Goodbye Bloemfontein!

Our last two days, we spent more time at the different organizations we had visited earlier in the week. Wednesday morning, we began at REACH. The first day we were there, the building had flooded. Today everything was cleaned up so the children could be inside. We were only there for games in the morning, so we didn't get to see how the rest of Drug Awareness Week went. Next, we went to Tshepo. This time, we were able to teach the children using educational toys. I taught my group of kids parts of the body using a puzzle. They were so excited! The volunteer told us that they don't get to use these toys often since there aren't enough workers to take only a few kids at a time. That day, they were also handing out soup to the community, so there was a huge line of mothers and their children outside the gate to the daycare. This service will continue throughout winter, but this was the very first. Finally, we ended the day at Lebone. Again, we played with the children before serving them lunch and putting them to bed.

Thursday, we spent the entire day at Lebone. We sang with them for hours. They absolutely loved it! After feeding them a morning snack, we went outside to play games and get warmed up. The children were very sweet and made us a banner with all of their handprints and names on it to bring back home with us. After feeding them lunch, they took a nap and we said goodbye.

Friday, I left South Africa after a wonderful 6 weeks there! I not only learned a ton about medicine and the health issues the country is facing, but I learned about the country's history, culture, nature, and people. We also made connections with people here that we can maintain from back home. The relationships and knowledge I gained through my time abroad will certainly shape how I view health issues in the States when I return.

Community Engagement

This week, now that the medical students are on holiday, we are back to doing community engagement. This involves visiting various NGOs around Bloemfontein and helping out however we can. On Monday, we went to Tshepo Foundation’s daycare and crèche in a township of Bloemfontein. It was founded in 2000, and it is a Christian-based organization. It has grown a ton since it began, and now it even has a wellness center. A local doctor volunteers her time to screen the children and refer them to another doctor if necessary. This prevents them from having to wait days at the clinic to be seen by a sister, who may not even catch that there is something wrong. She says she has found TB as well as HIV/AIDS in the kids. They hope to expand the program by getting more doctors to volunteer time. This way they can also reach other parts of the community. We visited all of the classrooms to see the different age groups. The children were extremely well-behaved and excited to see us. One group sang us a song about HIV/AIDS and how it affects their community. It was amazing to see how much these young children know about this disease, since it is a part of their daily life. Later, we had a chance to play with the children on their playground. They were very excited to speak whatever English they knew, teach us games, play with our hair, and just be held. It was a fantastic experience, and we couldn’t wait to go back! Later, we went to Lebone village again. We were only there an hour, so we played with the orphans a little, then helped feed them lunch. Afterward, we put them to sleep for naptime.

The children at Tshepo Foundation

Tuesday, we spent the morning at REACH. We had gone there the first week we were in Bloemfontein, but the children were not there since it is only an afterschool program. Now, it is their school holiday, so they are there all day. This week is Drug Awareness Week, and the children are doing various programs all week to learn more about drugs and their effect on the community. They were divided into four teams, with names like “The Drug Chasers” and “No High.” Yesterday, they performed skits to earn points for their team. Today, they had to create a poster showing the negative effects of drugs. At the end of the week, the winning team will get a prize. While there, we also played several games with them and had a short prayer, since it is also a Christian-based organization. The woman working there told us that many of the children are victims of abuse, so they have a social worker there that helps advocate for the children.

While we did not want to leave REACH, we were beyond excited to go back to Tshepo today. We went on a walk around the township to see what life is like there. We saw all of the shacks, as well as the RDP homes that are built for families by the government. We also stopped by a shop that sold vetkoeks (fat cakes), which were basically sweet, fried balls of dough. When we returned to the crèche, the children were finishing their snacks, and we played with them again.

