took place was meant to bypass the dead arteries in his leg by cutting out the full length of a vein and inserting it into the top and bottom of the artery so the blood flows through the vein, which now acts as an artery. The overall goal of the surgery was to send enough blood flow to the foot so the amputated toe would have enough oxygenated blood to properly heal, if not, his remaining leg would have to be amputated.

After class, Sami and I took a cab to the mall which was about 10min away and costed R65. Since I haven't explained yet, R10 is about $1, but the exchange rate today was R10.8 = $1, yay! We bought our friend Adelle (we watched the two World Cup games at her apartment) a gift because her birthday is on Saturday and birthdays, regardless of the person, are always exciting! The malls here close at 6pm, which is very strange to me, but I don't make the rules, I just have to follow them.

Happy almost 4th of July!!

Day 2 of Surgery!

Day 2 surgical room set-up. The first one was much smaller with much older equipment.

Some of the aftermath

Against my better judgement, I decided to take a "selfie" to give an outfit reference to future students so maybe they won't be lost in a dark cave with a wet match as I was. We were given these white lab coats and all students wear them daily. The hospital is usually very cold because they don't heat the buildings here so long sleeves are a must. The other female students wear leggings (with a dress), jeans, khakis, etc with boots, flats, tennis shoes, etc. Basicaflly, as long as you don't look like a bum you're good to go.

Surgery...ooohhh...aaaahhh

For day 3 at the hospital we got to stand-in on a surgery and I even got to "scrub-up"! I had to be taught the proper procedure of washing my hands which took about 5 minutes because I had to wash 5 times, and then I put on a sterile gown and got to stand next to the surgeon for a whole surgery. The surgeon was the same vascular doctor, Dr. Piers, that we met the first day, and he was extremely approachable and willing to answer any questions. He performed a Peritoneal Dialysis Catheter Surgery due to renal failure so it wasn't too advanced, but still very exciting.  Basically, they made a vertical cut about 2-3in long to the right side of the belly button, cut through the abdominal muscles, (Dr. Piers, who jokingly teased us "dumb Americans" the first day, but actually criticized our healthcare system, said "this is where the six pack would be, have you Americans heard of that term, have you ever seen one?" Ha! You're hilarious...Although, he actually is.) and insert a catheter tube into the peritoneal space. The muscle is sewn back up around the catheter insertion area, but the catheter tube exits closer to the pelvis. A bag of dialysate (not sure what is in that) is drained over a period of 15 minutes into the peritoneal cavity to dilate bodily fluids normally filtered by the kidneys, and is then drained back out. The patient much perform this 30 min process twice a day for the rest of their lives.

So official

Dr. Piers made a curious point saying that this procedure isn't often done in America, but since they do not have enough dialysis machines, facilities, or patient transportation, they do this surgery instead. This surgery is also not ideal for the patient and Dr. Piers made Cherade address a scenario in which the patient might live.

The senario was:
A 3 month's supply of dialysate bags weighs ~240kg, which the man must transport from the hospital to his shack in his township. He lives with 5 other people in a two room shack and the bags will fill the majority of one of the two rooms, etc. Food for thought.

On another note, since we've stayed up until 1am the past two nights with a couple of the med students watching the World Cup, waking up at 6:30am to go to clinicals at 7 has been pretty rough, but if they can do it then so can we, right? Plus, we get to try awesome drinks and foods like their green cream soda that is about as common as Mountain Dew, caramel creme jello stuff, and Rooibos tea which is definitely a staple in every household.

This afternoon we went shopping and "had tea" with Megan, Devon, and Anna.

The green cream soda

My South African Farm Breakfast with Red Velvet Hot Chocolate (why not?) at Mugg & Bean. Literally the best scrambled eggs I have ever had.

SA has some distorted views on some of the things we eat. For instance, baked beans were included in the "All American Breakfast" at Mugg & Bean. Uhh...no thanks

If I was a local I would definitely buy these for every occasion.

The caramel cream stuff. Delicious!

PS...Sorry all my pictures are food. I'll work on that. 

The Other Side of Town

Side Note: I added pictures to a few previous posts so go check them out!

Today was much like yesterday, (as we have the same schedule everyday) but we started our morning at a hospital across town. The side of town in which the campus is a much a nicer area. The entire campus is surrounded by a high barbed wire electric fence, and the houses have them as well, but I never felt truly endangered when walking around outside the campus, even at night. The other side of town was much different. It was about 35F and there were people EVERYWHERE. Walking, riding bikes, standing around, probably just trying to get out of the township they were all centered around, but I can't say for sure. The buildings were older and there was not a single white person anywhere near this area. There are basically no white people on our part of campus, our dorm, or any of the areas we have walked to, only people of color. When our mentors arrived the first day, I was surprised to find that they were white, and the ratio of non-whites to whites in the medical school is much like that of Appalachian.

In the hospital we followed the same routine as yesterday, but this time in the burn unit and in the pediatrics department. We saw many young burn patients and learned about the process of healing these wounds, the success rate, possibility, and need of skin grafts, and the great lengths taken to provide a safe, bacteria-free environment. Unfortunately, our doctor was very soft spoken and spoke Afrikaans about half the time, so I did not get too much information from the pediatrics portion of our day. We left this hospital and returned to the one on campus to sit-in on exam room appointments for more pediatrics. Most of these children had cerebral palsy, down-syndrome, etc, and most of these parents spoke Sotho and had to be translated by a certain doctor, or a Sister (basically a CNA).