My service learning site is the Tafelsig Health
Clinic in the township of Mitchell’s Plain, the largest colored community in
Cape Town. The clinic sees over 500 patients a day for tablets, BANC, club
dates, family planning, psychiatry, TB clinic and any general complaints (and I
do mean any). On an average day, patients start queuing outside the clinic
around 6:00 am. The clinic opens at 7:30 am and madness ensues. Club patients
are those who have an appointment with the doctor. All patients see the doctor every
6 months for a full checkup and to have their medicine adjusted if need be.
There are specific days for certain chronic illnesses such as diabetes and
hypertension. While the patients wait to see the doctor, the nurses or students
(us!) give a talk about risk factors for these diseases and prevention methods
with an emphasis on exercise and healthy eating. When patients are done with
the doctor, they bring their script to the pharmacy/chemist. They join the long
lines of people waiting for their tablets. This line includes patients who are
there only for tablets who give their card to the pharmacy and wait while their
pills are counted and bagged. For most patients they have a date once a month when
they pick up their tablets and the pharmacist initials to indicate that the
patient hasn’t defaulted. BANC patients are those in maternity care or young
child care. Family planning is the sister who sees patients for birth control,
condoms and HIV testing.
Anyone tested for HIV will also be tested for TB
because of the high incidence of the two together. (The same is true if someone
comes in for a TB test; they will also be tested for HIV) TB testing is done in
the TB clinic where patients will give a sputum or spit sample to be sent away
for analysis. For every patient, two samples are taken an hour apart. The two
samples have to be stapled together in order to be sent for the new TB testing
which can tell if someone has TB or is susceptible before they even feel some
of the symptoms. To confirm TB diagnosis, an x-ray will also be performed at
the day hospital. On the x-ray the doctor looks for white patches in the lungs
which can be signs of the disease progressing. There are two types of
tuberculosis: pulmonary and multi-drug resistant (MDR). MDR TB occurs if
someone comes in contact with someone else who has MDR TB or if they default on
their medication from their first round of pulmonary TB. What impressed me the
most with the TB clinic was the in-depth counseling for every suspected TB case
and confirmed case. There is a flip chart presentation which describes what TB
is, how TB can be transmitted, what the treatment plan involves and the
importance of healthy eating while on the medication and beyond. For the first
patient I sat in on Sheena, the TB counselor, told me to give the talk on
healthy eating because she noticed I’m always eating healthy at tea time and
lunch time. (Turns out all of the nurses have taken note of this)
The standard TB treatment cycle is 6 months: 2 in
the intensive phase and 4 in the continuation phase if the sputum comes back
negative after two months. The important factors in changing to the
continuation phase are weight, compliance with treatment and sputum results.
One of the main symptoms of TB is weight loss so the patient’s weight is
closely monitored to ensure weight gain while on treatment. Compliance is a big
part of the decision because the patient must continue medication even if they feel
better. During the first two weeks of treatment, the patient must come in every
morning to take their medication so the doctor can sign off. If the patient
completes this then they are given medication in two week intervals and must
initial their card saying they took their medication. At the two month mark the
patient must bring in a buddy who vouches to handle the medication and
administer it each morning. Throughout this time a community care worker goes
to the patient’s house to do a pill count, ensure the patient is taking their
medication and that the living environment is safe. This integrated treatment
is key to their success at curing TB patients and was something I’m very
grateful I had the chance to experience.
There’s something so powerful about knowing how to
help someone with anything and solving people’s problems to give them peace of
mind. They leave knowing they’re being sent somewhere to be helped or were
given something to help them. And the doctor is the person with the knowledge
to do this. What I appreciate most about the doctor’s, however, is their
humility. They acknowledge when they don’t have all the answers and sometimes
they ask for advice from clinic members considered beneath them or are taught a
new procedure from a sister. And the patient trusts the doctor with their
health anyway. In the US, doctors don’t falter on their diagnoses and their
opinion is presented as fact. Because of this, asking for a second opinion can
be seen as an insult to the first doctor who may have showed signs of
incompetence. Medicine is always changing and you might not be as caught up on
a new policy as someone else, but the willingness and openness to learn is so
much more powerful than ego. Something else I really like is the bluntness of
the doctors and sisters. There are no excuses allowed and they tell the
patients exactly what they’re thinking. In the US doctors are concerned with
hurting feelings and are sure to be delicate when talking to patients for fear
of offending someone which could get them sued. Here, if the patient smokes
they’re given a stern looking and a scolding with “shame” used at least three
times. If the patient is diabetic and had 6 sugars in their tea this morning,
“shame, shame, shame, why would you do that when you know you’re coming to the
clinic today?” If the patient has hypertension and is overweight they’re told
to lose a certain amount of weight before their next visit because being fat is
affecting their health. Patients have been told they’re killing themselves with
their current lifestyle, they’re going to have a heart attack or a stroke, or
they’re a walking target for health problems. There’s no sugarcoating in this
clinic; clean up your life or something bad is going to happen, end of story.
Honestly, it’s a refreshing attitude that I am not accustomed to hearing and I
still chuckle a little when the doctor scolds a patient. Overall, we’re getting
invaluable experience that we wouldn’t come close to having access to in the
US. My days at Tafelsig will stay with me for the rest of my life and maybe,
I’ll be back here some day in the future after I’ve completed my schooling and
have the confidence to really make a difference down here.
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