Spring Tide in Cape Town

The supermoon this past weekend brought a majestic spring tide to Blaauwberg, Cape Town. I went snapping away with my tiny camera along the esplanade.

This was taken seconds before I was drenched by the wave. Underestimated it…

If you’ve never been to Blaauwberg: no, the water doesn’t usually reach there…

This one makes me want to wax poetic.

Notice Table Mountain faintly in the back.

Unfortunately my little happy-snap camera couldn’t adequately catch the beautiful moon, but I’m sure pictures will abound of that soon.

 

The Meeting: Ni & Mi

Today (a public holiday) I went to Stellenbosch, in the Winelands District of the Western Cape. The medical campus is far from the main campus, so I don’t get to go to Stellenbosch very often. But today I met Nazirah.

Yes, the tree has to be in there. It's pretty, and I was having a bad hair day

Nazirah and I are both medical students – she in Malaysia and I in Cape Town. She’s doing her elective rotation in Cape Town. We met via our blogs. And no, we’re not the kind of people who readily meet people over the internet.

Because I don’t know Stellenbosch very well myself, one of my friends, Dee, joined us for the day. She gave us the royal tour and it was lovely. And a royal tour must of course start with some lovely tea. We went to The Birdcage, a quaint little coffee shop with the most amazing teas. I had French Vanilla tea, Dee had Raspberry and Blueberry, and Nazirah had Rooibos tea – the endemic and famous “red bush” tea of South Africa. And she liked it!

Dee's tea is pink, Ni's is reddish. How lovely are the tea sets?!

We learned a lot about similarities and differences between our countries in terms of healthcare, politics and infrastructure. It was amazing. It was a chilly – but not cold – Autumn day, and the town was simply beautiful.

And I got to meet an international friend, and that with the aid of WordPress.

Easter Away from Home

My family is big into family-stuff. I can’t say I have always been appreciative of that (I am often a grumpy, anti-establishment child), but I love my family. And there is nothing I love more than spending family-time with my family.

Easter is such a family-holiday. And this year is the first time that I spend Easter away from my family. It’s difficult, and what’s worse is that it’s not even a matter of clinical obligations. It’s just that for the first time, plane tickets were flat-out unaffordable.

I hate petrol prices.

Fortunately, The Boy is making this long-weekend very special.

Yesterday we went to the V&A Waterfront. Neither of us really like the place, because it is teeming with tourists and so everything is super-expensive. But he needed to buy something there. And I suppose it’s kind of pretty.

There’s a Haagen Dazs Ice Cream Parlour there. Their ice cream is really expensive in South Africa, so I’ve never eaten there. But he decided, “Try everything once.”

So we did. This ice cream cost ZAR70! That’s about 7 Euro. Ridiculous. But it was delicious. Not that ANY ice cream should ever cost that much. No matter how wealthy you are. He said, “You should enjoy it, because as long as I’m paying we are never having this again.”

Funnier part: he locked his keys in his car. I climbed in via his sun-roof. I thought it was funny, but I think he was a little embarrassed.

I miss my family. I guess it’s part of growing up. But Easter and Christmas will always be family-time for me.

So today we eat lots of chocolate. As my Friend says,

“I think it’s a law or something.”

Clever Patients and Patient Education

During my two weeks in the Rural Western Cape, only two of my patients had finished high school. One was an elderly lady from a privileged background.

It was shocking to see how low the literacy rates were in that little place and how that affected patient education. Medicine compliance, smoking cessation, family planning… it’s tough. Especially with the high rates of FAS in the region (lots of vineyards).

But the biggest lesson was not health education to these patients. Rather, I learned not to slack on health promotion of the more “educated” patients. I look at my class, of whom probably 50% smokes regularly. Intelligent people make stupid life decisions.

I almost skimped on speaking to my patient (who had finished high school many years ago) about smoking cessation. Good thing I changed my mind. Turns out he thinks that puffing eliminates the cancer risk. So we had a nice discussion about oral cancer (yum).

You want to save the world? Figure out why health promotion rarely works. And find a way of making it work.

If ever you should visit Africa…

…mind the cattle overhead.

Also, mind the traffic police, who might (or should) give one a fine for driving while operating a cellular phone or a camera.

This made me laugh. I don’t know where in Cape Town this was taken or by whom. But in Bhisho (Eastern Cape, RSA), there are goats grazing outside the huge and very fancy office blocks.

Great Frustrations: Patients who do not take Responsibility

The thing that bothers me the most is when patients allow a disease to progress so far that almost nothing can be done – especially when something could perhaps have been done.

My surgery rotation has had numerous such cases.

Once, during a night-time call, the most horrible, moist stench filled the entire corridor of the casualty ward. The cause was a patient with anal carcinoma… so advanced that he had a 10x6cm lesion where his anus should have been. It had completely destroyed much of the muscle and all of the sphincter.

This image is the closest I could get on Google, but it is not nearly close enough:

http://www.gastrohep.com/images_pdfs/images/medium/mallison35.jpg

The link is safe, but the picture is a bit graphic for sensitive readers.

Two days later a lady entered the ward with the worst venous ulcers I have ever seen (not that I have seen terribly many). I could see one of the metatarsals of her right foot. She was in so much pain, but that she had waited til now to seek help goes beyond my understanding.

The thing about the Western Cape is that the Department of Health here has gone through a lot of effort to ensure that there is a community health clinic walking distance from any settlement in the province.

So as much sympathy as I have for these patients, I simply do not think they have a valid excuse.

When the Battlefield visits Hospital

My country has rogue soldiers and they live on the streets.

They are young boys – boy soldiers. Child soldiers. They fight a fight started by politicians, historians, money. Not a fight started by themselves. Not a fight they entered voluntarily.

