Our Final Week

It’s our last week in Cape Town, South Africa and I can’t believe it! We’ve been able to fully immerse ourselves in the culture by tasting new foods, exploring the beautiful country and trying to make a difference along the way.

Working at Tygerberg Hospital in Bellville, South Africa has been a very eye-opening and educational experience. As I mentioned before everything is handwritten besides the occasional labs which are recorded on computers. Yes, I said the occasional labs. This was probably the most shocking/frustrating aspect of working in the hospital setting here. In the United States labs are done daily if not multiple times a day whereas here I would be lucky to see a basic metabolic panel or a complete blood count every third day. As a pharmacy student and a future pharmacist one of the first things I do when I look at a patient’s chart is check their labs and make sure their kidney/liver function is okay and if not then recommend dose adjustments or stop offending medications. Since daily labs for each patient were very rare, you can imagine how frustrated I was. After speaking with multiple nurses and doctors I learned that due to the lack of resources they don’t always have access to frequent labs.

Each day I would work-up about 10-12 patients, however, two cases, in particular, caught my eye from the start and I ended up following them for the remainder of our time at the hospital. One of the patients was admitted for end-stage renal disease or ESRD and presented with a GFR of 2. This means that basically, his kidneys were not working at all and brings up another point I wanted to mention. In the U.S we mostly use creatinine clearance (CrCl) when dosing patients however in all of the written notes by doctors and nurses they would only report GFR. This didn’t seem like an issue at first but when I went to calculate the CrCl most of the time there was no weight recorded for the patients. We were then told to estimate a weight and use that for the calculations. When I looked at my patient and tried to estimate his weight I realized that the smallest thing as a weight measurement I take for granted.

This patient was the nicest man who was so optimistic every day despite his state of health. A little while after he was admitted he was initiated on dialysis three days a week. Shortly after he developed pneumonia and was started on two antibiotics. When I came in that day and saw his antibiotic regimen I immediately checked the drug database for the specific antibiotic dosing in dialysis patients. Since the physician was not around I notified him via a sticky note of my dosing recommendation. When I returned later that day I was happy to see that my recommendation was accepted and the patient’s antibiotics were dosed appropriately and in accordance with his dialysis.

South Africa has a very high prevalence of tuberculosis (TB) and HIV and since in the U.S we don’t see this as often it was a mission of mine to learn more about it since I am interested in infectious disease. The second patient I followed was previously diagnosed with pulmonary TB but failed treatment due to obstructive jaundice, which is a major side effect of the TB medications. He also had a prior RVD + diagnosis. In South Africa, as well as the rest of the world there is a social stigma when it comes to HIV. With that in mind, the patients, as well as the healthcare professionals in South Africa, prefer the term RVD + which means retroviral disease. Reading through this case there was a lot that I was unsure about. After talking with the South African pharmacy students and reading many articles and guidelines, I learned a great deal about the treatment of TB with concomitant HIV. So much so that I decided to use this patient for my patient case presentation. I was great to explore these two disease topics, especially since we didn’t get too much exposure in pharmacy school back in the U.S.

Throughout our time here we have been working on a community outreach project in collaboration with two South African pharmacy students who are completing their Master’s degree. This project’s main focus is infection control and prevention. Our responsibility was to come up with an interactive way to teach home-based care workers (nurses, dieticians etc.) the proper way to wash their hands. Hands are the main way germs are spread during the care of patients, therefore hand hygiene is the most important method to avoid the spread of harmful germs and prevent healthcare-associated infections.

Last week we had the opportunity to visit the community where we will be presenting in order to get a feel for how they operate. Each of us was paired with three home-based care workers for the day and observed their daily activities from 9am-1pm which are their typical hours. They are located in the town of Delft which is a township on the outskirts of Cape Town. It is notorious for its high crime rate, substandard schools, lack of jobs, and numerous government-built housing projects. As you can imagine, his was an extremely humbling experience. Theses home-based care workers are superhumans. They visit so many homes throughout the day to wash patients, check up on medications, and make sure children have up-to-date immunizations. Before one of the visits, the nurses asked if I would show one of the patients how to use a new inhaler that her doctor prescribed since she was unfamiliar with the product. The patient was so excited when she found out I was a pharmacy student. She had so many questions and I was more than happy to answer them for her. I explained the difference between her rescue inhaler and her maintenance inhaler and she came to realize that she has been using them wrong this whole time because no one explained it to her. This experience further demonstrated how essential the pharmacist’s role is in patient care.

When we weren’t working in the hospital, working on projects and observing community healthcare we explored all that Cape Town has to offer. Since I last posted, we have done a quite a bit and I definitely surprised myself with how adventurous I became. If someone told me I would be jumping out of a plane, I would say they’re insane! But there I was 9,000 feet above sea level falling from the sky. I know this may sound super cheezy, but at that moment I have never felt more alive. Don’t get me wrong I was absolutely terrified, but seeing the beauty of the world below you when you soar the skies under the parachute is a sight unlike any other. It was breathtaking.

Shark-cage diving was next on our list of adventures. This was another scary yet incredible experience. All four of us were completely submerged in the ocean surrounded by sharks. Looking a shark directly in the eye is terrifying. They came right up to the cage and even whipped their fins at us. If you ever have the opportunity to see a shark up close (with a cage protecting you of course), take it!

We then decided to take a six-hour African road trip to Plettenberg Bay which is east of Cape Town where we would spend the day with elephants. We stayed the night in backpacker’s lounge which was a fun experience in a quaint town. In the morning we headed over to the elephant sanctuary where we met five African elephants. Jabu, Thandie, Marola, Tabo, and Tomela were rescued from the wild and brought to the sanctuary for safety and recovery until they are fit again to return to the wild. We were told we were elephant keepers for the day. This consisted of brushing them, walking them and feeding them lots of pumpkins, which we learned was their favorite food. We learned so much about these beautiful animals and how they differ from Asian elephants. It was an unforgettable day and I can’t wait to go back one day!