Adam’s Elective Journey in South Africa

General surgery at Groote Schuur hospital

 

Experiences and Benefits

Introduction

During my elective medical placement at Groote Schuur Hospital in Cape Town, South Africa, I had the opportunity to work in the general surgery department for four weeks. This experience was divided into four specialities: vascular surgery, colorectal surgery, hepato-pancreato-biliary (HPB) surgery, and acute specialities. The placement provided me with an in-depth understanding of the medical challenges in a developing country, ranked 109th on the Human Development Index, and highlighted the stark realities of healthcare in South Africa, characterized by low health education and high rates of violence.

Week 1: Vascular Surgery

My first week was spent in the vascular surgery unit. The prevalence of vascular diseases was notable, with many patients suffering from advanced stages due to delayed medical attention. The week underscored the disparity in healthcare access and the urgent need for public health education. It was eye-opening to see how late-stage presentations complicate treatment options and outcomes. This experience reinforced my understanding of the critical role of early intervention and preventive care.

One of the most memorable cases from the whole four weeks at Groote Schuur was a patient seen in the clinic 3 years after being the victim of a drive-by shooting with her husband and three sons, all of whom luckily survived, in a case of mistaken identity in a local gang feud. This case illustrated the reality that many people have to live with in Cape Town with high rates of gun crime, but also the high levels of skill and experience of the surgeons who have to deal with trauma cases on a regular basis.

Week 2: Colorectal Surgery

The second week was focused on colorectal surgery, where I observed numerous bowel resections and surgeries for colorectal cancer. One particular case involved a young patient with a severe case of Crohn’s disease requiring a complex bowel resection. The advanced state of the disease was a stark reminder of the limited access to early diagnostic and therapeutic services.

The complexities of managing colorectal diseases in a resource-limited setting were evident. The high incidence of late-stage colorectal cancer highlighted the need for better screening programs and public awareness. The experience deepened my appreciation for the challenges faced by healthcare providers in ensuring timely and effective treatment.

Week 3: Hepato-Pancreato-Biliary (HPB) Surgery

During my week in HPB surgery, I observed a Whipple’s procedure and several ERCPs. These procedures were performed on patients with advanced pancreatic and liver cancers as well as biliary obstructions. One of the cases involved a middle-aged man with pancreatic cancer who underwent a Whipple procedure. The surgical team’s expertise was impressive, but the patient’s prognosis was poor due to the advanced stage of the disease at the time of diagnosis.

The HPB unit demonstrated the high level of surgical skill available at Groote Schuur Hospital, yet also highlighted the limitations posed by late-stage diagnoses. This week reinforced the need for robust healthcare infrastructure that includes early diagnostic capabilities and comprehensive cancer care.

Week 4: Acute Specialties

Unfortunately, I did not get the opportunity to attend theatre in my last week with the acute team. I did however get involved with lots of post-operative ward-based care such as dressing and cleaning wounds and got to practise several clinical skills like catheterisation and ABGs. The trauma cases underscored the societal issues contributing to health challenges in South Africa. The high volume of violence-related injuries placed immense pressure on the healthcare system. This week highlighted the resilience and dedication of the medical staff, who work tirelessly under challenging conditions.

Heart transplant museum

One final opportunity myself and the other Swansea students took advantage of was the Christian Barnard museum at the hospital. Groote Schuur was the site of the first successful human-to-human heart transplant in 1967. The museum at the hospital contains information on the build-up to the operation, techniques used and life of the surgeon Christiaan Barnard, the patient Louis Washkansky and donor Denise Darvall. This experience was very informative and highlighted the need for constant innovation and research in the world of medicine and surgery.

General Reflections

Overall, my elective placement at Groote Schuur Hospital was a profoundly educational and transformative experience. It provided a unique perspective on the intersection of healthcare and societal factors in a developing country. The high burden of trauma, late-stage presentations of diseases, and the impact of socioeconomic disparities were recurrent themes throughout my placement.

The experience emphasized the importance of comprehensive healthcare that includes public health education, early intervention, and preventive care. It also highlighted the resilience of both patients and healthcare providers in the face of significant challenges.

One of the key takeaways from this experience is the critical need for improved healthcare infrastructure and resources in developing countries. The dedication and skill of the medical staff at Groote Schuur Hospital were remarkable, yet the systemic issues they face require long-term, sustainable solutions.

In conclusion, my time at Groote Schuur Hospital not only enhanced my clinical skills but also broadened my understanding of global health issues. It reinforced my commitment to contributing to healthcare improvements, both locally and globally, and underscored the importance of empathy, resilience, and advocacy in the medical profession.