Finally, we made our last stop for the day at New Horizons. This is an organization that provides nursing care for patients that are homebound in Heidedal. It was founded by a nurse who had lupus and saw the need for such a service when she wa unable to take care of the people in her neighborhood due to her illness. We went with the nurses to three different houses. The first man we saw had epilepsy. The nurses basically made sure he had taken his medication for the day and that he knew when he had to go to the hospital for follow-up appointments. The second patient was a woman who had a stroke and could not move. She lives alone with her two children, but is unable to take proper care of them. She can’t leave the bed, so her bed is always wet. However, these nurses are working with such limited supplies, time, and funding, that they cannot wash the bedding for her. They could only bathe her. It was very difficult to see. The last patient was a woman recently diagnosed with AIDS. The nurses wanted to make sure she was taking her ARV medication, since many patients stop taking them due to the extremely uncomfortable side effects. It was nice to see that there are people to check on these sick patients every day, but hard to accept that they can’t do very much with the lack of resources available. 

Obstetrics and Gynecology

Brief Overview

This past week I switched from surgery to the obstetrics and gynecology rotation. I was able to see some of the smaller clinics, as well as large hospitals. This gave me a better understanding of how the health system works here in South Africa, as well as the different services offered at each level of care. In addition, I learned more about the role of sisters in antenatal care specifically. I went on call one night, and only one baby was born the entire night! It was amazing to be able to watch the C-section. Lecture topics this week included biology of aging, anemia, adrenal gland physiology, mitral valve disease, biological effects of radiation, statistics, neonatal endocrine and metabolic abnormalities, trauma surgery, physiology of the eye, the district health system, and diagnostic imaging. There was also a guest speaker from the UK presenting “101 Things to Do While On Call.”

Clinical Rounds

My first day of rounds was at Pelonomi Hospital’s prenatal ward. In South Africa, pregnant women first go to their local clinic to be treated. When there is a complication, they must go to a more specialized institution, such as a hospital. Therefore, all of these women had some kind of complication or risk factor for which they were referred. The first thing I learned about OBGYN was the structure of the H-10 form. This is a form that all South African medical facilities use when treating a pregnant woman. The woman then keeps the form with her throughout her pregnancy, so that any medical provider can know everything important about the woman’s history. It includes demographic data, information about previous pregnancies, social situation, family history of diseases, blood work, past operations, current medications, plan for contraception after delivery, and the estimated date of delivery (EDD). The EDD is determined by a combination of the following: calculation of 40 weeks past the start of the last known menstrual cycle, sonar imaging, and SF measurement. It was actually quite complicated—especially when there was discrepancy among the different types of measurements. The doctor was very stern when the fourth years presented their cases, making sure they knew what each part of the H-10 form meant, what all lab results signified, what the diagnosis was, and what treatment was necessary. She was so thorough that it took two hours for one patient!

The next morning, I was at Heidedal’s prenatal clinic. We learned how to take patient history on the H-10 card, and were even able to practice on a patient! We learned specifics about the blood work that is done on each patient. They test each mother’s HIV status, hemoglobin, Rh factor, and for syphilis. We also observed a full physical examination on several women, and learned how to take the SF measurement that is used to determine gestation. Finally, we were able to locate and listen to the fetal heartbeat. A sister typically does all of this. The sister we were shadowing was very helpful and patient, even though the clinic was extremely busy, so we learned a lot.

Wednesday morning, we were assigned to observe sonar at National Hospital. However, the woman there would not let students watch her. This was a problem, since the students have to see a certain number of different procedures during their rotation, and sonar was included. We ended up going to Universitas to observe. This ward was for extremely complicated pregnancies and was very modern looking and sterile. It looked just like an ultrasound room in the US. We saw three sonars. The first case had a baby that was not growing properly. The woman was 24 weeks pregnant, but the baby was only the size of 20 weeks. The physician had to explain to her that she would most likely lose the baby, which was tough to watch. The second mother had a mitral valve replacement (which we had already learned about in lecture), so she was taking warfarin for that. The problem is that this drug causes defects. The doctor was checking to make sure the baby was still growing properly, and it was. The final sonar was a 4D scan, which was very cool. It was to check for defects due to a genetic trisomy condition. It was interesting to see how much could be determined from an ultrasound. We listened to the fetal heartbeat and determined gestation by measuring the length of the femur.