My country has rogue soldiers and their war is on our doorstep.

They fight the fights of drug lords. They fight the fights of vigilantes. They fight a fight for life, for dignity, for survival.

My country has boy soldiers. Child soldiers.

They dodge ricochet bullets and uninformed knives. And when they inevitably get hurt, they come to my hospital.

Sixteen year olds with torn-open abdomens. Children with heamothoraxes. Boys who should be chasing girls and worrying about exams. Instead they lie in oversized hospital gowns, tease the nurses; rip their lines out by accident because they cannot sit still.

Some still have naughty twinkles in their eyes. Some have lost it many years ago.

My country has child soldiers, but not the kind written about in the papers.

 

Rural Gems of the Western Cape

I don’t think I ever officially announced it here: my campaign for TSR chairperson 2011/2012 was successful. Yay!

Anyway, it was the new TSR’s team building and planning camp this past weekend. We went to a farm near Greyton, a tiny village in the Overberg region.

Having grown up in the Eastern Cape with a love for the old Transkei, I have a soft sport for small towns.

Greyton is an absolutely amazing place to visit. We attended the Saturday morning market. Everyone there is friendly and happy and were very eager to get to know us. We made particularly good friends with this lady who makes and sells the most delicious pesto, “Loret’s Pesto”. More here.

Loret's Pesto and some TSR members

We then visited Genadendal, a township just outside Greyton. Genadendal is the oldest mission station in South Africa and was started by the Moravian Church.

The Moravian Church in the Village Square

The church bell in the Village Square

There is also a Museum which is said to be a lovely experience, but we unfortunately did not have time to go there.

Although living conditions here are still harsh, the village’s historic significance is well-preserved. The people are also amazing and everyone that sees you, will greet you.

We lost our hearts here...

Top Tips for Tygerberg Part I

Every year I get a substantial amount of queries from aspiring medical students regarding the school I attend. It is a prestigious university with some interesting factors at play, so it is wise for Matrics (high school seniors) to investigate their potential choices. They will be spending six years there, after all.

Seeing as the pool of high schoolers that know me personally is drying up I decided to post some of my usual answers here. A similar post will follow soon regarding studying medicine in general, but I don’t have that bit figured out myself just quite yet.

Here thus follows a short guide to studying medicine at Stellenbosch:

Stellenbosch Main Campus © universityfairs.com

The thing that is important to know about Stellenbosch Medical School is that the Health Sciences Faculty is located next to Tygerberg Hospital. When I was a wide-eyed and bushy tailed first year from 1000km away, I left home with big dreams of studying in the romantic historical town of Stellenbosch…

Only to find out that I would study 40 minutes away, not quite as beautiful. This has posed a problem to me on several occasions. My happiness is directly related to the aesthetics of a place. It has, however, taught me to enjoy the little gems of beauty: campus at sunset, campus after rain, campus during the springtime…

Another thing that causes concern in prospective students is the language policy. The medical course follows the “T-option”, which means that English and Afrikaans should be used in equal amounts during classes. Lecturers that cannot speak English must use Afrikaans slideshows and vice versa. Furthermore notes are to be available in both languages.

Needless to say this attracts many Afrikaans-speaking students, but causes some concern for students speaking other languages. I have, however, met many of those who chose Tygerberg for precisely that reason. There is nothing as difficult as attempting to extract a history from someone that does not understand your language. The ability to speak more than two local languages is even more valuable, but two is a good start.

The reason I consider our course to be superior? Stellenbosch FHS offers excellent practical training. We start early with clinical work and have access to a top-of-the-range simulated clinical skills laboratory. When on clinical rotations, students are treated as though they were qualified doctors apart from need their actions co-signed and quality-checked. I compare this to universities where practical work starts only in the fourth year, or where students have to get written consent for something as simple as drawing venous blood.

The final eighteen months of training at Tygerberg is called your student internship and is solely practical with no theoretical blocks. It is expected of SIs to conduct themselves as though they were already Interns – again very beneficial to practical training.

These are the tree most important things prospective students, in my mind, should know in order to make a good, informed choice. Be sure to ask if you have any other questions that need answering.

 

Birthday-thoughts

 Day 5: What do you prefer to do on your birthday?

Birthdays are big in our family – as are Mothersdays, Fathersdays, and holidays like Christmas and Easter. We have learnt how fragile life is, even the youngest of us. In my Grade 12-year we lost so many family  members and friends that I seemed to develop an anxiety disorder, convinced that I would be next.

© D. Puchert 1995

Every special day on the calendar our prayer is: Thank you for sparing us to another day of togetherness.

The photo alongside is of my fifth birthday party. We didn’t grow up rich, but my parents always managed to make our days special. My mom would choose a theme and have an awesome cake baked for me.

© D. Puchert 2008

As I grew up, I was a bit scornful of those kids who chose to spend their birthdays solely with their parents. I felt that special days should be spent with as many friends as possible. The photo is of my 18th birthday, a braai/pool/dance party. I love having mybirthday in the South African Summer!

© D. Puchert 2010

Since going to university, I haven’t been home for my birthday in three years. Nowadays I much prefer intimate do’s with those closest to me. They know that, so we all tend to make a plan.

This year I was lucky enough to celebrate my birthday three times. It was my 21^st so I think that justifies it.

The first was the night before I returned to Cape Town – two weeks before my actual birthday. We went to a lovely little place in East London called Pier99.

 On my actual birthday I went to Buena Vista in Greenpoint, Cape Town, with a couple of close friends. A few days later The Boy flew me up to Johannesburg to spend the weekend with him and his mom. I didn’t take any pictures though, boo.

Birthdays are big in our family. Not always what we do, but certainly how we do it.

Life is too short to be small.

Benjamin Disraeli