Journey to Africa

A TAFP Foundation scholarship recipient’s rotation in Cape Town

By Natalia Maani, M.S. IV, Baylor College of Medicine

In June of 2008, my esteemed colleague and friend, Tanvir Hussain, and I traveled to Cape Town, South Africa for six weeks and participated in a one-month internal medicine rotation in Tygerberg Hospital, which is affiliated with the University of Stellenbosch.

Before leaving, we had expected our trip to be an opportunity to learn from the health care system in a developing country with limited resources and to learn more about the training of medical doctors in South Africa. But during our traveling, we came to realize that there was so much more to learn from Cape Town itself, its people and its culture. From the moment we entered the cab leaving the airport, the driver began to explain the historical significance the different buildings in Cape Town played during the social and political revolution of South Africa. We passed by the building where Nelson Mandela had given one of his many speeches. We saw the hospital where the first organ transplant was performed. We were in awe.

As we continued to explore South Africa, we felt so liberated driving south from Cape Town to the tip of Africa, enjoying the peaceful scenery, looking at the penguins relaxing on the warm sand and listening to the waves crashing on the rocks. In addition to being astonished by the beautiful scenery, we were even more amazed by the people’s hospitality and their stories. Our attending’s aunt, “Mary,” invited us to her house in Bo-Kaap (“top of the cape”) for bobotie, a traditional dish. She explained how only 30 years ago during the apartheid, as a “colored” woman she was forbidden to own any property or business. Many times when officials entered her clothing store, she had to pretend that she was simply an employee while her white/Afrikaan employee acted as the owner. These were times of great frustration when the “colored” people had their rights stripped from them and were forced out of their homes into District Six. We were touched by Mary’s life story: how one woman endured such hardships and escaped the poverty that befell many of her people.

In spite of the poverty that has stricken the majority of its people, South Africa has a national health care system where everyone is authorized to receive medical attention while those who can afford it can have private insurance. However, even with universal health care, we learned firsthand how limited resources can mean the difference between life and death. For example, we as Americans take for granted that every patient has the right to live and physicians no longer have authority to decide who lives or dies. But in Tygerberg, physicians still hold this right given that there is only one ventilator machine in the emergency room and only 26 dialysis units for thousands of patients. I am glad that American physicians do not have to make everyday decisions like these. Nonetheless, we too must use our medical resources wisely before we come to a situation where even those who can be given the opportunity to live a fruitful life are left to die.

My educational experience at Tygerberg Hospital itself never ceased to amaze me. The most striking aspect was how much emphasis was placed on physical diagnosis. As our admirable upper-level said, “by the time you order any labs, you must be 99-percent sure of the diagnosis.” Within one month, we were trained to pay attention to a patient’s skin color, mouth, nails, palms, etc. We used this detailed information to make a more focused differential diagnosis. We became quite familiar with the physical manifestations of tuberculosis and AIDS, which are endemic in South Africa. Moreover, morning teaching rounds were performed at the patient’s bedside, which aided our learning.

Unlike in the United States, medical students in South Africa are actually tested on real patients rather than standardized patients. They are expected to perform a history and physical examination and rationalize their differential diagnosis on the spot. I believe the combination of the above factors along with an extra two years of medical schooling prepares these medical students to become some of the best, most efficient and knowledgeable medical doctors. I was impressed to find that the critical care unit was run by two interns.

Participating at Tygerberg Hospital was one of the most eye-opening and rewarding experiences I have ever had. Not only did my colleague and I meet wonderful people in and outside the medical field, but we also felt immersed within the Afrikaan and “colored” culture from which we learned so much.

Receiving the Harold T. Pruessner, M.D., Medical Student Scholarship and the Valley Chapter Scholarship in 2008 granted by the TAFP Foundation made this trip possible for me, and I would like to thank them for the fantastic opportunity. As a medical student, even if you are not planning on practicing internationally, doing an elective abroad to expose yourself to how medicine is practiced elsewhere can prove to be a valuable and indispensable experience as was my trip to Cape Town, South Africa.

Editor’s note: The term “colored” is used in Africa to denote individuals of mixed racial ancestry.