Thursday morning, I was at the prenatal clinic at MUCPP, located in the township. The consultation rooms were very crowded because there were nursing students there observing as well. Even though it was a little hectic, we were able to do some physical exams on a few patients. The medical student I was with said that the observations and rotations they do during their third years are important for them to understand what the health professionals do. For instance, sisters perform physical exams on patients; these students will not do that as a doctor. It’s important, however, that they are able to know what the sisters did and understand their notes when a patient is referred to them. It was very inspiring to hear of this dedication to collaboration in the workplace.

On Call

I was on call all night on Wednesday at Pelonomi labor ward. When we got there, two twins had just been delivered, so we were able to see them. Then, we were in the theater for a C-section. It was such an amazing thing to watch, and it was interesting that the mother only had a localized anesthetic so she knew what was going on during her operation. I was also impressed by how many people were needed to deliver the baby. There were doctors for both the mother and the newborn, as well as students or nurses to assist. After that, I couldn’t wait to see more, but it was a very slow night. We actually did not see anything else, so we got a good night’s rest in the on call room.

Lectures

The biology of aging lecturer did a fantastic job of highlighting the importance of gerontology. He gave statistics about the elderly in the Free State and around the world, showing that the elderly population is growing rapidly. This signifies a growing need for providers for this patient population. He also gave a general overview of aging, showing the difference in life expectancy for different organisms (ex: flies live 18 days, sea turtles live 380 years, and trees live thousands of years). He also showed how the human life expectancy has changed throughout the years, dating back to the life expectancy of Bible patriarchs. It was interesting to me to see the frequency with which religion is included as a part of the lectures. He concluded that diet and exercise are the most effective ways to age in a healthy way.

The anemia lecture was very informal, with the professor introducing himself by his first name only. He stressed the importance of looking for the cause of anemia, rather than simply diagnosing and treating the anemia. He also pointed out specific things to ask when taking history. For example, he wants the students to ask separately if the patient is taking any over-the-counter medications, since patients often do not report this when asked if they are taking any medications. In addition, he showed the importance of knowing the cultural and social qualities of the patient. He gave the example that families who drink a lot of tea are often anemic, since tea inhibits iron absorption and that alcoholics have lower folate levels. The following lecture on adrenal glands was presented through a case study of a real patient with Addison’s disease. She also reviewed a few concepts from the previous endocrine lecture. The final lecture on mitral valve disease was interesting because he talked about how mitral regurgitation has different causes in South Africa than in Europe. In South Africa, it is typically due to rheumatic endocarditis, which requires a valve replacement rather than repair. This lecture overlapped a lot with the aortic valve lecture the previous week.

The medical physics lecture was on the biological effects of radiation and radiation protection. She provided guidance on safe doses of radiation by comparing the amount of radiation one receives in different ways, such as smoking, cooking with natural gas, living near a nuclear plant, and getting an X-ray. She specifically argued that medical radiation is an acceptable risk if it is used cautiously, since smoking can shorten your life by seven years while medical radiation only shortens it by about 49 days. She then taught how to protect the patient from unnecessary radiation and precautions to take during pregnancy.

The statistics lecture was extremely interesting. He argued the importance of statistics as having the ability to identify a problem or public health issue, so that action can be taken to solve it. He used an interactive computer model to show various health statistics for South Africa and countries around the world. For example, he showed that the most global child deaths occur in sub-Saharan Africa. Through these statistics, WHO has gotten involved to implement programs to save newborns, such as tetanus vaccines, malaria prevention, kangaroo mother care, and breastfeeding.

The trauma surgery was a continuation from the one last week. Therefore, it was taught in a similar fashion, using situations to teach different emergency medicine procedures. After this, a guest lecturer from the UK came and presented “101 Things to Do On Call.” The students liked to see the similarities and differences between their system of education and clinical practice and that of the UK. We were also able to practice some when we were on call that week.

