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As one of the publically funded state hospitals a large proportion of patients were underprivileged and impoverished. Many patients lived on the outskirts of cities in townships. During the apartheid era black Africans were displaced from their communities when specific neighborhoods were assigned as “white only”. These areas were segregated into townships and the housing in these areas was informal, with lack of access to essential services like clean water and electricity. Common medical conditions seen in the pediatric ward were a direct consequence of poverty and overcrowded living circumstances. These included infectious diseases (tuberculosis, gastroenteritis), food insecurity (severe acute malnutrition, preterm labour), and smoke inhalation from home fires (asthma exacerbations).

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My global health elective took me to a special part of the world - to my home country of South Africa. As part of a well-established partnership with UBC Pediatrics, I had the opportunity to spend 3-months working at Paarl Provincial Hospital. The hospital is located in one of the oldest towns in the Western Cape and is a secondary level state hospital that acts as a referral center for a number of neighboring townships and small cities.

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Apart from giving teaching sessions on the ward, one unique example was working with the local residency program to deliver ‘journal club’. During my month, we worked on analyzing the original article appraising the Rochester Criteria, for febrile infants suspected of serious bacterial infection. Traditionally, journal club had been taught by the education director, but we had an idea that I could ‘teach the teacher’, so local residents could start to deliver journal club in the Khmer language. In this way, more physicians could understand and participate in discussions of epidemiology and critical analysis of a scholarly paper. Furthermore, as more residents from Ottawa go to AHC for elective experiences, we hope to develop a longitudinal partnership to contribute to the resident education at AHC.

Clear differences between the children’s hospital in Vancouver and Paarl included open wards with multiple cribs and patients per room. Children were segregated into a gastroenteritis room and a respiratory/medical room. Isolation rooms and use of personal protective equipment for contagious illnesses was limited. In these close quarters mothers had a difficult time. If nasogastric feeds were required, mother’s hand expressed for hours as breast pumps were not available. They were required to sleep on the floor on thin mattresses during lights-out from 11pm and 5am. They also faced a lack of privacy and confidentiality, as fellow mothers often listened eagerly to what the medical team was saying about other patients during rounds. Despite these trying situations there was a clear sense of community between families. If a patient’s mother stepped out to shower or tend to a child at home, other mothers in the group would work together to look after the child.

During my time at the hospital I worked closely with the medical interns as we often shared call shifts. With a busy maternity ward we attended many newborn deliveries together. I noticed that interns quickly jumped to CPR in their treatment algorithm without going through all of our typical MR SOPA ventilation steps to correct low heart rate. Unfortunately interns do not receive formal training with neonatal resuscitation prior to starting their intense pediatric rotation, likely due to financial constraints and limited staffing. I was able to teach neonatal resuscitation with mannequins and simulation training, and feedback from the interns was positive. I also provided teaching on common pediatric topics including immune thrombocytopenia and asthma. Local interns reciprocated with specific teaching on HIV and tuberculosis; illnesses that we see less frequently in Canada.

Overall my pediatric experience at the Paarl Provincial Hospital was invaluable. While at times overwhelming, my experience is one that I would thoroughly recommend to my fellow residents. It provides a unique and impactful opportunity to gain practical skills and help provide care in a resource-limited area.

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To share this international experience with others, grant recipients are required to submit a brief written summary of their elective (1-2 pages) within one month of their return. The report will be published on the CPS website in the language of submission and may be included in a future CPS publication.

My sweat continues to fall, drop by drop. How am I the only one sweating on this ward? It cannot be humanly possible, even for these Cambodian people, not to be sweating! It’s 35 degrees Celsius and there isn’t even air conditioning. Am I nervous to make a good impression? Or rather, am I excited to see some interesting tropical infections?

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Or perhaps am I uneasy because I stick out, the one dressed not in scrubs, but rather, a clean dress shirt and pants (which are now drenched in sweat)?

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