The End

For the last week I have been on 'holiday' in Cape Town, SA. What a beautiful place! I love the ocean; I love the city; I could live here.... ok maybe in a couple years when they get the public transit system working well! Emily and I tried our hardest to fit everything there was to do in Cape Town into the week we had there, and I say we did really well.

We went to several bays and markets, explored the Waterfront, ate a ton of seafood, went to a Carnival/parade, took a bus tour of the city, had a beach day including dinner on the beach and watching the sunset over the water!, went to a concert in the botanical gardens, climbed Table Mountain (and I mean climbed it was basically tall stairs(rocks) up the side of a mountain), went on a wine tour, went on a bike/van peninsula tour, went to a concert (complete with a booing of the mayor), climbed Lions head, and finally went out on the town our last night in the city. We packed all of this in only a week with only minor battle wounds (the wind pushed me off of a bike and Emily broke a sign at Cape Point)! We saw so much and had so much fun. All in all we met a lot of friends and found Cape Town a great place for vacation!

I already miss the friends that I met in Jo'burg and I haven't even made it home yet. I miss the day to day that I had gotten used to there. I'd like to say that I am glad to be back home, but I find myself dreading starting a new clinical in a place that I don't know; hoping that I know all of the answers and what to do. It was hard sometimes, it wasn't ideal, and it was certainly not in the comfort zone, but once I got used to it, I could see the difference Physio made and it became normal and exciting. I will miss it, but I'm sure I will find an exciting place to work as well.

Although Jo'burg (and Cape Town definitely) are not the 'norm' of Africa, one is able to see the lack of resources and the way the government/health care plays a role in the lives each citizen in SA. It was a very interesting, growing experience. I recommend getting out of the comfort zone and see what else happens in the world to everyone. You get to learn so much. I went to South Africa thinking that I would show someone something new or at least we would share information and teach each other, but in the end I feel like I was the one who was taught everything and I really didn't have much to share with anyone. I learned so much while I was there. It was an incredible experience, and I'm sad to be done with it.

Goodbyes

I never had thought goodbyes are all that bad. They never have seemed all that permanent to me so I never get too worked up about them. However, this is a little different. Knowing that I most likely will never ever see these people again in my life and only have slim chances at really keeping in touch with them makes me a little sad! They have all been so great, kind, friendly, and helpful. We had a lot of fun together, they taught me a lot, and I will miss them. The goodbyes have been a bit sad and I don't really want to leave this place that I've gotten so used to now. Hugs and emails exchanged to try and keep in touch, but the goodbyes are still a little hard when I think about the finality of them. So as per usual with things like this, I am just going to try not to think about it!

After completing our inservice on biofeedback and giving info on PT in the States (several people were asking several ?s) we celebrated by having our first South African braai on Tuesday evening. One of our co-workers, Marilu, hosted the braai for us. Thank goodness we finally got to experience a braai after all this time of being in SA. It was great. A lot of fun watching the braai process and the meat cook. Everything made was delicious! We took devilled eggs (trying to think of something traditional American barbecue that we could take). They were a bit improvised from to having all the normal ingredients (we added peronaise, since that is what we had and no mayo). They turned out a little dry but ended up being a hit anyway (or maybe everyone was just being nice)! It was a lot of fun to be able just to chat and have fun with the people that we work with everyday instead of just talking about patients and physio. We began saying a few goodbyes here and there will be more to come in the next (out last) 2 days of work. We'll see how it goes, and then it is off to Cape Town for the start of our real holiday!

Eating and almost being: Food.

On our final weekend here in Jo'burg, one of our co-workers at Bara took us to Neighborgoods market where there were tons of food vendors with tons of different types of food and a couple of clothing and jewelry booths. We ate our fair share of lots of delish food: chocolate crepes, spicy chicken rolls, samoosas (fried bread with different foods in the middle, ours were cheese and corn), butternut squash pumpkin quiche, Thai chicken meat pie, and Jamaican jerk sandwich. All was amazing, and split between us needless to say.

