How the other half dies

24 Nov 2008:

First, a challenge: can anyone name the group and/or song that inspired this blog entry’s title? No googling! (Hint below) Post it if you know it!

This morning we went to a crosstown hospital called Grey’s. This is the mysterious hospital to which all of our patients who have needed CTs for the past few weeks have been ferreted. We went in search of a consultant (aka attending) who used to work at Edendale and was a popular teacher for MGH residents, Dr Devan Gounder. He has since moved on to private practice but still attends at Grey’s (a government hospital and formerly the “white” hospital during apartheid, just as Edendale was the “black” hospital) two mornings a week.

Dr Gounder is a surprisingly young man of Indian descent, born and raised in South Africa and never having left the Continent in his life. He was indeed an engaging teacher who led “pimp” style rounding – putting us and the South African interns and residents on the spot as we went from patient to patient, quizzing us about physical findings, lab values, diagnoses, or whatever was on his mind. It was fun, actually: the sort of thing you hear about a lot on Scrubs but doesn’t happen all that much, at least in my experience. And he did a good job mixing in questions that we (the US kids) knew and the locals didn’t, and vice versa, so that each group of residents had a chance to teach the other.

Grey’s and Edendale were like chalk and cheese. The place just “felt” like a western hospital. It had a working CT scanner (heck, maybe more than one!), an MRI, a cardiac cath lab, a cardiac ICU, and more fundamentally, the basic organization/infrastructure/resources required for reasonable patient care (all features that Edendale lacks). Now that it is no longer exclusively for whites, Grey’s population is predominantly black as well, reflecting the local population. But unlike Edendale, it is not a primary hospital; patients can only be admitted by referral/transfer from another hospital. I guess that’s a way to ensure that only the sickest get this level of care (though they have to be stable enough to survive the journey to Grey’s; in truth, Edendale's patients seemed sicker on the whole than the ward patients at Grey's). From what I hear, the next level of referral hospital up, Albert Luthuli hospital in Durban (a big city an hour east of here) has facilities that even puts MGH to shame, so South African government hospitals really seem to run the gamut. All told, fun as pimp rounds were, and though we did see some interesting “TIA” type cases, for the most part, this was not what I came to South Africa to see. We were invited to stay and watch some cardiac catheterizations later in the day, but we’ve both seen those before, and of the many differences between medicine in the US and in South Africa, I’m willing to bet that coronary anatomy is not one of them; we chose not to stay.

It was interesting, if somewhat depressing, to hear Dr Gounder’s take on why he moved to private practice. He is in all respects a very competent doctor who takes responsibility for all patients in his care. He left as soon as his debt to the government was paid, though, because his salary is 20 times higher in private practice. Literally. Twenty times. By comparison, that’s the difference between the poverty line and a radiologist’s (somewhat egregious) salary in the US. He had a young child, sounds like it wasn’t a hard decision for him. (Also, my 30 second take was that he wasn’t quite cut out for Edendale, evidenced by his statement that what he missed about working there was the fascinating pathology… one needs either an overriding commitment to service or, perhaps, an inability to function in a competent hospital system, to endure working at Edendale, and he had neither. But I have little to base this take on.)

That night, Rachel and I fulfilled our obligation as part of the “Zulu meal plan” (normally our host cooks for us most nights) and prepared a small feast for Gugu and ourselves. I made my specialty (or, as they say around here, “speciality”), green eggs and ham. It was a hit. (A complete aside, spurred by “speciality”… I didn’t realize they spelled that the way they pronounce it; ditto for “aluminium”. Other random favorite things about the accents of white South Africans: they say “fifty” like “fufty”, or maybe “foofty”; also, instead of “also”, they say “AS well”, with strong emphasis on the “as”. OK, I’m done for now.)

(Hint on the group/song that inspired the title: think 1980s. And no, everyone, it’s not Bob Dylan.)