by Keely Kriho
Four emotions, always in the same order, greet me every morning at 6 AM when I wake up to begin my day at Red Cross War Memorial Children’s Hospital.
The first is panic in response to my alarm going off at such an early hour. My five roommates don’t get up until around nine, and therefore I try as quickly and silently as possible to press the “off” button on my new, 120-Rand ($10 USD) South African, opposite-of-smart phone.
The second emotion is amazement: Even after being in Cape Town, South Africa for an entire month, I still can’t get over the fact that I’m on a completely different continent, 32 hours of travel from Chicago, by myself, in the most beautiful, diverse, and captivating city I’ve ever experienced.
The last two emotions, which closely follow the amazement, are excitement and relief. The excitement is caused by the work I’ll be doing at the hospital, which could consist of watching an open-heart surgery, getting to listen to medical lectures, talking to patients, running around the clinics to get data, typing up that data, reading articles, going to the townships to help treat patients there in mobile clinics, or any combination of the above. And the relief comes from knowing that what I’ve wanted to do for my entire life is something I actually get excited to do.
From the moment I started thinking about doing a gap year, I knew that I wanted to spend at least a portion of it exploring the global aspects of medicine. I’ve wanted to be a doctor for as long as I can remember, but before beginning college, I wanted to make sure this was still my goal and not just an idea I’d become comfortable with. When I found out about Red Cross War Memorial Children’s Hospital and its affiliation with UNC, I was overjoyed: The place I wanted to go—South Africa—and the field I wanted to volunteer in were actually an option… together! So after getting home from South America and spending the holidays reverse-culture-shocking with my family and friends, I set off on the surreal and turbulent flight to Cape Town.
Cape Town, in the words of my research partner Dr. Storm de Klerk, is “the best city in the world.” I certainly haven’t seen every city in the world, but I can definitely see how it could be. Cape Town is loud, busy, colorful, hot, and windy. It smells of ocean air mixed with fruit, heat, and exhaust (mainly from the hundreds of minibus taxis, my chosen mode of transportation, constantly circling the city). There are so many parts of Cape Town: the inner city, with its mix of modern buildings and older Cape Dutch architecture; Observatory, where I live, with its jam-packed, vibrantly-painted houses and quaint restaurants; the national park and garden areas, teeming with greenery, steep slopes, and wildlife, all with the backdrop of Table Mountain; and the townships, where poverty and disparity can be seen twenty minutes from the middle of the city.
Cape Town is an area of rich history, passionate and welcoming people, controversy, beauty, and forward momentum. I do love it here.
I spend most of my days at the amazing Red Cross War Memorial Children’s Hospital as a research assistant for Professor Rode, a pediatric burn specialist and surgeon who is the most knowledgeable doctor I’ve ever met and who gives me chocolate whenever I figure out how to do something tricky on Excel.
The research that Storm and I are collecting data for is about the surface area of the hand in pediatric patients. When children are brought into the emergency room with burns, the percentage of their total body surface area covered in burns is determined by using the palm as a rough one-percent estimate, and so doctors will take the palm of the child and see how many times it covers the burn, using that number to determine the burn surface area and to then administer fluids and medication according equations that use that percentage. The problem is that the palm estimate is just that—an estimate—and has never been proven to actually be 1% in children, especially since children have much different proportions than adults.
So Professor Rode wants to see if the hand-equalling-one-percent theory is true, and if not, do something about it: Eventually, we will have templates made that are an average of 1% body surface area for each age that will be kept in the ER as a more precise determinant of burn surface area in children.
So I go to the hospital’s daily clinics and measure the hands of children, type the data into Excel, analyze it using my very minimal knowledge of statistics, and write about what I did for the eventual research report. I like this work a lot, especially the active, engaged aspect of it: interacting with patients, especially children; learning how to present the study accurately and concisely to parents; and being a part of every process of the research, from the collection of the data to the recording of it to its analysis to writing about the findings. It’s really fulfilling, satisfying work.
Soon, I’ll begin work on a second research study, aimed at burn prevention. We will be seeing how much kids retain about burn prevention from reading this book, of which Prof Rode was one of the contributing authors.
