Thursday, April 3, 2014

outreach visit to dundee

on the very first day at edendale, one of the consultants insisted that going on an outreach trip was a must. in fact, he made some calls that day to see if he could get a spot on the plane for the following day! although unsuccessful for that trip (the plane only has six passenger seats), i was lucky enough to be able to go this past tuesday to dundee. totally worth it! 

orientation: dundee is north of pietermartizburg, still in KZN province

so on tuesday my day started out early, just like going to edendale, waking up before sunrise. tiptoeing around in the dark with the just-prior-to-sunrise light streaming into the windows of our cottage... and then, as if in an instant, the rising sun creeps through the windows and bathes everything with golden light, reminding you it's the day and you must get on with things!

marybeth dropped me off at the airport where i waited in the arrivals area. the plane, a pilatus aircraft used by the south african red cross, cannot be missed. it's bright red, with a cheery propeller at the front, and streaks across the blue sky and green fields in no subtle fashion. when it arrived, i was ushered through a security point and then directly onto the tarmac. i'd never been on a helicopter or other small aircraft and found the whole thing a bit intimidating for the first time. i climbed the four steps into it and sat in one of the six seats in the cabin. i was promptly handed paperwork to fill out detailing my name, position, contact information... and next of kin. breathing deeply in attempts to loosen the gigantic knot that had formed in my stomach, i snapped my seat belt into place and re-focused my attention on enjoying the fleeting moment in my air travel career in which i would have both an aisle AND window seat at the same time.

the plane!
inside the plane, view forward standing next to my seat

the flight was surprisingly smooth. it was sort of fun having the cockpit open to the rest of the craft, listening to the pilots go through their routine of turning things on and off. we were instantly in the clouds... and climbed no higher. i'm not sure the altitude or speed at which we were flying, however i'm sure some sort of physics problem might be able to solve this if i were so inclined as we arrived at our destination, dundee, within 40 minutes. 
the view out my window: flying over the tugela river

as we approached dundee, it became abundantly clear that an airport did not exist here. no matter! one of the many benefits to taking such a small, nimble aircraft is that it routinely lands in fields. the pilots brought the plane in for landing, and then quickly took it back up again. we all looked at each other nervously. the pilots banked, made a loop, and came down in another spot landing the plane safely in the field. one of the pilots turned around, grinning: "sorry about that -- we didn't want to take out the the horses!"

popping out of the plane, a bright yellow kwa-zulu natal department of health vehicle appeared out of thin air. we were beckoned into it. it was at this point that i met dr. caldwell, a seasoned medicine consultant from edendale, with whom i'd be spending the day in his medical specialty (yes, specialty!) clinic at dundee hospital. 

entering dundee hospital.

dundee is a provincial hospital, and as i came to understand, only has "general" doctors. they provide first-line care to the patients in this part of the province, however if something becomes medically more than routine, they refer the patients to dr. caldwell's medicine specialty clinic which he holds on the first tuesday of each month. (in fact, dr. caldwell goes every tuesday and thursday on these outreach trips, holding eight separate medicine specialty clinics at eight provincial hospitals each month.) the clinics work on 'referrals' and thus every patient seen has a letter describing the nature of the problem, basic labs, XR, ECG, or whatever else is relevant. these letters are of varying help; one such letter stated: "dear doctor, please evaluate this patient. the trouble is most certainly with the heart." (and the referrer was right: the patient was a 14yo with syncope, palpitations, and the most impressive visible thrill and massively palpable impulse i've ever seen -- really almost no need for a stethoscope at all.) dr. caldwell would carefully re-hash salient points of the history, examine the patients, and help arrange either follow-up with himself at the next month's clinic or with specialists at a tertiary care hospital in pietermaritzburg (cardiology, pulmonology, etc). the patients were not dissimilar from those at edendale; the burden of TB and HIV/AIDS was overwhelming. even so, he saw patients with other medical conditions like pulmonary fibrosis, dilated cardiomyopathy, peripheral neuropathy, and heart block.

the clinic lasted for the morning and early afternoon, after which time the staff had prepared a light lunch and tea for us. it was charming, really, to be in such a simple hospital where dr. caldwell was clearly so well looked-after.

we met the pilots back at the field mid-afternoon and made our way back to pietermaritzburg. less smooth, however, as we were working against the weather on the way back: a sudden late-summer afternoon storm had rolled in. flying through the clouds, we witnessed a terrifically frightening lightning show off to our west and the fascinating view of rain showers from the side of the cloud. much to the improvement of our collective blood pressures, we arrived safely (on a paved landing strip!) at pietermaritzburg airport just before the heavens opened.

heading back to p-burg, xrays in tow.
the view on the way back: rain showers in the (not so far) distance

what an experience! obviously, the excitement of the flight itself is still at the forefront of my memory. beyond that, though, the trip was really illuminating. it's quite a position for dr. caldwell; he is able to primarily diagnose many conditions and help coordinate care for these individuals, many of whom would otherwise go undiagnosed and/or treated. not only that, but he is also able to have ongoing therapeutic relationships with patients he cares for through the recurring monthly clinics -- the continuity being something so many of us in internal medicine value greatly about our career choice. it was a pleasure being witness to this unique program and involved in small ways.

until next time,

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