A Middle Income Country

As we enter the last week of our stay here in South Africa (!), I'm starting to reflect a great deal on our experience and the country we have called home. South Africa is such a contradiction in terms, and it's healthcare system is just as chaotic and inconsistent as the landscape. As we've mentioned earlier, Edendale, a government run hospital, suffers from many problems secondary to lack of resources....not nearly enough attendings or residents (when someone is sick or on leave, there is no one to replace them), 1 CT scan (and no MRI), and scanty support/ancillary staff (intern = phlebotomist, IV nurse, and scut monkey). Labs can be drawn and sent, but after spending the majority of my morning redrawing blood that had been sent days earlier, I've certainly come to realize that it often cannot be found. On the other end of the spectrum, as an Afrikaner said to me the other day, if you have money, you go to a private hospital and pay for your care. There they have the resources, technology, and staff to adequately evaluate, diagnose, and treat patients (shocking I know). While inequalities certainly exist in the states (and obviously Columbia, hello McKeen), the degree to which it is displayed here is shocking to outsiders, but simply the way of life for South Africans.

Similarly, the burden of disease is overwhelming and just as diverse. At Edendale we tend to see mostly patients with advanced AIDS, often complicated by TB (apparently 1 study done by an attending here demonstrated 19% of which is MDR!); however, it is not at all uncommon to care for diabetic/hypertensives admitted with CVA (stroke) in the next bed. And as we experience more and more of this country, let me tell you, obesity is just as common as in the states and fast food is everywhere (KFC seems to be the overwhelming favorite). Infectious disease (AIDS, TB, malaria) remain wildly uncontrolled, and chronic diseases typical of wealthier countries (stroke, heart attacks) have begun to emerge and threaten to overwhelm the system.

South Africa is a land of mountains and savannahs, BMWs and mud huts, cachectic AIDS patients and diabetics, rural townships (hours from the nearest hospital) and bustling metropolises. A land of have nothings and have way too much.

-N