We then took an adventure through a VERY comprehensive beer tour at SAB World of Beer through the history of beer and the current brewing process. Very informative, very yummy.

Today we hired a car! Emily was a great manual driver even on the other side of the road. It was a successful day without getting too lost, hitting anyone or anything! We made out way to the Rhino & Lion Park to see a very small enclosure of cats! We got to see them being fed because it is such a small enclosure that they cannot hunt for themselves... cheating, maybe but we're glad that we finally got to see some cats. 



We also hit up another section of the park were we got to pet/play with the white tiger and white lion cubs! It turns out that tiger cubs are way more playful than lion cubs...

We then traveled over to Carnivore restaurant and had our fill of chicken, beef, pork, beef sausage, pork sausage, chicken liver, crocodile, kudu, zebra, ostrich, and impala meat. With lemon cheesecake and malva pudding (SA tradition, chocolate cake with pudding on top) to top it all off. We were so stuffed after two days of delicious, adventurous eating! I say, way to end it off right!

Nearing the End.

I am currently in the last section that I will be a part of here at Bara: the medical/surgical section which includes trauma, burns, amputations, and any medical problems not falling into another section (mostly HIV or TB related problems). I am really enjoying it as most of this I have not seen in previous clinicals so I am really learning a lot. This also makes me feel much less confident in my skills/treatments than I did in my last neuro section. I really felt like I mostly knew what I was doing in neuro (most likely due to my previous clinical) and could really work along side these people. Now I totally feel like a student again, rethinking my decisions and taking my time considering what to do next. Let me tell you this is a hard transition! I really miss neuro, but I am trying to look to the fact that I am gaining so much invaluable experience here and increased time taking is not so bad. I have already learned so much here and will still be sad to go (although maybe a little less sad to leave this section than I was to leave neuro).

Speaking of learning things, I got to view a skin graft surgery on Tuesday. It was so cool to see how it is done, when they choose to do it, and reasons for graft failure (common problem). It was also kind of gruesome! But it turns out that if you dissociate the process from happening to an actual person and focus on the awesome science it's  really great to see. (I would like to report that I was a trooper and did not faint, puke, or have to sit down during the surgery even though the OR was small and about 90 degrees F). Skip to the next paragraph if you don't want details: I don't really know how I thought they harvested the skin, but I was not expecting an electric shaver type thing. All I could think of was how much that would have to hurt! Good thing the patient was put under. I had to help turn the patient once she was out and then they harvested skin from the side of her thigh. Crazy how thin skin is. I could see through the pieces they harvested. Harvested skin got put onto hard plastic boards according to how finely you wanted to mesh the skin which then went through a compressing type of machine that reminded me of the thing you squish the noodles through when you make homemade noodles. Then meshed skin was stapled onto her chest which was the most granulous part of the burn that was not healing well. Crazy, but so interesting.

After all that excitement, Emily and I were waiting for the bus and talking about our day when a guys sits down next to us on the bench. We didn't think much of it and continued talking. After a while, he grabbed Emily's arm. He looked like he was in pain or something was wrong, but he wouldn't answer any of our questions and his eyes were closed. After several minutes of trying to get any information out of him, we looked at his outpatient file he had with him. At this point his eyes were slightly open and we could see that his eyes were fluttering, so we decided that he definitely needed medical attention. While trying to convince this eyes closed man who may or may not understand English to go down to trauma, he started trying to lay down. We were like no standing is the way to get to trauma. He than began to have full on a tonic-clonic seizure. So Emily held his arms down and kept him from falling off of the bench and I held his head so he didn't give himself a concussion and kept it rotated so that he didn't choke/aspirate on the copious amounts of saliva that was pouring out of his mouth. He only seized for about a minute, but in that time a hospital employee stopped by and asked if we needed a stretcher after several people just passed us by. Several minutes later she returned with the stretcher. At that point, this gentlemen was less confused, his eyes were open, he was speaking (not in a language we understood), and his distressed breathing had returned to normal. We loaded him onto the stretcher, gave our report to the trauma nurse, and caught our bus home. At least this wasn't another boring wait for the bus!

