Stories From the Field:

South Africa

Infectious Diseases in South Africa

Alison Castle, MD, a Resident in the Department of Medicine, received an MGH Global Health Travel Award and completed a clinical rotation at Edendale Hospital in Durban, South Africa.

On March 21st I traveled to Durban, South Africa for a clinical away rotation at Edendale Hospital. The hospital was located one hour west of Durban, therefore I resided in an AirBnB apartment in the suburban town of Hilton. Under the leadership of the Chair of the Department of Medicine, Doug Wilson, I was integrated into one of the four medical teams. The medical team included two to three interns, one medical officer, and an attending also known as a consultant. The day began with morning report where we would all convene and hear the list of admissions and deaths from the oncall intern. On occasion the consultants would also present case reports or give a lecture pertaining to a general medicine topic.

Following conference, I would round with the consultant and see between thirty to fifty patients. We would walk from bed to bed where the intern would present the patient sitting in front of us. The consultant would often ask for my opinion on management options and this would prompt discussions into our vastly different healthcare systems. KwaZulu-Natal has the highest rates of HIV and tuberculosis coinfection in the world. The majority of cases we saw were HIV opportunistic infections, tuberculosis, or medication side effects related to these diseases. Many presentations I witnessed in South Africa I have never seen during my residency training in Boston.

The consultants did not round on patients everyday. I recognized this was due to the reality that bloodwork, imaging, and other tests took two to three days to return. This delay in diagnostic workup often delayed any decision making to advance patient care. The alternating consultant schedule also empowered interns to have more autonomy. On these days I would round on patients either alone, with the intern, or with the medical officer. Given the complexity of the paper medical charts, I gained the most understanding about a patient if he or she was able to communicate in English or if I accompanied an intern. Medical students were often present throughout the wards. Several afternoons I would teach them about general medical topics (DKA, hypertension, AKI workup, UA interpretation).

The afternoons were variable. The admitting schedule was every fourth day for each medical firm. Our team would present to the emergency department after rounding on our native patients and admit the new walk ins directly to our service. If we were not on call to take admissions for that twenty four hour period, we would have MOPD clinic (medical outpatient department) or INR clinic. One afternoon, I accompanied a consultant on a Red Cross Flight to a rural outreach hospital. All of the consultants are required to visit Edendale’s outreach hospitals on a monthly basis. This trip to an area where the entire hospital was overseen by one physician was quite memorable. The hospital was half occupied and the patient population had a much lower percentage of HIV. We rounded on all of those admitted and triaged the more complex patients to be seen at Edendale.

My rotation at Edendale Hospital helped to solidify my future career path of infectious disease fellowship and global health. Moving forward I hope to return to Edendale next year as a senior resident and again as an ID fellow to establish a clinical research project under the guidance of Doug Wilson.