1. International Rotation Natalie Stucky
Manguzi, South Africa
International Rotation
Natalie Stucky

2. Location In the Kwangwanase Region Language: Zulu Population of 5,500
90% of the population is unemployed
Largest employer is the hospital.
Location

3. Hospital 280 bed District (level 1) Hospital
Hospital serves a much larger area. Serves about people
Services provided include Theater, Resuscitation Unit, Wards, Outpatient Department, Mobile clinics, Satellite clinics, Physio, Occupational Therapy Audiology, Dieticians and Social Work.
My favorites: MDR and High risk maternity

4. Tuberculosis Prevalence of TB
405,000 people will develop TB this year.
About 1% of the population.
80% of the population has a latent TB
majority of multidrug resistant TB are from the community rather than the hospital setting

5. Tuberculosis Definitions: MDR (Multi Drug Resistance)
Resistant to Isoniazid and Rifampin.
XDR (Extreme Drug Resistance)
XDR is classified as resistance to isoniazid, rifampin, a fluoroquinolone and an injectable 2nd line drug.
Pre- XDR

6. Tuberculosis in the Hospital
Manguzi has an MDR ward.
Bedaquiline – newest TB drug
An ATPase inhibitor
Pregnant patients
Side effects of other second line agents. (kidney and optic neuritis)
Regime change
6- 8 months.
Initial phase 2-3 months
Continuation phase months

7. Tuberculosis in the Hospital cont.
Bedaquiline will help Manguzi to better serve their population.
Prior to being approved for the drug, patients needed to go to King George V Hospital
King George is roughly 5 hours away in Durban, South Africa

8. Most Profound Cultural Experience
Positive Cultural Experience
“Ceasar, Ceasar, Ceasar”
While assisting with a c section, the patient began to sing. Doctors and nurses around the room joined in until the baby had been born.
Negative Cultural Experience
Race relations in South Africa
White South Africans had a perception of being above black Africans.

9. Most Profound Clinical Experience
South African code
Suction
Ventilation
Lack of records
Expired drugs
Nursing staff
Location of Code Cart

10. What I will remember
More confidence in my physical exam skills to determine the diagnosis
Greater appreciation for awesome nursing staff and quick lab results
Lots of amazing experiences

11. References
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Special Thanks to Erin Willard, Jasmin Nwachokor, and Dr. Becky Acquam