Kristen’s Blog

Last week in South Africa

Saturday and Sunday Aug 27 and 28

Another great weekend full of great activities. On saturday I went to Mozambique to a market where we ate lunch and did some shopping. Afterwards, we went to Tembe Elephant Game Reserve and drove around for a few hours. We were able to see about 20 elephants together. It was mostly moms and their babies. Tonight we stayed in Kosi Bay Estaury in a challet.  On sunday we got up early and went snorkeling/diving/whalewatching. I guess that I wasn’t as use to the sea as I had thought and I turned very green and was sea sick for most of he ride. We were able to see groups of 3 and 5 humpback whales about 30-50 feet from our boat. It was amazing!!!!  Those of us that were not dive certified went snorkleing close to the coastline.  Afterwards, we went the LaLa Nek to another beach for a few hours.

Monday Aug 29

Today I was able to counsel a type 1 diabetic that was just started on insulin during this admission. I believe he was admitted with DKA. Most patients are started on Actraphane 30/70 which is just humulin 70/30 and is dosed twice daily. I went over injection training, type of insulins, storage, treatment of low blood sugars, etc.

Wed August 31

Today I spent the day with a social worker to see their role in patient care. Their role is very important as they are a big part of the discharge process to make sure the patient is going back to a safe environment. Social workers help patient with both finanical and emotional issues.

Today I learned more about Zulu medications. These medications are given to a patient by someone in the community. The medications are made by mixing together whatever the person is led to add by the “spirit”.  The patients don’t ask what the medication is made of but just trust that it will help them to get better. Sometimes the “Zulu medication” may contain toxic items such as bleach. One day on rounds, a mother was found with the zulu medication in a vitamin medication vial that was dispensed by the pharmacy. The child was doing better for a few days and then developed diarrhea probably after receiving the Zulu medication.

During the lunch our, I attended a meeting that was to celebrate women’s month. It was an informational meeting for the workers of the hospital about different services that were provided. Most of the discussion was in Zulu, so I understood very little. Women were asked to dress in their traditional dress so many of the women had bright colors and beads on.

Thursday Sept 1

Today was my last day at the hospital as I was headed to Durban after work. It was very sad to have to leave the hospital and all of the friends that I had made.  I was able to catch a ride back to Durban with a few of the doctors and medical student that were headed that way. This saved me from having to ride one of the minibuses again.  I decided to spoil myself and stayed at the Protea Hotel next to Gateway shopping center, which is one of the largest shopping centers in Africa.

Friday Sept 2

For my last full day in Africa, I decided to spend the day shopping at Gateway Mall. I was able to buy more souvenirs and I also watched ”The Lion King 3D”. 

Saturday Sept 3

Today was my flight back to America. I got to the airport a little early and ended up having to wait before I checked in my bags. I was able to get a window seat for the flights on South African Airways. On the flights back I was able to sleep about 4 or 5 hours. Entertainment for the flight was various wildlife movies and “Something Borrowed”.

This 40 day experience was some of the best times of my life and I hope to go back in the future for a longer period of time. It will probably be several years though

THE END

Week of more adventures in South Africa continued

Wed Aug 24
Today we rounded in the female TB ward. A few of the patients had renal issues so I stayed behind after rounds to help see if medications were renally dosed. Coming from a completely electronic medical record to no EMR makes looking for information very frustrating. I was able to easily find an age but trying to determine a weight (or a recent) weight was more difficult. I have trouble figuring out exactly what medications a patient may be on except for what was written from their last visit.
Afterwards I was invited to go to the ARV clinic with a doctor again to see what goes on their. The first pt we seen was suffering from TB and had drug induced hepatitis from his TB medications and was admitted to the hospital. Several of the other patients were being seen to determine if they were ready to be started on ARV treatment.
The policy at the hospital is to start patients who’s CD4 is

