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Welcome to South Africa!

October 4, 2018

Hello from Cape Town!

 

 

I have now been in South Africa a little over a week and being honest it has completely exceeded all my expectations. To say we have been busy the past few days would be an understatement. I’ve pet a cheetah, climbed a few mountains, been to the oldest winery in Africa, and taken way too many pictures. We are definitely making the most of our short amount of time here! It has been a bit of an adjustment for all of us as things are much different here than in the US. For starters driving on the left-hand side of the road is very strange. You have to constantly remember that the right lane is now the passing lane, at roundabouts you go left, and there is no turning on red here at all. Other adjustments include having to ask for water at dinner as it's not regularly given, paying with Afrikaans Rands, and having very limited Wi-Fi as it’s not as prevalent or consistent as back home. Speaking of Rands the best thing about being American here is the currency exchange rate. While we are here the exchange rate is about 14 Rands for every 1 US dollar. To put this in perspective, at dinner I can get a very nice steak, mashed potatoes, and a glass of wine for R200 which is about $14. Back home that dinner would be $30 easy. Needless to say, we have been eating very well and the food here is delicious.

 

 

 

It is absolutely gorgeous here. Wherever we drive we always have a mountain or ocean to stare at. From the vineyards on hillsides, boulders on the beaches, to Table Mountain towering over Cape Town this is truly one of the most beautiful and diverse places I’ve ever been to. We knew we wanted to see the city from a great perspective, so we woke up at 5am to hike Lions Head Mountain at sunrise. My fellow climbers were a little hesitant of going so early but the view from the summit was completely worth it. The hike is definitely not for the faint of heart and has some iffy chains and ladders on the way to the top, but absolutely a must if you every come to Cape Town. I also highly recommend going at sunrise as the crowds are less, and the pictures are breathtaking. The next day to give our sore legs a break we took the cable car up to the top of Table Mountain, one of the New Natural 7 Wonders of the World. Much like the Eiffel Tower is to Paris, or the Golden Gate Bridge is to San Francisco, Table Mountain is the heart and soul of Cape Town. It truly is amazing both from afar and from atop.  

 

 

As I told you in my previous post the reason I am here is for an international pharmacy rotation. My school, MCPHS, has partnered with The University of the Western Cape here in Cape Town. During my time here, I will be precepted by Dr. Renier Coetzee. For those of you who are unfamiliar with pharmacy rotations I have a different preceptor during each one, they are licensed pharmacist that I report to and act as a one-on-one mentor during my different blocks. Dr. Coetzee is one of few PharmDs in South Africa and has a truly amazing backstory. The importance of pharmacist in a clinical setting is not very well understood in South Africa and Dr. Coetzee has worked very hard to showcase the value pharmacist can bring to hospitals. No other medical profession understands medications as well as we do and as medication is the main path for better health we are an invaluable resource. We understand not only what medications do, and how they work, but also how they interact with each other in the large picture of a patient.

 

 

For our first few weeks my peers and I are working at Tygerberg Hospital. It is a very large hospital with 1500 beds. To give you some scale Massachusetts General Hospital has a little over 1000 beds and its one of the largest hospitals in New England. Floors are referred to as “wards” and each patient room has six beds. The largest adjustment has been that there are no computers other than in a few doctors’ offices, so all patient charts are in folders and handwritten. Tygerberg is considered a government hospital which in America equates to a public hospital where most of its funding comes from the government and tax payer money. There are private hospitals, but these are for the higher economic classes. Government hospitals have a much smaller selection of medications to choose from. A good example of this is their most common Statin to give for high cholesterol is simvastatin 20mg and you see almost every patient on it. In America we tend to want most patients that qualify to be on atorvastatin or rosuvastatin as they have better outcomes data and are higher intensity statins to lower your cholesterol levels. One of the largest frustrations for me personally is that metformin and sulfonylureas are for the most part the only options for diabetics. As I have a special interest in diabetes it is frustrating to see patients on suboptimal treatment.

 

In the wards we work with current pharmacy students from UWC and they are a huge help in understanding SA brand names we don’t have in the US, as well as cultural things we would not know. On the flip side we as pharmacy students from America have received a much more detailed and in-depth education than the pharmacy students here so we are able to precept them, which is a very rewarding experience. Most get a Bachelor of Pharmacy in SA and not a Doctor of Pharmacy like I will be receiving so they truly value our knowledge. Our daily responsibilities in the wards are to evaluate patients and make sure they are receiving the most optimal treatment. For this rotation specifically, we are comparing how we treat in the US compared to how they treat diseases in SA. We work up patients like you would in the states and make recommendations like you would in the states, and then compare to what they are doing here in SA.

 

In the coming weeks we will be learning about the more prevelent disease states here such as Tuberculosis and HIV. It will be a very eye-opening experience to see these diseases first hand as they are not as common to see in the states. I’m interested to see how they manage these illnesses that here are so common, but also so devastating. We are also working on making a training module for local home-based care physicians in collaboration with an antimicrobial stewardship program. We hope to spread awareness on proper hygiene and antibiotic usage to these physicians that they can then pass on at a community level. On top of all this we are beginning our studies to prepare for the licensure exam in June, so we expect many coffee shops in our future.

 

 

I feel unbelievably fortunate to be here and have this experience. It is difficult seeing the very extreme economic diversity South Africa has, and makes me very thankful for everything we have in the states. I feel we often get so caught up in our own little corner of the world and that it is very important to see it from the outside. I look forward to continuously learning and being surprised during the coming weeks. As I said before we are making every second count, and if this much as happened in 10 days I can’t even begin to imagine what’s in store for the next 30.

 

Talk to you soon,

Mitchell

 

 

 

 

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