This rotation takes place at a community health system in Durban. You will be part of a bustling facility that meets a wide range of healthcare needs for the surrounding community.
Durban is the heart of the Kwa-Zulu Natal province in South Africa, and the heartland of Zulu culture. This dynamic city of over 3 million people is South Africa’s third most populous city, known for its warm subtropical weather and beautiful coastline.
Since Apartheid’s fall in 1994, South Africa has improved infrastructure, education, economic opportunity and healthcare services for the underserved. Kwa-Zulu Natal province was the epicenter of the HIV/AIDS epidemic in the 1990’s with lasting impacts in subsequent decades. This challenge led to innovative approaches to provide access to prevention, treatment and education. Despite great efforts, the repressive legacy of Apartheid and the HIV/AIDS and TB pandemics have continued to overburden the fledging healthcare system.
There are two specified options for 4th/6th year medical student rotations in Durban, South Africa: Pediatric Medicine and General Surgery.
Pediatric Medicine: This rotation takes place in the inpatient and outpatient services of a community-based hospital in Durban. The local healthcare teams are excited to welcome you to their midst and showcase their approach to addressing the burden of disease in their community. Durban has the highest HIV incidence in the country. In addition, there is a large burden of disease of respiratory illness, diarrheal disease, TB, malnutrition, neurologic conditions, and childhood cancers. The structure of a referential health system is emphasized as you will see children referred from rural areas for care that is only available in urban centers.
General Surgery: The Lancet Commission on Global Surgery put forth recommendations for improvement in global surgical care systems in 2015. The commission suggests six indicators to monitor access and quality of surgery: access to timely essential surgery (less than 2 hours), specialist surgical workforce density (20 surgical specialists per 100,000 population), surgical volume (5,000 procedures per 100,000 population), perioperative mortality (goal is to collect data and then set targets), protection against impoverishing expenditures (expenditures that result in putting a family below the poverty line), protection against catastrophic expenditure (expenditures that threaten the household’s ability to maintain its subsistence needs).
They also described The Three Delays framework to understand why people who need surgical care do not get it. The First Delay—the delay in seeking care—occurs when patients often wait to seek health care because of financial and geographic restrictions, cultural beliefs, poor education, a history of being disconnected from formal health systems, and low awareness of available services or low confidence in those services. The Second Delay—the delay in reaching care—occurs when hospitals with surgical capacity are scarce, meaning the nearest facility can be hours to days away, depending on mode of transportation. The Third Delay—the delay in receiving care—occurs when attendance at a hospital does not guarantee treatment, due to staffing, availability of operating rooms, sterile instruments, and other requirements of safe surgical care.
This rotation takes place in a busy general surgery service at a community based hospital in Durban. You will not only appreciate the local approach to surgical care, but also see a referential health system in action – where patient’s are directed to the lowest level of care that is necessary for their condition and referred to higher levels of care based on structured triage systems.
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To apply, select “Global Health in South Africa (Durban).” After you fill out the application forms and receive confirmation of acceptance from the CFHI team, please indicate your preferred elective focus under the placement preferences section in your dashboard.