Needless to say, Tuesday was a very eventful day! Wednesday we again helped our friend Nici with the mobile soup kitchen. It always amazes me at how open and talkative the people are who come to the kitchen. Also a fun/interesting time! We are now down to 5 days of clinical left, and if they continue to be this eventful I am really going to need that week in Cape Town!

No work and all play

Emily and I have been very social the past few days, and it's been great! First off, co-workers in the neuro section threw a "party" (snacks just before lunch) for one of their birthdays and celebrating my last day in neuro. They told me I had been a great student to have and made me feel like I had been very helpful (I hope!). Much appreciated. That evening we had a social event (dinner out) with some co-workers. They filled us in on every kind of food we should try while here in SA. Some already taken care of, but there still is a huge list. They also offered to bring their favorite South African foods one day to work so we can try them all, and they have a delish South African braai (BBQ) in the works for us! We were introduced to rusks this week (crunchy biscuits that you dunk into coffee) and a couple of traditional appetizers most of which include meat. Their biltong (jerky like stuff, but way better), bunny chow (anything stuffed into a hollowed out 1/4 loaf of bread), and boerewors (sausage) are very popular foods here which we have already tried and love. I think that I have eaten more red meat in the time I've been here than in the past 6 months at home, but I still can't wait to try everything new they have to offer! Friday we had to see all of our patients before noon so that we could participate in team building! That afternoon we split up in colored teams and had to dress in our color and bring snacks that were our color. We completed challenges, mostly mind and team/cooperation games, for points. All I have to say is way to go winning black team!!

A lot of fun (and smack talk) was had by all!


Today (Sunday) Nici took us to the cradle of humankind which is the caves/excavation site where they found the oldest humanoid bones/fossils. We got to walk around in the naturally formed caves and see the areas where these fossils were found/still being excavated 14 years later (pretty delicate process). It was a beautiful area, and it was a lot of fun to learn about all of this and how it was formed and later found.

This is where Mrs Ples (oldest fossil) was found:

But tomorrow it's forget the fun and back to work in a new section! We'll see how it goes.

Game drive:

This past weekend Emily and I went on a game drive to see the animals of South Africa! Namely "the beg 5" which I learned are called that because the are the 5 animals that are the deadliest to hunt and would kill you if you messed up. We didn't actually get to see all of them. We didn't get to see any cats (lions, cheetahs, or leopards). It was very hot this weekend and they were hiding in the shade. Here are some pics of the awesome things that we did see!:

Baboon Family (kinda cute if you ignore their butts)-

Hippo-

About 100 elephants at the lake at once:

Wildebeest-

Impala pack-

White Rhino-

Springbok (SA's national animal)-

Zebra-

It also turns out that SA has fields of sunflowers just like Kansas! So we stopped to have a look. This picture is for GJ and papa-

My time here is passing so quickly. At first I was counting down the days, but now I am very sad to see them go. It is actually a very nice place here with kind, considerate people. In my time here, I have also realized that I have either been up or down not really ever in the middle. It’s either patients who are so frustrating and can’t understand or want to do anything with you or situations that make you want to pull your hair out. Then a minute later it’s a patient who tells you about improvements and changes in their lives and thanks you over and over and you can see in their eyes that they really mean it or a helping hand when you don’t expect it. One second I’m wondering why everything has to be so terrible and frustrating (three patients that I have worked with have passed away since I have been here), and the next second I’m wondering why I have to leave because it’s an exciting challenge every day that we are all in together. I guess that’s the way it is everywhere; you just get used to it.

12 working days left & counting and wanting to hold on to every minute… at the moment.

Chaos

Well this has been a very hectic last few days! I'm just getting used to being in the neuro section which is great! and these people are awesome.

On Wednesday after our clinical, Emily and I went with our friend Niki to help at a mobile soup kitchen which drove through the street and stopped at the three spots it always stops at every Wednesday on the side of streets or near abandoned buildings. We would then pass out cups, water, pour soup, or hand out slices of bread. Once done handing out we would talk to everyone and get to know them. It was very interesting. A very good experience!

