Penguins!

England are losers...

Friday 14th September

...but it was a cool location to watch the match. The funniest thing about the entire cricket game was ever time there was a four, a six or a wicket loud music would be pumped out over the tannoy. Then, two girls and two guys would spring up onto a mini stage at the front of the seating stand and thrust their pelvises, wave their arms and grin inanely in a crazy dance! The dancing even incorporated "umpire moves". When Australia were batting they hardly left their stage. I would love to see Lords get them in.

Cuba and vineyards

Wednesday 12th September

Today, I met the a group of South African medical students who have spent the last 7 years studying medicine in Cuba. They were there as part of a South African government funded scheme aimed to get more doctors equipped and prepared to work in rural, under served areas of South Africa. They have just come back, and now dealing with the culture shock and prospect of starting final year medicine here. I joined them on their orientation to get back into South African medical school life and today was their trip to a rural hospital.

It one the best med school trips I’ve ever been on. It involved a trip to vineyard on the way to the rural hospital, and on the way back! (Included tour of the cellars in photo). The ladies who run the rural health health department, Ukwanda, thought it would be a good way to get them keen on working in a rural setting when they qualify.

After 3 hours packed into the med school minibus we arrived at Ceres valley. It’s an incredible setting, the hospital encircled by jagged mountains. We met Hans one of four doctors there. The challenges of rural medicine are significant: they serve 94000 patients over an area of 80km, by 200km, an HIV prevalence of 15.2% with 30 beds, 4 docs, and a team of nurses. The UK has about 600 patients per doc. As a doctor in a rural hospital you have to be a generalist, Hans will do everything, trauma, performing Caesarean sections (from anaesthesia to delivery), paediatrics, HIV treatment, geriatrics, neonates... part of a exhausting routine of over 80 patients in a morning.

I was fascinated to meet the students who had been studying in Cuba. Cuba is put on a bit of a pedestal in Global Health, boosting one of the highest life expectancies in the world, despite being one of the most economically poor in the world. The Cuban students were explaining how infectious disease “hardly ever occur in Cuba - it’s all prevented”, “there you are basically treating healthy patients”. There seems lots South Africa can learn from Cuba, but they felt that some of the key elements of the success are intractable from communism. In particular they thought you couldn’t get doctors to work where ever they were told, so every one has a doctor living near by, without communism.

There was an animated debate about how you can enforce or motivate more doctors to work rurally, and equally importantly not leave the country entirely. And they know what its about - they all bonded to work for 5 years in their home community once they have done two years as a junior doctor. Cuba seems to have left many of them with strong views about being motivated by treating patients, not money, but at the same time a few have aspirations to work in Canada. Whatever happens they have an impressive grasp of public health and are an interesting lot. The dean here joked that the next health minster will come out of this group!

Ukwanda

I’m based in the department for rural health. It’s called Ukwanda and is a 4 staff team in the heart of Stellenbosh medical school. You see that tree to the left of the photo...the office is directly behind it, one floor down. The team mostly organize medical students placement to rural areas - sometimes up to 500 km away from Cape Town. But they have a very broad social view of health, which is partly why I'm here.

In fact, the one word Ukwanda, translated from Xhosa means:

“Grow advantageously and develop within the context of the community.”
It’s said: ooo (gutturally like a monkey, lips out ) - kw (a clicking sound from top of mouth) – and - a. I’ve been practicing much to the rest of department's amusement!

So their hope is that after students spend part of their degree out in rural areas that more docs, and other health people, end up have a grasp of community development and working in rural areas professionally. In the times of global health worker migration, with rural areas beocoming void of health professionals, this is a big deal. However, I’ve joined them to learn about and research TB. I’ve been straight into work and so far thoroughly enjoyed it.

And I spent the weekend getting to know the international student crowd out here on elective.

First week done!

Jo’burg to Cape Town

I took the train 1393 km from Jo’burg to Cape Town though barren dusty fields, snow capped mountains and sweeping vine yards. I arrived the next afternoon in CT city centre, laden with 2 enormous back packs on my front and back, perched on the top of my mountain bike - crazy foreigner look guaranteed.

I spent the evening with a family friend called Firle and her house mate Adam. Adam turned out to be a stunt man. I watched his showreel dvd he gives to companies who want to hire - imagine watching 20 movies in one go but only the crazy action scenes back to back. The most impressive one was him driving a car off the end of a half built motorway flyover. And the lift to the medical school with him the next morning - I survived!