the McCord Hospital and Sinikithemba Clinic
My first few days at the McCord Hospital and Sinikithemba (Seen-icky-TEM-ba) Clinic have been quite exciting, if fairly intense. Because the director of the Monitoring and Evaluation department has been out of town at a funeral in Jo’burg, I have been spending most of my time with physcians who work in both arms of the complex. In the mornings I have been going on rounds with the doctors in the wards of the Hospital, where residents present information about patients that are of particular interest (sometimes relating to the unique nature of the case, sometimes because the patient represents an excellent example of issues endemic to the hospital/region/disease/etc.). Once the resident has finished presenting the case, the attending physicians give a brief impromptu lecture, explaining any pertinent clinical information about the treatment of the patient to date, and what steps must be taken in the coming day(s).
Nearly 90% of the patients admitted to the hospital have late-stage HIV – usually compounded by things like TB, lactic acidosis (a blood pH problem), and other opportunistic infections – and many of them have died between one days’ rounds and the next. And while seeing these critically ill patients has certainly been emotionally difficult at times, these experiences have provided me with immeasurable insight into the daily lives of medical students and physicians, and in many ways confirmed for me that this is the profession for me. I think I find the scientific, clinical, and problem solving components of the job – along with the professional camaraderie between physicians (and the physicians-in-training) – to be an ideal working situation for me.
Once my direct supervisor returns, however, my daily routine is going to change significantly. Hopefully I will still be able to go on rounds with the physicians once or twice a week, but most of my energies will be devoted to working on the Antiretroviral (ARV) Decentralisation (note the funny spelling) program that will enable some new clinics in the Durban Metropolitan area to begin distributing free ARVs in the coming months. This is absolutely essential because the Sinikithemba Clinic is currently initiating ARV treatment for more than 80 patients each month, which along with the requisite education and training sessions is rapidly overwhelming the capacity of this site.
In particular, my responsibilities for this expansion program will revolve around the establishment of a functional Monitoring and Evaluation (M&E) structure at each of the new sites. As far as I can tell at present, a functional M&E system will address tracking of patients and ensuing good linkages to ongoing care. Additionally, a first-rate M&E system should allow the physicians and researchers at a given site to manipulate patient information to create data for clinical research publications – an absolutely essential step in trying to stem the tide of the HIV pandemic in Sub-Saharan Africa, both for information-sharing as well as for fund-raising purposes.
At the moment I have been doing a lot of reading about the timeline for this Decentralisation Programme, trying to understand how the hospital and clinic systems function in South Africa, and getting myself up to speed on all of the different ARV therapies that are currently being administered to patients
Hopefully this lengthy post will give you all a bit more insight into what I’ll be doing here in the coming months. And I will be sure to keep you updated as progress is made on these projects. My next post – if things go as planned, which they often don’t – will address some of the Social, Religious, and Racial issues (often these three are inextricably lined) I have experienced in SA thus far – and maybe even pick up on some of the theme in Dale’s last post about Affirmative Action and skill set disparities.
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Labels:
AIDS,
Durban,
HIV,
McCord Hospital,
Medical School,
public health,
Sinikithemba,
South Africa