Thursday at work I had a patient faint on me. Let me first just tell you that 70% of hospital beds here are stomach height crib-looking beds (bars on all sides that go up and down). The beds do not raise and lower and the head/feet do not raise and lower. So after doing a 2 Max transfer of a patient (SCI quad) from this tall bed to a chair after a few minutes of being fine he passed out. Oh and also there's no continuous monitor on this patient to know any vitals. So dead lift back up the huge incline to the bed where he was breathing on his own and still had a fair pulse,  they decided to intubate him. Anyway after about 2 minutes of being intubated he was trying to spit out the incubation tube. Anyway after that craziness I got to practice some chest PT and use a vibrator pad to break loose some mucous plugs (apparently gentler than chest PT on patients with 2 broken ribs and broken clavicle) which really can help get some frustrations out! Later in the day, one of the physios told me she wished we would stay and work there and another patient of mine said "oh thank you my child" after treatment! So all in all crazy day, but I wouldn't change it. I think that is what I love about neuro! Every patient is so different presenting and just about anything can happen, crash or make major gains in independence. It keeps every day interesting.

So then today (Friday), I thought my head might explode. I asked for 4 patients to be transported to the gym for treatment today and none of them ended up getting there correctly. Then for icing (of sorts) on the cake, I went to treat a patient in the ward and there was literally crap everywhere in his bed. I was going with the benefit of the doubt and thinking the nurses (sisters) hadn't seen/smelled it which was pretty hard in the open rooms with 20-30 beds, you can pretty much see everything. So I notified them and was told that there were no more linens and nothing could be done. After a few minutes of asking questions like: 'when will more get here' 'are there no more you can borrow from other wards?' 'and there are no gowns we can clean him and redress him in?' and 'could we just clean him and let him lay on the something on the mattress?' and not getting much of anywhere with the nurse seeming completely ok with leaving the dependent patient in his soiled bed for hours, I turned and walked out doing some very deep breathing and walking very quickly for a very long time. I don't care what your policies or lack of resources are my conscience can't handle that and if you can there is something wrong.

After saying all that about the state of the hospital and lack of nursing/support staff, I will say that the reported condition of the hospitals in Bangladesh, as told by a young physio who had recently traveled there, is patients lying on the floor (not on mats, literally on the floor) because there are too many patients for the hospital to handle and IV poles and curtains that wrap around each bed in the large room of about 30 are non-existent. Bara is fancy compared to that. So I guess it could always be worse. I guess I should be grateful that the sick have some place to go for some treatment whether or not they can pay. Next week I suppose I will try to be more optimistic and look for the good.

On to the next thing...

Well, my time in peds is done. Yay! and I'm feeling pretty good about it. I think I may actually be able to do it as a job if I had to... probably not my first choice though. One final thing that I must say about peds is that on Friday I saw one of my patients leaving the hospital (he'd been there for quite a while and we were both counting the days until he could go home). and he gave this hand shake/signal to me that several patients had before, like a snapping motion except with two separate thumbs (two people's thumbs). I only have learned later that it goes with a saying "sharp, sharp" (pronounced shop, shop) that means I am ok, everything/ life is good. I was teased for not being able to infer what the signal meant, they said it was like two thumbs up communicating that everything was good! "where was I from that I didn't know that that is what that meant"!

Anyway, I think I did ok in peds, and no better way to celebrate than going to my first every rugby game with a few work friends! I learned a ton about basic rules of rugby and loved being at the game. Turns out rugby is super fun! I would say that America should get more into this rugby thing, but we would just rule it all up and it wouldn't be fun anymore! They even taught me how to throw a rugby ball after the game (it has to do with a down-by-your-side-two-handed-spin-pass thing)... The rest of the weekend was kind of low key/relaxing. We tried "Mama Shebeen's", authentic S.A. food, and a few of the local pubs with our nursing friends from Kansas. On Sunday we traveled to the market and grilled some ostrich, cooked vegis, chips (fries) and drank wine with the Kansas crew. In all a very nice, but not altogether sleepful weekend!


