After taking one week off from the clinic to celebrate Women’s Day, I was feeling very anxious to get back to it. I decided to try out another night and ended up going to a different clinic than the one I’d been going to in Khayelitsha. This clinic was in Philippi, and instead of being a building was a trailer that had been transformed into a makeshift clinic. We didn’t have a lot of fourth years, so I ended up with a third year medical student in a cubicle. I knew that the shortage of students would allow me to be more hands on and have more responsibility, which made me excited but also nervous.
The first person we saw was complaining of back and leg pain. We examined her back and saw that she had severe scoliosis. We decided to send her to a physical therapist (physiotherapist as they say in SA) to learn some exercises to deal with her pain.
Our next patient was a young girl. She came in with her mom, and I could immediately tell that she felt uncomfortable and very ill. The medical student I was paired with was in the medicine room, so I was in charge of taking medical history by myself for the first time. I learned that the girl was having extreme pain in her right upper abdomen along with pain between her buttocks and in her vagina. She had been experiencing this since January, and had lost all of her appetite and energy, causing her to lose 6kg (13lbs). She had stopped menstruating, was having trouble going to the bathroom, had stopped going to school because of fatigue, and was in constant pain.
At first I thought she may have Hepatitis because of the liver pain and vaginal issues, but I wasn’t sure what the disease looked like. I did an abdominal examination but didn’t find anything out of the ordinary except pain near the liver. I called in the doctor and presented the case to her, and she decided to do a vaginal exam. She determined that the girl had an infection and that her body was struggling to fight it off. She recommended an HIV test. South Africa has the world’s highest HIV rate, with almost 20% of the population being infected. HIV status is one of the first questions asked, and knowing your status by being tested regularly is a critical part of their health system. This was my first time testing someone for HIV, and the medical student showed me how to do the test, which is much like a pregnancy test that used blood instead of urine. The first test didn’t work, so we did a second. That time the test initially said negative, and then switched to positive. For the first time, I had to go through the HIV counseling procedure and discuss what the disease is, how you get it, and how you live with it. I felt extreme sadness having to go through this with a girl one year younger than me. This was my first time seeing how sick someone with HIV is, and the pain they feel. The need for education on prevention of the disease is a serious issue in South Africa, and despite efforts to improve the rate it remains a serious problem.
I left the clinic that night feeling less ecstatic than the weeks before, but still knowing I had learned. I was able to see first hand a serious problem in South Africa, and it made me think about what else could be done to prevent the spread of HIV. Education on the disease and sexual health, and also making protection more available not only to people in town, but also people in the townships, could prevent so many people from contracting the disease. I will never forget that night, and I hope that I can somehow be involved in helping with this effort while I am in Cape Town.