Week of more adventures in South Africa

Friday Aug 19

For a change today, I stayed back with the medical students and a doctor and went on rounds in the TB and CVA wards. Most of the patients in the CVA ward were at the point that not much could be done medically for them. They were being prepared to go home with home health/hospice care. Then went to TB ward to see some patients. On of the patients had probable Kaposi Sarcoma on her legs and I was able to see the biopsy of the site. It was neat to see Kaposi Sarcoma in real life since its something that I had heard about in the movies and read about in pts with AIDs. Mortality rate is as high as 100% for these patients and getting a diagnosis is beneficial in that you can help prepare the patient and family for the upcoming circumstances.
Later in the afternoon I went the OPD which is the emergency room and helped see a few patients with the students. Patients that we saw were a patient with hemmoroids, STDs, broken foot or sprain, and a patient with “end stage” HIV who likely wouldn’t make it through the night.
Next I went to theater to see a cesarean (C-section). The patient was having twins. It was very neat to see what goes into the procedure and to see babies’ taking their first few breathes. A prayer was said for the patient before the surgery began.

Saturday and Sunday Aug 20-21

The trip planned for the weekend was to Kosi Bay. We stayed in the Kosi Bay Lodge which is located north of Mseleni about 1 hour. We stayed in a nice 6 bed-cabin. On Saturday we went to Kosi Bay and spent the day on the beach. On side of the area is the ocean and the other side is the bay were you can snorkel and where they catch fish. The views were amazing. To get to the beach area you have to wade through water so it is best to go at low tide so that you don’t get your stuff as wet.
The roads in most of these areas are sandy and require a 4×4 to get to the locations. We were only on the beach with about 20 other people. The beach is located less than mile from the Mozambic border…you can see the barricades for the border when you turn off to go to the beach.
On Sunday, we went to Black Rock, a beach located north of Mseleni close to Kosi Bay. This beach was just as AMAZING and we were the only people on the beach for about 3 hours. We went out in the ocean for a few minutes, but the waves were very strong.
Had “rusks” for the first time today. They are very common cookie/biscuit to dip into tea or coffee. I hope to find these in America or get some to take back before I go back.
Also had a Savannah light which is a Cider that is actually very good. I also hope to find this in America. It is produced in South Africa so I am a little worried 

Monday
Compounded a cream in pharmacy today. Rounded in Peds ward. Went to lake after work with people from hospital.

Tuesday

Zulu phrases that I have learned (I think)
Sowana- hi
Mjani-how are you
Yapilla-I am fine
Sapilla- I am fine also, than you
Yaybo-yes
Cbonja-thank you

Very fun day today. I was able to go to a rural clinic with Annie, one of the doctors. We went the clinic that was about a 45 minute drive from the hospital. Patients were seen from about 10am to 3pm. The first to patients were for circumcisions. They are done in SA as a health initiative to lessen the spread of STI’s. Both were done in males in their late teens or early twenties. A lot of the other patients were seen for ARV management follow-up or HTN management.

Went to Mseni lodge for dinner tonight and enjoyed some Calamari and chips (French fries).

Wed Aug 24
Today we rounded in the female TB ward. A few of the patients had renal issues so I stayed behind after rounds to help see if medications were renally dosed. Coming from a completely electronic medical record to no EMR makes looking for information very frustrating. I was able to easily find an age but trying to determine a weight (or a recent) weight was more difficult. I have trouble figuring out exactly what medications a patient may be on except for what was written from their last visit.
Afterwards I was invited to go to the ARV clinic with a doctor again to see what goes on their. The first pt we seen was suffering from TB and had drug induced hepatitis from his TB medications and was admitted to the hospital. Several of the other patients were being seen to determine if they were ready to be started on ARV treatment.
The policy at the hospital is to start patients who’s CD4 is

Lions, Giraffe, and Zebras….Oh my.

August 10 Wednesday

Today we rounded in the female TB ward. In this ward, you are required to wear a mask but unlike in other hospitals, the room does not have special ventilation to keep any air in the room. In
South Africa where HIV is more prevalent, TB is also an infection that is seen more often in patients. Its seems like I hear on rounds or from other students of at least one patient with elevated LFTs due to TB meds. Today I also dispensed Biltricide (praziquental) to a 14 y/o child. FYI: in patients older than 4 years of age, you just use adult dosing. The patient had schistosmiasis detected in their urine.