Today was my first day of neuro in Bara. I spent about an hour of the morning getting "oriented" to neuro wards, and then they sent me off to see my/Emily's leftover patients. Not too bad so far. It was all pretty much things I've seen before (except Guillain-Barre which is just like a spinal cord injury except it gets better). Everyone is VERY nice and helpful in the neuro section. although some maybe still slightly intense... I had a patient refuse me today and I had tried bargaining with her, telling her this is the only way she'll get out of the hospital, anything I could think of, I even tried just getting her set up and doing it anyway but she started flapping her arms and saying no. So I told one of the older PTs in the neuro section who reported to the MD and proceeded to just fling her up from the bed and into a chair even with the flailing and refusals. I was thinking 'ok so that's how you do it'; although I think I would have had to stop in the U.S. though, no is no there. On my last clinical in the States I learned that if the 80yo woman says 'get the F*** out of my room' you just turn around and leave! I am praying for a good experience in neuro these next two weeks and hopefully can learn a ton too..

Adventures

We have already had many adventures in our short time here in SA, and I'm sure we'll have many more. The first fun (non-work) things we did included visiting the "Origins" museum here on Wits Campus (tell about the origins of the human species here in Africa), and this weekend we went on a tour of Soweto (stands for south west township) which is where Bara Hospital is located and included the Apparthtide museum. We figured that we should know a bit about the majority of the people that we are treating in the hospital. The museums are very interesting, and the Apparthtide was touching. After a trip to the museum, we were taken to Soccer Stadium, Nelson Mandela's house, the memorial to where Hector Peterson was shot (12-13 yo boy shot in Apparthtide protest), and finally the different housing districts in Soweto. Upper class Soweto which in my opinion looks like middle class larger city (because they are very close together) USA :

Then there was the middle class housing which looked pretty low by US standards (look past the tin low income home and to the brick house:

These long concrete buildings are divided into government owned units converted from old mine housing (Jo'burg used to have gold mines) which are free but don't have water, sewer, or electricity:

Finally here are the poor shanty houses made of tin scraps: 

It was very interesting to see the different regions here in this poorer African suburb. It was also very, very sad. It hurt my heart to see how these people who are the majority of this suburb live everyday with water pumped from a well, port-a-pottys for toilets, and no electricity (which makes it impossible for us in the hospital to send them home with oxygen if they need it). I know that we have homeless in the US very similar to this, but to see the magnitude and volume of poor here felt like someone had punched me in the chest. I felt like the worst person in the world for leading the life that I do. I still get upset just thinking about it and knowing that there is not much I can do. The government here is working to help but it all takes so much time which is not what these people have. I thought that I knew how I felt about this from working at Bara, but I was apparently mistaken because it hit me like a ton of bricks no matter how clique that is. I pray for the best, or at least survivable conditions, for all of these people here and that everyone reading this blog never has to experience this in their lives. Anyway, the tour was very interesting and eye-opening. And I’m sure there will be more.

On a lighter note, other than humility being learned on this trip, I have learned that South Africans do a lot of cool things. Like using energy in kilojoules instead of Calories to measure food products which takes away the negative connotation, I mean you need energy to survive right? They also use lots of cool words that are fun to say, like: explaining to us the dodgy (iffy) parts of town. I learned that local is lekker (awesome), you can use the word ‘shame’ to respond to something good or bad which could be useful when you don’t really know what someone just said to you (as long as it wasn’t a question), and when someone asks if you want chips say yes because they mean fries my fav food. They also make their own chocolate, wine, beer, and liquor here which are all very good. As Emily puts it ‘peri-peri makes everything better’. Peri-peri is a type of pepper usually made into a spice that is good on literally everything (all meats, rice, vegis, and eggs).They also make aluminum cans and plastic bottles much thicker here than are in the States so I shake my Pepsi can and try to sip more several times before I decide that it is really all gone. I guess my proprioception overrides the other senses because all my life I know that when the can is that weight there is still some soda left. I have learned a thing or two about security of the threat of security because everything even private residences have high walls and barbed wire around them, all grounds like universities and hospitals have gates with security, and in Soweto they have police that stop random cars to search you, the car, and your bags and question you about your travels. I don’t know what they were looking for but they sure didn’t look very hard which is why I say ‘threat of security’. None of the guards really do the most through job but it must be enough to scare off at least some of the criminals because it is everywhere here. No one is really bothered by it; that is just their culture here: if you don’t protect/lock it, it’s up for grabs. And finally I learned that the online weather for Jo’burg is never correct. It has said 80-90% chance of rain most of the days we have been here and its only rained twice.

