Tuesday, May 15, 2012

South Africa: Trauma Elective


Elective: Trauma
Location: Cape Town
Hospital: Tygerberg (University of Stellenbosch)
Affiliate: University of Cape Town Emergency Medicine
http://www.emergencymed.co.za/


Trauma: Tygerberg Hospital
This experience was amazing. I spent the month of March living in Cape Town, South Africa.  I lived in Camps Bay just below the Twelve apostles and Table Mountain National Park. I went running on old Jeep Trails and hiking on Table Mountain.

 I worked nights in the trauma front room @ Tygerberg which received all traumas including stab wounds, gun shot wounds, motor vehicle accidents, burn victims.

Many cases came from the nearby township: Khayelitsha.

I also spent some time working in the township itself.  A brand new hospital (Khayelitsha District Hospital) within the township was opened in February 2012.





I was very impressed with the South African medical system. The trauma surgeons and EM residents that I worked with were very competent and their patients received high quality care rooted in ATLS standards.

 
with my friend Khalid (an EM resident @ Univ. of Cape Town)

The sheer volume of cases was great for learning: Intubations. Central Lines. Chest Tubes.

The Emergency Medicine service offers the opportunity to participate in transport medicine on the helicopters and in the ambulances.

Khayelitsha District Hospital

It was in my opinion a dream location for an elective.

Khayelitsha 
I made some great friends that I hope to keep in contact with for years to come.

I had experiences that will stay with me throughout my medical career.

I fell back in love with medicine South Africa.

website: http://www.trauma.org/index.php/resources/elective/352/
contact: Rachel Pullen crp@sun.ac.za



11 comments:

  1. Ismet Lukolic, MDMay 15, 2012 at 8:56 PM

    Wow this looks amazing. I am sure the experience you got while there was not only a great learning opportunity but also a opportunity to help others! Kudos to you Dr. Stegeman!

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  2. Hi Kristen,

    I'm a final year med student trying to organise my elective at the moment - hoped you might be able to give us some pointers re: Tygerberg?

    I've applied to spend 5 weeks with the Emergency Medicine department at Tygerberg but just wanted to check I'll get to see plenty of trauma cases as I've heard there's a split between the ED and the trauma department proper. Do I need to try to alter my application to join the trauma unit or is there crossover?

    Any help much appreciated!

    Thanks,
    Tim.

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    Replies
    1. Tim,
      Great to hear from you. So excited you will be going to Tygerberg. You are in for an amazing adventure and experience. So essentially you will be able to work in the trauma front room if you are registered with trauma or emergency. Just make sure you request to work there. Also a few more details... With being registered with the EM service. You also have the opportunity to ride along with ambulances in townships and even in the helicopters with the royal air service. Just make sure you inquire about these opportunities months prior to your arrival so you can assure your participation. There is a short air safety course you must take to fly with the helicopters.

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    2. Tim,

      Additional thoughts:

      Try and work in khayelitsha at KDH ( the new district hospital).
      Habitat for humaniy also builds homes in the townships if you want to get involved.
      The philani project is another amazing place to visit. It is a health and empowerment project started by swedish doctor Ingrid Le Roux.

      Best of luck,
      Kristin

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  3. Kristin,

    First off so sorry it's taken me this long to get back to you - I totally forgot I'd posted on here, really didn't meant to be so rude!

    Thank you so much for all of the advice - it's incredibly helpful. I have a real interest in prehospital care (I'm hoping to eventually work with HEMS in London) so I'm especially excited about getting invovled with the helicopter services.

    Looks like I'll be spending 6 weeks in Cape Town and 4 weeks in the US doing wilderness/adventure medicine training - at times like this I can't help but think medicine is easily the best profession I could have chosen :-)

    Thanks again for all the tips!

    All the best,
    Tim.

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  4. Hi Kristen :)
    I'm also an emergency medicine resident in NYC (pgy-2) and I'm looking to do an emergency medicine/trauma elective in South Africa as a third year. I was looking at both Tygerberg and Chris Hani Bara, and came across your page. So informative! It sounds like you had such a nice time. I just had a few questions for you:

    1) how much responsibility and autonomy do you get as a resident? i'll be a third year when I go and while I like autonomy, I also like having good backup :)

    2) How do all the services get along? EM and surgery have an extremely antagonistic relationship at the hospital I train at; the EM folks think the surgeons are barbers and the surgeons think the EM folks are soft idiots. Which is not at all conducive to patient care or resident education... :(

    3) How many other residents are there? Did you feel like you saw enough cases and did enough procedures to feel immersed?