August 11 Thursday

After work today, we were invited to one of the Dr’s home to enjoy sushi. We were instructed to dress the part also, so we all found sheets and fabric at the house to make costumes. The doctors and others doing their community service all have small houses/trailers that they live in on the hospital grounds (about a 2 minute walk to the hospital. The sushi was great!!!!

Aug 12 Friday

Today we rounded in the peds ward. Today I was able to work out of another small pharmacy on the hospital grounds. The PTMTC clinic where they mainly dispense 30 day supply of all of the anti retroviral medications. The 3 main drugs given here are Lamivudine, Efavirinz, and Tenofovir. Other medication used include Neverapine, Zidovudine, stavaudine, and lopinavir/ritonavir. The hospital doesn’t have quit the selection of ARVs that I am use to working in the states.

Other differences that I have noticed and expected. Laboratory values are in different concentrations. For example normal Scr is 45-90. Scr of 1mg/dl = 76.26. Scr 2 mg/dl=152. Blood sugars are in mmol/L vs. mg/dl so in South Africa, a blood sugar < 70 is 3.885,  100=5.55, 300=16.5, etc.  In the medication information books, I have noticed that Crcl is referred to as eGFR. And of course everything is discussed in Celsius not Fahrenheit J

We went back to
St. Lucia for the weekend and I was able to enjoy some Lasagna and Ice Cream at a local Italian restaurant.

Saturday Aug 13

Today we walked to
St. Lucia beach area and saw some more hippos and a bigger crocodile. I also was able to buy more souvenirs at a local market.

Sunday Aug 14

Today was Game Park Day “Safari”. The morning started at 7am when we were picked up from our hostel in
St. Lucia. We traveled about 50 minutes to the park. It was a little cold riding in the back of an open truck all day, but it was AMAZING!!! I was able to see 2 lions, giraffes, zebras, rhinos, hyena, wilderbeast, warthogs, impola (like a dear), baboons, and a lot of birds. For lunch we stopped inside the park at a picnic area where we had steak, potato salad, pasta, garlic bread, and rolls. The food was AMAZING!!! The only thing missing from the day was seeing an elephant.

Monday Aug 15

Today was the yuckiest day so far. It rained all night and was very windy and very cold. I learned more about the area that I am working in today. The internet wasn’t working at the hospital today and the cell phone service keeps going in and out. The OPD is more of an emergency room than an ambulatory clinic that I had originally thought it was.

I love working/volunteering in international settings and I could see myself in the future doing more long-term work in various areas. The only limiting factor would be high speed internet connections as I feel that I waste a lot of time waiting for the dial up internet and I don’t have all of the information at my fingertips as I would back home.

Tuesday Aug 16

Still raining. Still cold. Yuck!!!

I learned today more about pharmacist salaries in
South Africa. The pharmacy manager discussed with me the various pay schedules working in a government locations.

Community Service Year= 240,000 rand

1^st year pharmacist          = 340,000

Pharmacy manager         = 610,000 rand

Clinical Pharmacist (requires more certifications)= 420,000 rand

For example, most pharmacist in the
US start out around $100,000 which is close to 660,000 rand. So I would be making about ½ the salary as in the states if I would work in
South Africa.

I have been complaining (or I like to call it discussing/reminiscing) on some of my favorite American foods. So we decided to have a Mexican food night tonight with fajita (shells made from scratch), chicken, potatoes, etc. It was again AMAZING!!!

Wed Aug 17

New thing today was an order for glucose tolerance test. We got a baggie and measured out 75 grams of sugar from a box in pharmacy and handed it to the nurse to give to the patient the next day to do a test.

For insulin, there is also not much of a selection of the newer types. We have protaphane (N) or Actraphane (Regular insulin) or a 30/70 mix. Most patients are dosed using the 30/70 mix as far as I can tell from the insulin that I have dispensed. Diabetes medications include Meformin, glivenclamide (glyburide), gliclazide, and insulin.

