I’ll be honest—when I learned I was
not accepted for the exchange semester abroad in Murcia, Spain back in
undergrad, I thought my last opportunity to spend a generous amount of time in
another country had slipped through my fingers. If I had decided to major in
foreign language, international studies, business, history, etc…I figured I’d
have plenty of opportunity. But I chose pharmacy, which was the nail in the
coffin of my international experiences. Or so I thought.
My first unforeseen opportunity was
my adventure in Spain, which in itself was a life changing experience...simply
because I had dreamt of living there for years.
Now I’m in South Africa working with HIV/AIDS and tuberculosis patients every
day. How I got so lucky as to stumble into two opportunities to not only
travel, but travel while gaining insight into the profession I am passionate
about---I’ll never know.
More than a week has gone by in
Port Elizabeth before I’ve written my first post, so I’ll try to skip over the
fact that it took me four days to get a working cell phone, a whole week to get
internet functioning at our apartment (where the breaker box regularly needs
flipped when we plug in the toaster and
the coffee pot), the maid steals our
clothes (okay, she doesn’t steal them, but she does take two days to wash
them), learning to drive on the wrong (left) side of the road, and most
evenings the first week were spent catering to the schedule of our preceptor's work day so we could do topic discussions via Skype when he was available (despite all these issues)….and I could go on. But like I
said, let’s get to the good stuff.
As a briefing, the health care
setup varies a bit from the States. Those who can afford insurance (or “medical
aid” as they call it) can visit hospitals in the “private sector,” while those
who do not buy it (assumed to be those who cannot afford it) must go to
hospitals in the “public sectors,” which are completely funded by the
government. As of yet, the four of us have only visited the public sector. From
what I understand the private sector hospitals are very similar to what we have
in the States. But the public sector…..is a different world entirely.
Even from the first glance of the entrance,
where the metal letters are gone and one can only read the words “Livingston
Hospital” that have been faded by the sun, it was easy to assume we were in for
a whirlwind. Walking into the hospital was like walking into a nightmare. First
of all, the smell is indescribable. Whereas hospitals in the States generally
smell like cleaning supplies, this hospital smells more like a microbiology lab
overtaken by bacteria. If this building were a school, I wouldn’t send my child
there. Everything is run down and the elevators are “use at your own risk.” The
ICU, or the “CCU” (critical care unit), is the only place that somewhat
resembles an average hospital. Constant monitoring of blood pressure, pulse,
oxygen saturation and individualized nursing staff—it actually almost runs like we would expect it to.
The wards, where the three pharmacy
students are reviewing charts, would generally be ICU patients in the States
(or so our South African Pharm. D. student, Renier, tells us). And I’m very
literal when I say we review “charts.” Everything is still kept on paper.
Instead of having all the information charted electronically (and more
importantly, legibly), all the information for the patient is kept bedside in a
raggedy old folder that you’d see in a clinic. Nearly every other patient has
HIV, AIDS or tuberculosis, and most have both. And these aren’t just any HIV
patients….they’re patients who were diagnosed with complications---caught way
too late. We’re seeing things like cryptococcal meningitis, PCP pneumonia, milliary
(disseminated, or literally “everywhere”)
tuberculosis, and other opportunistic infections we rarely get to see in the States. So these aren’t just HIV patients.
They’re deathly ill HIV patients. Deathly ill HIV patients who are lucky to get
all their medications in a day and who rarely get more than one bag of
fluid given to them even if their blood
pressure is bouncing around 90/50 with a heart rate in the 140’s (for all you
non-healthcare people, that means dangerously dehydrated).
Every detail of the public sector’s
health care scares me, especially when we are on the verge of healthcare reform
being touted as “healthcare rationing.” I hope for the sake of us all that we
never get near something as frightening as what we are seeing here. God help
the less fortunate if we do.
