This being our very first visit to a community clinic, I was feeling quite nervous when we stepped off the bus at Levai Mbatha Clinic in Evaton. Our little group was ushered into a doctor’s room, and we were divided into groups of 3 and assigned different wards to assist in. My group was assigned first the labour and maternity ward, followed by the women’s health ward, and finally (if there was still time) we could assist in casualty.
What an incredible learning experience! All my nerves were replaced almost immediately by excitement because the Sisters were very engaging and were happy for us to be (quite literally) as hands-on as possible! We were shown around the ward and within 5 minutes we were being guided through an entire examination of a woman in labour.
Everything from introduction, to history-taking, to examining the patient file and previous medical history, to general inspection, inspection of the abdomen, and finally examination of the abdomen and vagina. This was no passive learning experience! The Sister asked questions to test our knowledge, and where wrong she would correct and explain in detail why every step of the examination was necessary. It was an interesting contrast to our structured clinical skills sessions at UUME, but there was such overlap and application that it felt quite natural and logical in helping this patient. I was guided through performing the vaginal exam to assess dilation and effacement, and for the first time in my life I felt a baby’s head in the correct position for birth to commence! Unfortunately, as we ended our examination of the patient our time for the ward was up and we had to move on to the next. We did not get to see the birth of the baby, but the mother delivered successfully within the next hour!
In the women’s health ward, we were able to draw on a lot of the Themes classes we’ve had so far this year. The patients again were examined and advised on family planning and contraception. Part of the history-taking components centered on TB exposure and risk, as well as PMTCT for HIV. We could observe a pap smear, as well as administering some of the injectable contraceptives. In our second week, my group was exposed to IMCI and we performed examinations of the babies for head circumference, mid-upper arm circumference, weight and length measurements, and finally administration of measles vaccinations. We were guided through completing the Road to Health books for each patient, as well as health promotion and guidance for the mothers with regards to diets and follow-up appointments as per the EPI schedule. This was a great learning experience, as we were putting into practice a lot of the theory we’ve covered in the Themes classes for primary health care!
Our final ward for our first day was the casualty department – and what an incredible yet eye-opening experience this was! It was a Tuesday afternoon, and in the hour that we spent in the casualty we saw four stabbings. The two doctors that were running the ward were very helpful, and tested us on our knowledge with each case that came in – a child presented with an acute asthma attack and we were questioned on the pathophysiology and mechanisms of treatment; a case presented with generalized oedema secondary to possible liver failure, and we were questioned as before. Where we were lacking in our knowledge, the doctors explained carefully and took their time to make sure we understood. They were very gracious in answering all of our follow up questions
The most exhilarating experience came right towards the end of our day – we were waiting for the bus to arrive after our debrief for the day when the doctor came outside and asked if anyone was interested in learning how to suture! We all jumped up and went inside to watch. A young man had been stabbed in his left upper arm and on his back. After taking a quick history and asking who committed the crime, the doctor proceeded to explain the technique to us. She talked us through how to inject the local anesthetic and then placed one stitch on the arm; she then asked if anyone wanted to do the rest. Our friend Rosy volunteered and we watched in awe as she was talked through the procedure by the doctor! Finally, the doctor asked who wanted to suture the wound on the patients back – I raised my arm, quickly washed my hands and donned some gloves and approached the patient. I greeted him and then listened to the doctor as she demonstrated the techniques – first the local anesthetic, and then the suturing technique. The crazy thing was that I didn’t feel nervous at all! Perhaps it was the fact that it was very sudden and there was no time to overthink things, but I felt very calm and excited to learn. One by one I completed the sutures, placing four in total. When I was done the doctor checked the work and said she was happy, and that we were done. I thanked the patient, took my gloves off and washed my hands. The bus had by now arrived and we left the clinic for the day.
As I took my seat on the bus, I was still buzzing – the adrenaline was still flowing through my veins, and I sat and thought about the day we had and how much we had learned. The community is very poor, and the clinic saw constant foot-traffic and waiting lines. The people we helped were understanding and patient, and it was simultaneously heart-breaking to see some of the conditions that our fellow countrymen must endure. Having started off the day feeling nervous, I ended the day feeling more so than ever before that I am incredibly privileged in my life, and incredibly privileged to be on this journey of becoming a doctor so that one day I can help our people even more.
My South African Medical School Journey 