The only statins available are atorvatatin and simvastatin and the only ACE-I available is enalapril as they have no ARBs available for patients.

Week 2 in South Africa

Thursday Aug 4
On Thursdays, the team rounds on the male ward with patients that had various conditions such as viral menengitis, cerebral ischemia, dvt, etc. Today I spent most of the day in the pharmacy dispensing medications.
Yesterday, we got a new house guest, Vicki, a medical student from Ireland. There are also 3 students/workers from UK that were here before I arrived.

Friday Aug 5
Today we rounded on the peds ward where most kids were either malnourished or had some type of gastroenteritis. Fridays are busier for the pharmacy as the wards need to restock their ward supplies. The inpt/outpt pharmacy is closed after 4pm on the week days and on the weekends and no pharmacist is on the grounds. Pharmacist are not able to review each medication order before the nurse gives the medications. Pharmacist see the medication orders only when the nurse needs to get medication from the pharmacy and brings the medication order to the pharmacy. It seems like there are several medications mistakes that can be made. I am used to working in a health system where the medical record was completely electronic and pharmacist had to verify every order and nurses used bar codes to verify correct medication and correct patients. There is no IV room in the pharmacy (no IV medications made in pharmacy). Most antibiotics are supplied in ampules vs premade bags.
For entertainment tonight, we watched August Rush on the big screen at Dr. Fredlund’s house (a projector hooked upto a laptop on a sheet). It was a very nice treat and a great movie.

Saturday Aug 6
Decided to stop taking my antimalarial today as I have had some GI side effects that I didn’t wont to continue during my duration here. Malaria is not as common in this area and it is currently winter here. Not all of the students are taking antimalarials and I have yet to be bitten (knock on wood!!!!)
For entertainment today, we went to a Cultural song and dance at the local community center in town. We then went to Sodwana Bay to “The Lighthouse” for dinner where I enjoyed pizza and some ice cream w/ chocolate sauce. It was great. This has to be my favorite restuaruant as they played 4 or 5 Celine Dion songs while I was there.

Sun Aug 7
Went to beach for most of the day at Sodwana Bay.

Mon Aug 8
Today was peds ward for rounding. Had an “ah ha” moment today. I was counseling a patient to take with food for an NSAID or Abx and told the patient to take with food. The patient looked at me confused and questioning. The other pharmacist said to me that not all patients have food and when you tell someone to take with food it may not actually be an option for them. I never really put much thought into saying take w/ food because you assume everyone has food…but it is important to realize that that is always not the case. I am starting to say that it is better to take with food as its easier on the stomach or trying to phrase it a different way and be more considerate for patients situations.
For dinner tonight, I got to enjoy some liver which was actually really good. After dinner, most of the children from the children’s home came to the house at watched a movie on the projector.

Tuesday Aug 9
Today is a national holiday, National Women’s Day, and most things are closed including the pharmacy. I decided to go to the hospital for a few hours in the morning with the other medical student and round w/ one of the on-call doctors.

Plans for this weekend were to go to Tempe Elephant Park, but do to rainy weather forcasted…I believe we are going into St. Lucia this weekend

Adventures of the First Week

This is my first post since arriving in South Africa. I only have internet access at the hospital, so I will probably only post once weekly, but I will try to blog about the previous week. I have been keeping a daily journal that I can quickly reference as to what occured each day. Please excuse spelling mistakes because I am not sure how to correct those.

Day 1 and 2 (July 27 and 28)
I awoke with the thought of “I’m going to Africa today, I’m I crazy?”. Prior to leaving Columbia, I realized that on S African Airways, you can only have carry-on luggage that is less than 18 lbs and my current carry-on was atleast 30 lbs. Instead of repacking stuff, I decided just to check two backs but also bring another small bag with important paperwork, reading materials, and a change of clothes for the first day.