Not too bad.

Having to work on your birthday: not great, but being in a foreign country on your birthday: not half bad! Both the head of the Peds dept and "The Intimidator" gave me feedback today and seemed to think I was going well. And I was thinking 'well you could try showing it a little more!' Anyway after work Emily and I went to "Mike's Kitchen" a South African restaurant. They had such amazing sea food, drinks/beer, and desert! I ate prawn for the first time and loved it! (Thanks to Emily for a really great birthday) All in all a very successful day, and I don't even have to go to work tomorrow!

Also sorry to Emily! I think I kind of freaked her out yesterday (and by kinda I mean very). I was all of 15 minutes late getting back to the office from the wards yesterday and she thought I'd keeled over or something. I treating my last patient, and I was thinking that 15 minutes in the States mean absolutely nothing but here when 15:45 hits and it's the end of the day everyone locks the door and bolts. My fault! I was still in an American mindset. What's weird is that productivity is just about as important here as it is in the States...


Here are some pictures of the grounds of the hospital were we work and the converted army barack wards that I work in all day:

So... Day 2 in Bara

Ok so I'm in a country that I'm not familiar with, with customs that I am not familiar with, and now I'm stuck in Peds for 2 weeks (Thank you Jesus, it's just 2 weeks) which I also don't feel very comfortable with... I kind of feel like I am double in over my head. Not to mention that my afternoon lead therapist is "The Intimidator". She (and quite a few therapists here) are very to the point, don't smile at me or give me much feedback at all. It could be my imagination but I think she gives me weird looks and I hope she's not thinking " what is that girl doing with that kid". I know that I take too long but she always just says yeah that works. I think peds treatments are kind of subjective, right? Like lots of things can strengthen, actively stretch, cause weight bearing, etc. during play right?? Well anyway I guess just say a prayer for me that my peds knowledge starts falling out of my head onto patients.

I was in the pediatric burns ward this morning. Very sad, very small, not as sterile as you would think. And of course everyone cries when you have to range them, so you leave feeling like the worst person but knowing you did it for their own good. The outpatient burns room was just a room. Moms and babies lined up all around the outside of the room and out into the waiting area. The nurses (sisters) would come by and undress the wounds, then the PTs would come spend 5ish minutes ranging, doing something functional if at all possible, and talking to the mom about how to keep/gain range at home, then each kid would see the MD and get a dressing put back on by the sister. It was complete caos: you would go child to child to an endless supply. I probably saw 5 patients in 40 minutes. Wow, but what else can you do with them...

Well back to work tomorrow.... Hope I can feel better about my situation/patients then.

In the Beginning-

First life skill I learned in Africa: how to change the proxy settings on my computer! Not what you’d think huh? But I learned a ton more things today, my first day of work at Bara Hospital. Supposedly the World’s largest hospital. Definitely huge and confusing. I know that I can’t do it justice by explaining it so I will have to take a picture soon. The quick description is that it’s a HUGE campus with long open to air halls that are divided into rooms that have multiple beds in them. There are also some multiple floor buildings as well, but I haven’t been in them much yet. I am stricken by how much treatment is the same as it would be at home, but then there are also times when it (or the circumstances) are very different. I guess that I came here thinking that it would all be very different so now I am amazed at how similar it really is.

A few cultural things that I have picked up are: word shortening, they have a lot of abbreviations or they just say the first part of the word. For example, I have written Feb. but I always say February not Feb. Also if you have to go to surgery you are going to the theatre. Sounds good right?!