Transcript Groote Schuur Hospital -HIV Neuropathy Research
Groote Schuur Hospital -HIV Neuropathy Research Neurology Department
-Nick Faunce GSH foreground. Devil’s Peak Background.
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Personal Goals
Immersion in a foreign setting • Deconstruct preconceived biases • Adapt to new cultures • Learn historical context • Find independence • Explore a new landscape • Develop clinical research skillset • Data gathering/ documentation methods • Follow-up/ specimen registry process • Data management tools • Statistical analysis techniques • Statistical Packages • Appreciate tools of neurology • Neurological physical exam • Electroencephalography testing/reading • Electromyography testing/reading • CT/MR/XR • Observe advanced pathology • Strokes • Duchennes • Guillian-Barre syndrome • Myasthenia gravis • Charcot-Marie Tooth syndrome • Huntington’s….etc.,
Groote Schuur Hospital - University of Cape Town
• Home of the 1 st Heart Xplant • Tertiary (quaternary?) Public Hospital serving >3.75M (Cape Town pop.) • 893 beds • Substantial NIH Funding for Infectious Disease Research (TB, HIV, etc.,) • Folder Research Elective (4 or 8 wks) – Apply 1 month advance • Clinical Elective (4 or 8 wks) – Apply 1-2 yr in advance (6 month min) • Amidst a Critical Crime Post (US State Dept.)
Background Information
• • • • 11 official languages (tribal origin) History steeped in turmoil • Dutch East India Trading Company stopping post in Cape Town • 1652-1795 a.d.
• • Established Boer pop. (became Afrikaaners) • French Huguenots fearing Napoleon’s persecution settled 1685-ish • • British Overthrow • 1795 a.d.
• • Returned to Dutch 1803 Anglo-Dutch war 1806-1814 • Dutch regained control
Apartheid 1948-1994 Nelson Mandela
• Imprisoned 1962-1990 • President 1991-1997 Resources • Agriculture rich • • Aquaculture rich Mineral rich • Gold, Platinum (78% WW), Diamonds, Coal, Chromium Current • Stabilizing from effects of apartheid • High crime rate (3 rd WW) • • High Pollution rate (Johannesburg 7 th Incredible tourist attractions • Stellenbosch vineyards etc. (Hugeonots) • • • • Great White Shark diving/Su Kruger National Park Cape Colony Penguins Table Mountain WW)
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Health Issues/Challenges
Systemic • Underfunded public hospitals/public health organizations • Resources, clinics, diagnostics, drugs, vaccinations, awareness • • Technological inefficiencies Patient Overload • • Inconsistent health professional training (Overall not at GSH) Emigration of health professionals • Nurses/physicians • Language/Cultural (home remedies/drugs) Pathology •
HIV 17% of adult population (US ~0.3%)
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TB ~80% latent TB
• Everything is late stage • Trauma!!
Learning Curve
• Resourcefulness • Implications of diagnostic tests on clinical management • Returning used assistive devices/unused drugs • Physician independence—triage, blood draws, US, BP, EKG, IV’s, Monitor relays • Physical Exam • Communication • Inter-collegial diplomacy • Accurate interpretation of patients words • Histories, symptoms, drugs-list • Personalizing treatments based on patients described responses • Objectivity with sensitive issues • Proper emotional responses • Sterility/Sanitation
Conclusions/Suggestions
• • Hospital is comprised of incredible physicians who see extraordinary pathology and treat with minimal resources • They manage to get along Profound diversity of race, religion, culture, language, and background •
DON’T BE AFRAID. TRY IT!!
Profound Clinical/Academic Experiences
• Clinical: • Textbook mumps orchitis • Post-MI status dystonicus—group of students watching a convulsing body while a nurse performed supportive esophageal suction.
• Locked-in syndrome—post-posterolateral thoracic stab wound. Students unaware of the impact of giggles while assessing clonus.
• Severe sepsis and Heart Failure pt—triaged as a yellow (2-5hr waiting time) • Academic: • EEG reading—Consultant sitting with me for an hour describing the theory of EEG and the nuances that make it so difficult.
• Learning sessions—Students required to assess patients and report findings in a group setting. Incorporation of physical exam and direct input from consultants on methods or findings.
Cultural Experiences
• Tuning my ear—for one accent getting caught off guard by another • Listening to my guide in Kruger Park describe how he learned about animals and astronomy so he could become a park ranger and not die in the mines like his father.
• Driving from Phalaborwa Gate to Johannesburg—observing the extent to which people have to wait/walk to travel between work and home • Observing the maids and workers walk towards the suburbs at 7 am from the train stations as we departed for the hospital.
• Listening to a fresh marimba band at Marco’s African place.
• Rugby Matches at Paul Ruus boys preparatory school
Professional Takeaways
• It instilled my desire to treat everyone with dignity • I’ve kept an open mind about my professional direction but it gave me tools to excel when I get there.
• • It exposed me to an array of pathologies that have given meaning and depth to my studies.
It prepared me for what to expect with the resource-limited work I do in the future.
• It presented me with uncomfortable situations which exposed my prejudices and biases, and allowed me to grapple with their relevance and origins.
Cape Town
Mitchells plains township Devil’s Peak, Overlooking the Western Cape South African National Gallery, Cape town Waterfront Mall, Cape Twon
Simonstown
Cape Penguin Colony
Hermanas/Haans Baai
Great white shark diving Hermanas Beach, Southern Right whale mating grounds Hermanas en Aarde, wine vallley