Monday through Wednesday night (and every other Saturday morning), I get to learn even more about South African medicine by traveling to clinics in the townships with the Student Health and Wellness Centers Organization (SHAWCO). The townships are settlements on the outskirts of Cape Town where small, one-story houses are built close together, and the area is characterized by poverty and crime. SHAWCO visits each township once a week, usually in mobile, trailer-style clinics with three exam rooms and a portable pharmacy we take with us.
SHAWCO—affiliated with the University of Cape Town—provides fifth-and-sixth-year medical students with the opportunity to be the doctor in an exam room, teaching the pre-clinical-year students (i.e. me) how to take a patient history, do a physical exam, perform diagnostic tests, and utilize the concepts of differential diagnosis and other diagnostic tools and tips. Then, when the students have made their diagnosis, a certified medical doctor, always with tons of clinical experience and great teaching skills, comes to assess the patient.
The situation is a win-win: students get to learn about providing clinical primary care in an impoverished, under-resourced setting, and the residents of the townships get free access to healthcare and medication if their illness necessitates it. Usually, I just write out patient histories, ask questions to the medical students and patients, and learn how to do examinations. But the other day at the pediatric clinic, another student and I got our own room, and I actually got to present the patient to the overseeing doctor! I did not do a great job (my medical terminology is basically nonexistent), but it just makes me want to learn more so I can do better.
While my time here has been exciting, it has opened my eyes to a few key aspects of medicine I’d never thought about.
I’m not a doctor, or even close to being one, but because I’m working in a hospital environment and have a name tag that says “Keely Kriho: Paediatric Surgery,” the patients and their parents see me as an authority figure, and the responsibility that comes with that—knowing that, for most patients, whatever you say will be unquestioningly accepted—weights heavily on my shoulders. Taking non-invasive measurements of patients’ hands is one thing, but being in the clinics is another, where you have the potential to diagnose what’s making someone ill, or of getting it wrong, which is especially precarious when individuals rarely come to see a doctor.
One of the young doctors put it perfectly the other day: “Patients are flown in on helicopter to receive care here, at the best pediatric burn center in the country, and then they’re given to me.” I feel so unqualified for this position, yet from what I’ve heard from the other medical students and young doctors, and even from what I’ve witnessed from the more experienced health staff, everyone sometimes feels a sense of inadequacy.
I used to think of medicine as a field of precision and perfection, a place where science was given a practical application, a human face, and where anything was curable. During this past month, many things have made me rethink that assumption. While we have rules and tools to help, mistakes are inevitable.
I see how fallible a diagnosis really is and how every decision in patient care is made by a real person who makes mistakes and who has a life outside of the hospital. Doctors only six or seven years older than me with a little more education and experience are put in a setting where they hold a powerful influence on a patient’s disease and in the course of their life. That sort of responsibility is overwhelming, and I don’t understand how anyone could take it lightly, which explains why few do.
Watching a surgery being performed on a baby, I understood for the first time how much is really at stake, how much knowledge a doctor must have, and how many things are outside of a doctor’s ability to control and treat.
Jeffrey Sachs, in the book The End of Poverty, spoke of medicine as “a hallowed occupation, a great and distinctive calling with very high ethical responsibilities.” I believe this to be absolutely true, not in spire of medicine’s apparent imperfections, but because of them. Medicine is not an esteemed field because of the supposed omniscience of the doctors. It is revered because of the absolute dedication with which health care professionals use their lives to better the lives of others. They respond to the needs of humanity in the most basic way: keeping others healthy and helping them when they become sick. It is because of this commitment, and, I believe, because of the knowledge of their imperfections, that the doctor can simultaneously see himself and the patient as equals while saying, “I am going to do everything I can, spend my entire life learning, to help make and keep you well.”
As Dr. Paul Farmer says, “At best, medicine is a service much more than a science.”
Thus far, my time here has made me infinitely more excited to be a part of this amazing field. I want to learn more about every aspect of medicine and public health and be able to feel confident in my ability to take someone’s life in my hands and give them the best care possible. Dr. Paul Farmer (yes, him again) was quoted in Mountains Beyond Mountains as having said, when talking about the medical field, “I don’t know why everybody isn’t excited by it.” Same here, Paul. Same here.