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International Child Health Section: Articles
Cape Town, South Africa
Submitted by Karen Trudel, MDCM
UBC/BC Children’s Hospital
Red Cross War Memorial Children’s Hospital
Cape Town, South Africa
I have never worked so hard in my life. Never seen so much malnutrition, so much illness, so much death. When I landed in South Africa as a third-year resident, I was ready to make the most of my one-year elective at Red Cross Hospital (RXH). I was ready to learn, but I soon realized that I was not emotionally prepared for the unique combination of third-world disease burden meets first-world medicine, which is the reality at RXH.
As luck would have it, my first few overnight calls at RXH turned out to be among the worst I would see in South Africa. Running from ward to ward, admitting sick children, restarting drips, trying to optimize the care of dying babies who had been denied admission to ICU, and responding to codes. There was the 3-month-old with severe gastroenteritis turned into gut failure on TPN who rapidly succumbed to nosocomial sepsis, the 12-year-old newly diagnosed HIV positive girl who went into respiratory failure secondary to VZV pneumonia, and the 18-month-old with kwashiorkor who suddenly arrested while recovering from gastroenteritis on the ward. All this in my first month. Things got worse when gastro season hit. Every day, when I got home from a particularly busy call, I wondered about the purpose of the work we do. And every day, I convinced myself that the next day would be better.
As the days went by and the hallways of RXH became more and more familiar, I started to realize that there was so much more than death and disease happening all around me. These beautiful little babies who came in so desperately sick would suddenly turn the corner and recover from extreme metabolic acidosis or extensive burn injuries in such a way that I was surprised to see them survive, let alone make a full recovery. I can think of several infants who spent days or weeks on ventilatory support for HIV-related hypoxic pneumonia and with whom I fell in love during my ICU rotation. For example, there was a six-year-old HIV-positive boy who came in with a bronchoesophageal fistula created by fulminant pulmonary tuberculosis. Despite our inability to communicate (he could only speak Xhosa), we managed to learn a secret handshake that he proudly demonstrated one morning on our ward rounds. There was a tiny six-week-old with severe failure to thrive who was in hospital for over a month with ongoing gastroenteritis and recurrent bacterial sepsis. One of the registrars called me to see the same patient in the emergency department six months after his discharge; he had come back with mild bronchiolitis and looked otherwise fantastic. He had become a chubby little man and his mother was so proud to show him off after he had been so sick! All of them were treated as my own personal patients by the other doctors and the nursing staff; they all knew how much I cared for them and would give me updates on their progress well after I had left the unit where they were admitted.
In the end, the most difficult thing of the whole experience was having to say goodbye and leave South Africa. I have never worked so hard or learned so much in my life. And despite all the malnutrition, illness and death, what I take back with me is awe for the sheer resilience and will to live that these children have. That, and a strong desire to go back as soon as I possibly can!
Posted: January 2010
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