For the last three days, we set out to get a big picture of the public sector of Kwazulu-Natal’s health care system. Kwazulu-Natal, a northwestern province in South Africa, has the highest incidence of HIV in all of South Africa (and the world) and thus requires a very specialized health care system. The District Health Manager, whom we met with on Wednesday morning, discussed the South African health-care system and arranged our visits to three hospitals that offer varying levels of care.
Northdale was both the first hospital we attended and the lowest level of hospital care that is provided in Kwazulu-Natal. It is what they call a district hospital and offers very few specialized services to its patients. On first glance, this hospital was nothing like you would expect in the United States. It was all one level, mostly open to the outdoors and it seemed a little bit run-down. Northdale was Kwazulu-Natal’s version of Allen Memorial Hospital in Oberlin, OH.
Once inside the building, we met a hospital administrator who, after quite a delay, introduced us to one of the head Sisters (or nurses). The Sister gave us a tour of the whole hospital in less than two hours and allowed us to stop and talk to a few of the doctors. What was very evident at Northdale was the very low doctor to patient ratio. Nurses seemed to be taking the roles of doctors since the burden on doctors was just too great. The doctors even encouraged us to scrub in and lend a hand in the trauma room. We walked through hallways lined with people waiting for care and waiting rooms that had obviously exceeded capacity. One of the fundamental resources missing from Northdale was a proper Intensive Care Unit (ICU). The hospital had a high-risk ward with four beds, only three possibilities to ventilate, and did not have the resources to properly care for a very sick patient. If a patient were to deteriorate, the doctors hoped to stabilize the patient and rush them to Grey’s Hospital, which offers a higher level of care.
Because Northdale was the first hospital we visited, the six of us left in a bit of shock. We all had entered the hospital with very different expectations. Chloe didn’t expect to see sick people (we later explained that a hospital is where sick people go). I wasn’t expecting the volume of patients, and with such limited resources the situation was disconcerting.
The next morning, we got up early to go to Grey’s Hospital. Grey’s is referred to as a tertiary hospital and offers the highest level of health care to the people of this region. It has all of the specialized services: oncology, pediatric surgery, and a cardiac critical unit fit with its own catheterization lab. Grey’s is a very large hospital and seems more like a typical American hospital. If Northdale was Allen then Grey’s hospital is comparable to the Cleveland Clinic.
Upon entering Grey’s, we went right up and met with the CEO of the hospital. We were divided up into groups of two and sent out to the wards to observe the doctors. We went to three wards throughout the day: Pediatrics, Internal Medicine and Ob/Gyn. Starting on Pediatrics was a great experience. The doctors were very eager to share their findings, tell us patient histories, and allow us to help on the physical exam. They even quizzed us on different patients cases and helped us understand the medicine behind the conditions. We switched around after lunch, but towards the end of the day we found ourselves on the antenatal (prenatal) ward following the doctors on their grand rounds. One Cuban doctor took a particular interest in us and answered all of our questions. He even went so far as to bring us extra information on the effects of the malaria parasite on pregnancy, a condition that was discussed extensively during rounds. Following rounds we went to the nursery, or the NICU, to visit the preemies. Being a tertiary hospital, Grey’s only sees the sickest of the sick patients, and that was very evident in the nursery. All of the babies were very small and struggling for each little breath. It was my second time in a NICU and I forgot how many cords they put into such little babies. After the NICU we decided to call it a day since we were getting the sense that the hospital slowed down in the afternoon.
Yesterday we went to Edendale, one of Kwazulu-Natal’s regional hospitals. In the morning we sat in with physicians in the HIV clinic as they prescribed antiretroviral medications (ARVs) to countless patients. After the clinic, we went to the notorious trauma center, but we were disappointed to see that it was almost empty (disappointed in a most curious, academic way – of course it’s a good thing there were no emergencies). Regardless, we talked to the doctor in charge and even observed a minor surgery. Finally we went up and met the head of pediatrics. She took us around to the variety of nurseries and even let us hold little babies. I don’t know about everyone else, but it was definitely the best part of my day. Holding that little life in your hands is a very magical experience and further confirmed my already strong interest in pediatrics.
Early in the week, the District Health Manager had told us that each hospital we would visit was originally designated for a specific racial group during the apartheid years. Northdale was for the Indian’s, Grey’s was for whites, and Edendale was for blacks. After visiting each of the hospitals, we could see the unequal treatment of racial communities by the apartheid government in the structure and décor inside each of the buildings. Hopefully in the next generations the traces of the apartheid era will fade and all South Africans will be afforded their right to quality health care.
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