    4) Do you split your time between medical resus and trauma during your elective? Trauma is exciting with the procedures and I want that but I honestly think medical resus is much tougher, so I would like to experience that. One of the attendings I know who worked there briefly said that a lot of people don't come into the hospital until they are reaaaaally sick/near dead.

    5) Where did you stay? Was it difficult to set up accomodations? Expensive?

    6) How long did the application process take you? I just looked through it and it makes my head spin! So many forms to get together. How early in advance did you have to get your app together?

    Thank you very much for reading and I hope to hear from you soon :D. Thanks for having such an excellent blog! (I can be reached at rokkugoh[at]gmail[dott]com, thanks!)

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    Replies
    1. Christine:
      Great to hear from you.
      1. You have a lot of autonomy which is great, but there is always a house officer to help with concerns, etc. There is also that Trauma Surgery residents which are really helpful. Did not seem there was EM vs. Surgery antagonism.

      2. Services seem to get along well.

      3. Not that many residents, but a lot of students. Felt very immersed although weekends super busy with trauma cases and weekdays there is a lot less. My recommendation: work overnight Fri/Sat/Sun for sure to get the most.

      4.I only did trauma front room and did not participate in any medical resuscitation cases. Lots of chest tubes. Lots of MVA's. Definitely had some trauma/burn resuscitations. + intubations. + splinting. FAST exams are done by radiologists. People don't come in for BS. That is for sure. Heard Trauma is even better in JO'burg (although the city is not as awesome/beautiful as capetown, but for medical experience I think it would be fabulous)

      5. I stayed in a gorgouse area (Camp's bay) in and rented a room in a private home. My housing was a bit expensive, but I stayed somewhere really nice. There is really cheap housing on hospital grounds. Otherwise I would recommend staying in Camps Bay or there is a great hostel in downtown called (The Backpackers). Coolest hostel I have seen. I also rented a car.

      6. The application process prior to arrival is VERY tedious (but it allows for autonomy when you arrive if you are registered). I started 6 months in advance.

      Please let me know if you have any questions. You should also look into working at KDH in khayelitsha. The residents I worked with also work at Groote Schuur Hospital (Cape Town). I met their ICU team and maybe you could arrange to go there some days to do your medical resusc?? University of Cape Town Emergency Medicine Residency Program.

      - Kristin

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  5. Hi Kristin,

    Great blog, thanks for sharing your story and all your pointers.

    I am an R1 in rural family practice in Victoria, Canada, and I'm trying to set up a short ER elective in Jo-berg. They have let me know that they can accommodate me, but that I must obtain registration with the HPCSA.

    I have searched the HPCSA website but cannot find any information that pertains to international residents. What form do we have to fill out?

    Also, how long did it take for you to be approved with them? Do you think it's possible within 4 months?

    Thank you very much in advance!

    Smiles,
    Chloe

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    Replies
    1. Chloe,

      Hi! So excited for you. I have heard electives in Jo-berg are great. Although Cape Town is so beautiful...... so definitely try to visit. The HSPCA application is quite long and extensive. I think you could probably do it in 4 months, but I would get started ASAP! They advise 6-9 months in advance. I suggest contacting the people at the institution where your elective is. They I am sure have had other visitors and probably have the forms you need. If that does not work you can send me an email at hospitalstyle@gmail.com and I believe I have a copy of the paperwork. Hope that helps! Best of luck.

      - Kristin

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  6. Hi Kristin,

    Thanks for all the input and answering everyone's questions. I'll be doing the Front Room Trauma rotation in February and am quite excited.

    I was just wondering where/with whom in Camps Bay you stayed (If you'd recommend it) and where you rented a car from. Was it pretty easy driving around everywhere?

    Cheers
    jesse

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  7. Jesse,

    So excited for you! I want to go back. I ended up renting a car from AVIS at the airport. There is also HERTZ, etc but rent online for a discounted rate on extended rentals. Also, I rented a room in the home of a friends friend. It was great. I would recommend checking out airbnb.com or vrbo.com which have some great places. It was really easy driving around. Just be careful driving at night... I was warned about carjackings at stoplights... but had no problems. I would recommend getting a GPS though.

    Best of Luck,

    - Kristin

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