Healthcare Challenges in South Africa:A Summer Spent in Cape Town’s Public Hospital System

Maggie Heine, Centre College Class of 2016

Sociohistorical ContextIn 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 SystemSouth 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afford to pay anything at all, so it’s severely underfunded, meaning that many public hospitals are overcrowded with outdated facilities.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 HospitalDuring 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, 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.

SurgeryThe 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 LearnedThe 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.

Special thanks to the James Graham Brown Foundation, Centre College, and Child Family Health International

My ExperienceThe 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 RoomMy 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 MedicineHere, 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.