Thursday, the students wrote a quiz on the anatomy of the eye. It was very short, and then we had a lecture on the physiology of the eye. The lecturer did not make the powerpoint, so she skipped many irrelevant slides. She did include several demonstrations and videos, however, to illustrate the concepts.

That afternoon, we had a lecture on the district health system. The students were presented with a project in which they must use the National Health Act to back up a case study. The lecturer compared the structure of South Africa’s health care system to the US, explaining that South Africa provides health care based on geographical districts rather than who can afford the services. He also taught about the importance of getting the community to participate in health care service delivery. Another point he stressed was developing a system in which people at the grassroots level can have a voice at the top of the system in order to effect change. There was much debate among the students, making it a more dynamic lecture than most.

The final lecture was on diagnostic imaging of the liver. I’ll be honest and say that this lecture was more above my head than the others because it was mostly just images of radiological scans. Since I didn’t have the appropriate background at reading these, I found it a little confusing. The professor did provide a lot of advice, however, about how to avoid making mistakes when reading the scans and preparing a diagnosis.

Clinical Education Facts

The students received their final grades for their third year of medical school this week! Those that passed are now fourth years. If students did not pass, but were close, they have a chance to rewrite exams in a few weeks. However, any student below the rewrite score fails the year and must repeat the entire third year.

For the OBGYN rotation, the students have a book with a certain number of procedures or tasks they must observe or do. When they complete it, the doctor or sister signs it off. This, along with a report on a case study is due for marks at the end of the rotation. 

Last Days of Surgery

Brief Overview

This week we continued hospital rounds in the surgery unit. We had one more day at Universitas Hospital, then went to Pelonomi for the remainder of the week to get experience in a different location. These mornings we went on rounds in the wards and then observed some clinic visits. We were also on call at Pelonomi Thursday evening after class until 11pm. We only saw two patients while there. One was not in a stable enough state to have his operation, and the other was an appendectomy. Lecture topics have included surgery, health policy and service delivery, ophthalmology, obstetrics and gynecology, and trauma.

Clinical Rounds

Our first day of rounds, none of us knew what to expect. We arrived and quickly began following a doctor from bed to bed. At each bed, registrars had to present the patient’s history, diagnosis, and treatment to the doctor. Then, the doctor would question both the registrars and the students. There were about 4-6 patients per room, so there was little privacy. There were some very interesting cases, however, since these patients were brought in for the 5^th year clinical exams that had just ended. We saw a 98 year old man with breast cancer, many hernia patients, breast cancer patients, and patients with thyroid conditions. It was interesting that the doctor never used gloves, even when undressing wounds and drawing blood. We later went to the endocrine clinic. We sat in on a consultation about a patient’s thyroid condition, but I was unable to understand much because they were speaking Afrikaans.

Rounds in Pelonomi were only slightly different. We were accompanied by some 4^th year medical students and two doctors. These doctors were much more interactive with the students. When they did not know the answers to his questions, he would make them find the answers and report their findings to him the following day, rather than tell them the answer. The students say they’ve learned much better that way. When they did know answers, he asked continually more detailed or challenging questions to really prepare them to be doctors. The students were also very helpful with explaining things to us. One of the fourth year students even taught me how to examine a parotid mass on a patient. The very next day, the doctor had to use a translator to tell this woman that the mass was cancerous and the removal of the tumor would compromise her facial nerve, leaving one side of her face paralyzed. He wanted the patients to see how to effectively deliver bad news, as this is a necessary skill for all physicians. At the clinic, the doctor took about a half hour to let the 4^th year students present their “homework” from the previous day and explain more to them about their patients. Then, we saw two consultations. The doctor was extremely compassionate toward his patients and addressed their concerns and desires regarding their treatments.

