1. Healthcare Challenges in South Africa:
A Summer Spent in Cape Town’s Public Hospital System
Maggie Heine, Centre College Class of 2016
Sociohistorical Context
In 1497, Europeans under command of Vasco de
Gama arrived to the Cape of Good Hope in South
Africa. A halfway point between Europe and
India, Cape Town became a flourishing city. Native
Africans,
along
with
imported
Indians
and
Malaysians, were enslaved in vast numbers until 1834.
Even after being freed, formerly enslaved peoples were
entrapped in a complex and highly subjective 17-tier
class system spanning from “White” (sometimes
included Chinese/Japanese), “Colored” (both mixed
race and unfavorable races), and “Black” (purely
African). The apartheid era continued until 1990 when
President Frederik Willem de Klerk began negotiations
to abolish it. However, South Africa is still highly
segregated even today.
Healthcare System
South Africa’s healthcare system is two-pronged: public
and private. Anyone who can afford private healthcare
is mandated to buy it, but those who are in the lowest
income brackets are given free healthcare.
However, most people in public healthcare cannot
afford to pay anything at all, so it’s severely
underfunded, meaning that many public hospitals are
overcrowded with outdated facilities.
G.F. Jooste Hospital
During my 5-week stay in Cape Town, I lived and
worked in the Cape Flats region, a poor, mostly
Colored neighborhood. The hospital in which I
worked, G.F. Jooste, was public and was surrounded
by townships that included the hotspot for gang warfare
in Cape Town and the one-time murder capital of South
Africa. Because of this, G.F. Jooste sees a lot of
stabbings, shootings, and drug overdoses. The hospital
is almost always above maximum capacity, leading to
the spread of many communicable diseases. Jooste
has the world’s highest tuberculosis rate, and its
HIV/AIDS rate is 80-90%. Furthermore, the lifestyle of
Cape Flats citizens results in many cases of
diabetes, hypertension, and alcoholism.
My Experience
The program with which I traveled to Cape Town, Child Family
Health International, allowed all of the students in my group to
serve four rotations within G.F. Jooste: Emergency
Room, Internal Medicine, Orthopedics, and Surgery.
Emergency Room
My experience in the emergency room was the most dramatic
of my rotations at Jooste. Some of the more noteworthy
experiences there included performing chest compressions in
the critical care ward, witnessing an abortion, interacting with
Xhosa patients who believe in witch doctors, and treating gang
violence victims.
Internal Medicine
Here, I worked closely with medical students from the
University of Cape Town. They took me on their rotations to
see long-term patients suffering from conditions like
tuberculosis, meningitis, and other HIV/AIDS-related
illnesses, along with various disorders stemming from nutrition
deficiencies.
My Experience, cont’d.
Orthopedics
In orthopedics, doctors taught me how to diagnose
simple fractures and sprains, and I also learned how to
cast and sling. Furthermore, I was able to accompany
the head orthopedist into surgery to witness bunion
repairs, surgical fracture repairs, toe amputations, and
even an above-knee amputation.
Surgery
The majority of the surgeries performed at Jooste are
abdominal:
that
said,
I
mostly
saw
laparotomies, appendectomies, and spleen removals.
However, on my last day in surgery, I was able to scrub
in and assist with making and stapling on a skin graft.
Lessons Learned
The reason I initially chose to travel to Cape Town was
two-pronged: firstly, I was very interested by the idea of
working hands-on in a hospital setting, something I
couldn’t really attempt until medical school in the
United States. Furthermore, South Africa has always
fascinated me. As a history major, I was intrigued by
the rich, multi-faceted climate that led to such a
beautiful, diverse, and, in many ways, dysfunctional
country.
The enrichment project was rewarding on both
fronts, though for very different reasons. While I value
the time I had at G.F. Jooste immensely, the five weeks
I spent there helped me discover that medicine is not a
field I’d like to pursue. Instead, I’ve become interested
in public health since it is broader-scale and more
holistic than clinical medicine. I’m hoping to pursue
some sort of opportunity in that field for my next
summer project.
I also fell in love with South Africa this summer.
Whether I was on safari, climbing Table
Mountain,
bungee
jumping,
exploring
Cape
Town, visiting shanties, or just spending time with my
wonderful host mom, I enjoyed my entire experience so
much and would love to go back again someday.