Health Care System At a Glance: Victoria Hospital

My roommate Carley is part of the service learning program here which matches students with a service site in the greater Cape Town area. Her interests are very similar to mine in terms of public health and wanting to make a lasting positive change, no matter how small. Her project is at Victoria Hospital. She is interested in hospital administration, public health and overall healthcare, just like me. She shared with me the humbling experience she has been having there the past two days. I am going tomorrow morning to see if it would be a good fit for me because I want to volunteer, learn and research.

It seems like this hospital system is vastly different than the US. Victoria Hospital is supposed to be the forefront of health in all of South Africa, it is where the first ever heart transplant was performed; yet it is lacking heavily in resources, regulations, education and even sanitation.

The doctors there, and throughout most of South Africa, do not specialize in one practice. They receive a generalized medical education because of the incredible need of doctors all of the time. They must be able to have the broad range of knowledge because they are seeing all different kids of medical problems. This is good because it allows them to work in any situation, but also bad because they know a lot of surface information rather than little things necessary to give proper care. There is also a huge distrust of the medical system. Because many people in Africa come from a spiritual and deeply rooted cultural upbringing, they are hesitant to trust westernized medicine when given the choice between that and an all-natural healing practice. But because many people experience very serious illness here (HIV, TB, pneumonia, malaria, cancers) there is a dire need to have the access to westernized techniques.

One would think that in an environment faced with serious health problems that they would be on the forefront of technology, yet Victoria Hospital uses absolutely no electronic medical records; everything solely depends on the doctors and nurses recording everything on physical paper. This leaves SO much room for human error and this is the most progressive program in all of Africa. I’m sure in this makes rural Africa look futuristic.

Carley said that she was shadowing a doctor in the surgery ward and they did not know where one patient was. They searched the entire floor for her only to find out that she did not make it through her surgery. The patient had passed away on the table and there were NO records because someone had ‘forgot’ to make note of it. I can’t even wrap my head around this. It is unbelievable. Can you even imagine? How do you tell someone’s family news like that? Never in a million years would this happen in the US.

There are huge incidences that patients will catch an infection just purely from being in the hospital. While this is common in the US, this is almost guaranteed if you enter a hospital setting because of the terrible sanitation practices and available resources. The top cause of infection in the hospital is from a catheter and line infection. MRSA (a hospital inquired infection) rates are SO high that doctors have to treat the infection the second you see it or else it can kill patients very easily.

Carley has been taken on rounds with doctors without wearing any type of gloves, masks, scrubs or head caps. She was able to touch patients, interact with them and check/ give their medicine when she has ZERO medical background. She is a public health and polisci undergraduate at GW, yet has been able to do things that 3rd year medical residents may not be able to do. There was one patient who had just had surgery on her brain. Half of her skull was exposed UNDER GAUZE and Carley was asked to touch the patient’s head, check to make sure she was bandaged properly and take note of it. She basically touched a patient’s skull. You most certainly cannot see that everyday/ever. It sounds pretty unbelievable to me, but I can’t wait to see if for myself.

TB is very prevalent here AND is airborne. Carley was surrounded by patients that most certainly had it, yet no one was concerned about properly protecting himself or herself from it. She wasn’t asked to wear a mask.

The doctor she has been shadowing, she says, is very smart, caring and wants to bring the hospital to a more modern level and create more of a sense of accountability for the interns. Because there is such little regulation, many interns will actually mess up patient’s medicines and care. This doctor created a new system to fine the interns who do something wrong. Every mishap is R100 (nothing). This is an attempt to keep the interns in check so that when they become doctors they are accountable.

Sounds absurd right?

On another note: they have the only palliative care program in Africa (!!!), called the Abundant Life program. I can’t even imagine what something like this looks like. I am sure that it doesn’t even compare to the programs we have in the United States. It seems like a complete ground up approach. This is the description on their website:

“We are a hospital based hospice/palliative care organization that specialises in Organ Failure patients. However due to the enormous need for palliative care we have decided to provide care for all who need it. We now care for Cancer, HIV, TB and Organ Failure patients. Most recently we realized that the patient in ICU with multi-organ failure which may be acute but deadly also needs our care. We provide holistic care including medical, psychosocial and spiritual support for the patient living with a terminal disease as well as their family.”

“We decided.” “We realized.” What rhetoric.

As you can obviously see, it seems very basic and unorganized. I’m picturing a room with beds and people singing African voodoo tribal music to people before they take their final breaths. (hahah) Just kidding.

In all seriousness, I’m extremely curious to see what it’s like and how they approach patient centered care and death here. Because of the deeply rooted spiritual practice, I hope that there is an emphasis to appropriately care for the dying.

Excited to see! I will also most certainly wearing gloves, a cap and a face mask. Do not think my family would be too happy about me coming home with TB!