When I got to Dullies Airport in DC, I had to get boarding passes at the S. African Airways ticket counter. I thought I had all of the needed documentation….but i for the moment misplaced the little tag they give you when you check your bags in. They instructed me that my bags would not be loaded if I did not have the tag. After about 1 min, I found the tag and was assured that my bags would be loaded.

My total flight duration was about 25 hours from Kansas City to Durban. I switched planes in DC and then we flew the first 7 or 8 hours and then stopped in Dakar, Sengal (a country in upper Africa) to pick up a few people and I am sure refuel the plane. The next leg of the trip was about another 8 or 9 hours which took us into Johansburg. During the flight, I was able to watch various current movies and also keep track of where the plane was. I ended up watching Hangover and Adjustment Bureau, which were both very good movies. In Jburg, we went through customs and then got our bags and checked them back in. Then we found the flight to Durban which was only 1 hour long. I landed in Durban around 8pm (SA time) and was met at airport by someone to help transport me to Mseleni the next day. I maybe slept 1-2 hours during the flight, so my sleep schedule was adjusted and I was able to fall asleep about midnight (5pm in Missouri) the first night.

Day 3 July 29
The next morning, we took a bus to Mseleni which is about a 4 -5 hour drive from Durban. When I arrived in Mseleni, I was greated by other students working around the hospital and Victor. They showed me around. The house I am staying at is very nice. I was told that there is not much to do on the weekends in Mseleni, so I went into St. Lucia with other students for the weekend.

Day 4 and 5 July 30 and July 31
St Lucia is a small tourist town. They have various shopping areas, restaurants, a pharmacy :), and places to stay. At the grocery store, I was able to find some Coke Zero…so I didn’t have to give up Soda for the trip!!! American money is not really accepted here like it was in Jamaica and Mexico. My adventures for the day consisted on going on a boat where we saw hippos and a crocodile and various birds of S. Africa. After that we went to a cheese farm where I was able to milk a goat and try various goat and cow cheeses. On sunday morning, I did see what I believe was 2 monkeys outside of the hostel where I stayed.

Day 6-9 Aug 1 Monday-Thursday…..I am going to try to summarize the last 4 days.

I have been in South Africa over 4 days not and its my first day of work. The morning starts around 7:20 with scripture reading (optional) and rounds start at 7:30. Each day they round on different group of patients. For example, Monday was Peds, Wed was female, and Thursday was Male. The team is multidisplenary (dietician, social work, OT, PT, etc) , but a pharmacist hasn’t been able to participate yet because of lack of pharmacist staffing. I am the only pharmacist on rounds currenlty. Rounds usually last at least 1 hour. Patients seen and discussed over the last week have included: Monday-child with abdominal TB, snake bite; Thursday-cerberal infarct, viral menengitis, gangrene, DVT.
The phamacy is located in the outpatient clinic area and services both the inpatient and outpatient clinic and the rural clinics. Pharmacist here go to school for 4 years and then have 1 year of internship and then an additional year of required community service. I really like the idea of requiring a year of community service wonder how that would work in America. The pharmacy staff are all very nice. Most of them can speak Zulu (the local language) and some English. So they are always there to assist me when I need help communicating to the patients.
Most of the brand names of medications in South Africa are different than in America. The majority of the generic names are similar so it depends how the medication order is written as to how long it takes me to figure out the drug. The controlled drugs are differnt here also. For example S7 is similar to our C2 but the same drugs are not in the class. S6 is similar to what I call a C3-4 but again not all of the same drugs.

On tuesday night I was also able to go to Sodwana Bay which is on the Indian Ocean and walk on the beach and put my feet in the water. It was very beatiful and I took lots of pictures. I will attempt to post pictures when I arrive back in the states and have high-speed internet access again.

I will try to post again toward the end of next week if not sooner. All is going well.

Three days till South Africa

I have almost finished packing & finalizing a few last details such as ride to & from airport in Kansas city. I received confirmation last week from Dr Fredlund & I will be staying in a hostel in Durban my first night & then traveling to Mseleni the next day.

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