On Call

After class on Thursday, we went back to Pelonomi to be on call until 11pm. It was very slow that night. We saw only two patients. The first was a middle-aged man with AIDS. He needed a surgery for an intestinal blockage, but the doctors could not operate due to the severity of his AIDS. The students said this is quite normal, since most of their patients are HIV positive (very different from the US). They’ve been taught to assume all patients are HIV positive until proven otherwise. If a doctor or student gets pricked, they are started on immediate ARV treatment for one month. We later saw a patient that presented with abdominal pain. It was fascinating to be there for the entire process of trying to make a diagnosis. It first began with eliminating ectopic pregnancy. We were told to assume every woman is pregnant until proven otherwise, and that every pregnancy is ectopic unless proven otherwise. We learned a lot about the different blood, urine, and radiological tests that are done. Even with all of the tests, it was unsure what her problem was, so they had to do an exploratory abdominal surgery. It ended up that she had appendicitis, so they simply had to remove it. We saw her the next morning, and she was recovering well.  

Lectures

The surgery lecturer handed out an outline of everything that is most important in each chapter to help guide the students. He is 83 years old and was the first trauma surgeon in SA, so it was very interesting to hear his advice and opinions. He highlighted the power of observation, listening to the patient, managing time, and asking open questions. He also spoke much about how different each individual patient is and the danger of making generalizations. Finally, he taught about establishing a trusting and respectful relationship with the patient by touching their hand before continuing with the rest of the examination.

The ophthalmology lecturer was substituting for the normal lecturer. She mainly read off of the slides and finished very quickly. The health policy and service delivery lecture was fantastic (probably because I’m more interested in public health than most of the medical students). He was very funny and interactive. He probed the students to think beyond the principles that seemed like common sense upon first glance. For example, he made them define the term “healthcare system.” At the end, he reviewed health legislature in the past decade in SA, but he went through it very quickly. The main things were the ability of children to consent to abortion at age 12, the implementation of a national health insurance plan, ARV roll out plans, and the role of the government in sustaining the private health care sector in SA.  The obstetrics and gynecology lecture was very interesting, especially since I’ll be in that department for clinical rounds next week. She was very effective because she showed the logic behind all the changes that happen during pregnancy.

The trauma lecture was two hours long. He began with a history of trauma, starting with Cain and Abel in the Bible, the Aztecs, ancient Chinese medicine, early ambulances, all the way to the current state of emergency medicine and trauma. He also mentioned ethics, specifically regarding prolonging one’s life and whether the patient will still have dignity once they recover. He included law as well, by teaching about prevention. For example, laws against drinking and driving help prevent motor vehicle accident trauma. This lecture also included some physics, treatment techniques, and information about providing psychological support for patients and their families. At the end, he predicted that in the future, more trauma will be due to terrorism, and biological or nuclear agents, as well as natural disasters. Additionally, he commented on the importance of technology, as the hospitals are now moving away from paper charts and toward electronic systems.

Clinical Education Facts

• The entrance exam is a general test covering math, reading, science, and writing; it takes a total of six hours.
• The students take OSCE exams, in which they see a picture of a condition. They must describe what they see, diagnose the condition, tell what other causes are possible, and outline what types of treatments may be used.
• UFS has an anatomy and pathology museum for students to utilize when studying. It was amazing to see how many different specimens they had--including embryos from every stage of pregnancy.
• The students joke that 3rd years are "medical spies," because they don't know anything and are just looking around, taking in information. The 4th years are "medical tourists," because they are observing everything. The 5th years are "medical slaves," because now they are expected to do everything they've learned and seen the past two years. 

Initial Days as a Medical Student

Short Summary

This week we started our internship with the medical program here at UFS. We essentially are shadowing a medical student and doing everything a medical student at UFS would do. In the mornings, we have clinical rotations. This week I am in surgery rotation. So far, we’ve spent a day in gastroscopy and a day in the operating “theater.” In the afternoons, we attend lectures, which have varied in topics from hematology and cardiovascular abnormalities to radiology and pediatrics. A few nights we will be on call overnight at different clinics around Bloemfontein. It’s busy, but I’m learning so much and making many new friends!

