Ollie Osunkunle / Foundation Doctor, Cambridge
Olaoluwakitan “Ollie” Osunkunle is a Foundation Trainee from Cambridge University. Here he looks back at his elective experience in Lesotho and Cape Town, South Africa.
The landscape in Lesotho is simply breathtaking – beyond words. Rather it is an experience. One that I am very fortunate to have enjoyed. Snow capped mountains frame the landscape, with stony sculptures beautifully carved from mother nature carpeting the terrain between.
Unfortunately, this picturesque view is made harsh by the bitter cold that bites sharply into one’s bones. Perhaps I should have made a wiser choice than to visit Lesotho in the winter. Fortunately, the hospital accommodation includes an abundant supply of woolly blankets, which I buried myself beneath every night to protect from Lesotho’s frigidity.
During my ten week elective period, I spent five weeks in the Orthopaedic department of the King Edward VIII hospital in Durban, South Africa and five weeks in the Maluti Adventist hospital in Mapoteng, Lesotho. I chose this combination so I could contrast the standard of medical care in the developed country of South Africa, against that of a developing country in Lesotho. One of my aims in organizing my elective was to learn more about the major health problems afflicting African countries. HIV and tuberculosis (TB) infection are two such notable issues, and Lesotho and South Africa have high rates of both. The HIV prevalence in Lesotho is the third highest in the world at 24% amongst those aged 15-49, while that of South Africa lags not far behind at the fourth highest: 17.8%. In addition, there is a prevalence of TB of 795/100 000 people in South Africa and 402/100 000 in Lesotho. A popular medical South African idiom goes, “Here in southern Africa, we are number one in HIV, TB and trauma.” What an accolade.
In Lesotho, the hospital is a 150 bed mission hospital run by the 7th Day Adventist Church but funded by the government. It serves a local population of about 100,000. As the Maluti Adventist Hospital is situated in a rural setting, the spectrum of disease varies markedly from that which one would experience in the UK. Amongst the paediatric population, malnutrition and infectious diarrhoea remain the major problems. In the hospital I performed the duties of a junior doctor, assisting in the outpatient department, the wards and the operating theatre. I was not confined to any particular specialty but spent the majority of my time in the outpatient department of the hospital, attending to a portion of the three hundred or so patients that attend each day. This offered me an excellent opportunity to improve my diagnostic and clinical reasoning skills. I also had the opportunity to improve my clinical skills. Suturing was frequently required, as wounds following episodes of violence were a common reason for presentation to the hospital. In addition, I was involved in the management of emergency cases, usually of shocked patients following trauma or obstetric complications. Unfortunately, language was a barrier here, as the local population were fluent only in their native language of Sesotho. However, student nurses were assigned to help translate for the doctors; none of the doctors were originally from Lesotho. The chief medical officer was originally from Argentina and there was a volunteer middle grade doctor from Amsterdam who was planning to stay for two years. The remainder of the doctors were from African countries, including the Democratic Republic of Congo and Zimbabwe.
The hospital was involved with outreach clinics, and I was able to assist in one such trip. This was to a rural village to provide free assessment and medication to those who could not afford to attend the hospital. The outreach clinic was set up at a school in the village. Here make-shift stations were set up in outdoor tents, with a volunteer healthcare professional at each station. Food was also cooked outdoors in large pots, and supplied to the patients as they waited.
The day was primarily focused on child health, with stations for mass immunization, growth monitoring, nutritional assessment and advice and dental reviews. There were also HIV DNA PCR test stations. A crew of four doctors were available to assess the multitudes and put into effect whatever treatments they felt were appropriate from the available list of ten or so medications… I joined the team in assessing patients and either prescribing medication or referring them to the hospital when I felt that the level of care they required was simply not possible at the outreach clinic.
Although I began the trip expecting to largely reassure the worried well, I was surprised by the sheer number of serious pathologies that I witnessed. The time I had spent in hospitals and general practice clinics in the UK had caused me to forget that elsewhere in the world, healthcare is not so easily available. From patients grappling with the devastating complications of HIV to babies scarred by severe burns. Unfortunately for some the cost of visiting the hospital (50 Rand, or the equivalent of £4 in the UK) was the limiting factor preventing patients from seeking treatment. When I think back to the abundance of investigations and treatment and available in the UK the plight of these patients is truly distressing.
- If you’re going during Winter, bring lots of warm clothes!
- If you’re planning to explore much of the surroundings, bring hiking boots. It can be tricky to navigate the terrain in trainers, as I discovered.
- Do get out of the hospital and explore the rest of Lesotho before you leave.
- There is plenty of interesting pathology to see at the hospital and the friendly staff of doctors and nurses are all very willing to teach.
- There is a very hands-on approach to the teaching so expect to be thrown in at the deep end from the beginning.
- As I said before, the landscape at Lesotho is gorgeous. There is ample opportunity to go hiking during your days off. Other fun activities include spending a day pony trekking across the mountains and visiting the local mountains.
- At the time that I attended Maluti, the hospital was short-staffed in terms of doctors, which meant that the care of patients was further compromised. This also meant that I was often left to practice unsupervised, which was potentially dangerous in cases where a patient required emergency care.
- Limitations in resources meant that investigations such as blood tests could not be performed, and the poor electricity supply posed a continuous hazard in theatre.
- In addition, during my stay I witnessed an outbreak of post-surgical wound infections which was later traced to a defective autoclave.
Destination / Maluti Adventist Hospital, Mapoteng, Lesotho.
Time of Year / July/August (Winter in Lesotho!)
Weather / Winter
Religion / Hospital is a 7th Day Adventist Campus.
Hospital contact / email@example.com (Chief Medical Officer)