THE ELECTIVE EXPERIENCE: Groote Schuur Hospital

In CMUL, 5th year is what most people look forward to. This is because it is allegedly 'stress free' and it's also when we go on medical electives. 

What is a medical elective? To some it's just time to go to London and take pictures in the snow #NoShade, To some it's time taken off school to learn a trade. But according to Wikipedia, it is a placement undertaken as part of a medical degree. The content and setting of the placement are largely decided by the student undertaking it, hence the name. In basic terms, you get to spend a certain amount of time in another hospital, either at home or abroad and in a field of your choice. Just to see how things are done outside your home hospital. 

For me, it is One month of Emergency Medicine at Groote Schuur Hospital of the University of Capetown and another month of Surgery at Kenyatta National Hospital of the University of Nairobi. 

I just finished the first leg of my elective at Groote Schuur Hospital and I'm currently en route to Kenyatta. 

This elective for me was an eye opener. I learnt so much and I got to appreciate a system that actually works unlike what we have back home. I've always known that when it comes to healthcare, Nigeria is still in the cradle. But being compared to what I saw at Groote Schuur, healthcare and even medical education in Nigeria is not even a foetus yet. A morula is more like it. 

Apart from some instances of racial prejudice, I had helluva time. I did procedures that I wouldn't have dreamt of doing until I become a house officer. Basic things like Blood collection, Lumbar Puncture, Setting up I/V lines, Pleural taps, ECGs, ABGs and blood cultures which are considered house officer duties back home. 
I was actively involved in patient care, clerking and formulating management plans, Patient counselling and so on. Unlike where I come from where I'm practically just an observer watching the doctors talk over my head. 

I got to appreciate;
-The patient record system that allows you look up patient information even from another hospital in the province. No issues of misplaced case note or the records staff are on strike. 
-Laboratory system that allows you request investigations on a monitor and then view the results when they come back in. Blood results, X-rays, CT scans and all sorts. Results come back within a few hours depending on how booked the lab is. You can also look up previous investigations that were done in other hospitals. All this instead of having the house officer/patient's relatives chase results up and down like headless goats. 

Above is a CT Angiogram of an Abdominal Aortic Aneurysm (Triple A). You don't get to see one everyday. 

-Ambulance/paramedic services that seemed effective enough. 
-Intercom system which is just so basic and makes things easy. Instead of sending people up and down to deliver messages, just make a simple phone call.  
-Response to consults. When you request a consult from another specialist, they respond in less than an hour to review the patient but back home requesting a consult is like applying for visa.  Especially when it comes to the surgeons. 
-Health Insurance. There was no issue of you have to deposit before we treat you. Or we need to put up a line so we have to send the family to buy cannulas, drugs, I/V fluids before anything can be done.  'Everything' was in place. I never observed out of pocket spending. 
-A referral system that works. This means patients don't present at the tertiary hospital with headaches. There's a hierarchy of referral from GPs to general hospitals and then tertiary hospitals. 
-Tap water. This may seem petty but in our wards and clinics we sometimes have to employ the use of buckets of water. During this elective, I was washing my hands like every 5 seconds that you wouldn't believe we don't have running water where I come from. 

At one point I told my friend Kafa that The Resuscitation area of the Emergency Room looks just like our ICU back home. I wondered what their ICU looked like. 

While I was busy appreciating the opportunity and bountifulness in the hospital that is Groote Schuur, then came another elective student from Austria who was totally appalled by the system there. She sometimes went; "It's really difficult when you don't have all the right things to work with you know?" Just because she didn't find something inconsequential  like a basket to put her blood collection kit in. She also felt that she wasn't getting enough procedures to do. You see, one man's heaven is another's dustbin. 

With this, I'm wondering how our leaders manage to sleep at night after going abroad and seeing how their health systems  work and not even try to improve what we have. Instead our hospitals just get crippled-er and crippled-er; Plagued by incessant strikes and corruption. 

I just pray change comes to Nigeria soon enough and I'm more convinced now than ever that I want to be part of the change in the health sector. -Even though I'm lazy.

PS: Discussing the students and doctors will be a topic for another day. 

Also, to medical students: if you're ever looking to do an elective, I suggest you do it in Emergency Medicine/Trauma you get to see many diverse cases, learn how to manage them and get to do more procedures. 

Kemi Windapo