Clinical Rounds

Our first morning of rounds was in gastroscopy. The first patient we saw had dysphasia and had to have a permanent feeding tube inserted. We could not understand everything going on because the sisters (nurses) and the doctor were not speaking English. The medical students tried to tell us what was going on when they could though, which was nice. I thought it was interesting that the patient only had local anesthesia, because it looked so painful. I also noted that the sister touched some materials that had been autoclaved without gloves.

Next, we watched a colonoscopy. This time, there were two doctors present, so one was available to focus on explaining things to us and questioning the medical students about the symptoms, procedure, and possible treatment options. It is amazing how much these students know since they are the same age as us.  He also gave them the tip to classify their future patients into the following groups: healthy, curable, palliative, or about to die. That way, they can determine the best method of treatment to maximize the comfort of the patient as well as efficient allocation of resources.

Tuesday, we were in the surgical theater (operating room). We learned the proper way to scrub in. It was interesting to notice that they even have a different protocol for washing hands than we use. The scrub sister was very funny and helpful. Even though we had to watch the operation from the observation room above, two of the students were able to scrub in and do some stitches! They were very excited and nervous since it was their first time on an actual patient! We watched a venisection called a “fem-pop.” It was above my understanding, honestly, but they removed a large vein running the length of the leg, attached it to the femoral artery, then to somewhere else to divert blood away from a clot. Overall, the operating room looked just like on in the US, and they were very cognizant of sterile technique. The only difference I noticed was the use of fabric scrub gowns rather than disposable ones.

Lecture

The students have lectures every afternoon, from approximately 12-5, with a lunch break. However, there is a new lecturer every 1-2 hours, so it really isn’t too bad. A sign-in sheet is passed around at the beginning of each separate lecture, and the students must attend 80% of lectures to be eligible to write exams. Most lecturers have a PowerPoint presentation, and the students have a massive bound book with all of the printouts of the slides in it. The style of lecture is very different depending on the professor or doctor speaking.

Our first lecture was on myeloproliferative neoplasias, which are cancers of the bone marrow. This lecturer was very interactive and used simple metaphors to clarify the concepts he was teaching. He also found it very important to relate research to clinical practice. He explained how research has increased the knowledge about these diseases so much so that current medical students often understand them much more than the older generation doctors. He also explained the problem that the drugs to treat this disease are extremely expensive since it isn’t very common. He then highlighted a nonprofit organization called Max Foundation, that provides these medications to anyone in need who cannot afford it. He even had specific numbers regarding how many people in Bloem benefit from that organization.

The next lecture was on pituitary function. This lecturer was more formal, and he had each disorder categorized into symptomology, screening, diagnosis, treatment, and follow-up.  He also included mnemonic devices and tips for the students as they study for their exams.

The final lecture for Monday was on aortic stenosis, a cardiovascular condition. This professor reviewed basic anatomy and physiology of the heart. He also went through a logical progression to help the students understand how the disorder affects the patient to determine the potential outcomes. His powerpoint was more of an outline, however, so the students had to pay close attention to take good notes.

Tuesday, the first lecture was on radiology. She specifically spoke about efficiency and accuracy. She highlighted the importance of requesting the correct test and providing the radiology department with ample and sufficient information to know exactly what is necessary. This protects the patient from unnecessary radiation, but also saves money (this is especially important in a public health system). Her advice was to always ask the question, “Am I going to act upon the results of this test?” If not, the test is unnecessary and should not be requested. One interesting thing she said was that they have patients keep their radiology films and bring them back for follow-up appointments rather than keeping them at the hospital.

The rest of the day was pediatrics lectures. One was on thermal regulation in neonates, and the other was on fetal development. They were both very interesting because they deal with such a unique and special patient population. The first lecturer taught without a PowerPoint by just asking the students questions and guiding them toward the answers. The second lecturer was very funny and passionate about the topic. One interesting thing she pointed out was the difference between the public and private systems. For example, there is more extensive screening of neonates for medical conditions in the private sector than the public. She also shared personal experiences, such as a time when she failed to diagnose hypothyroidism in a baby.

Clinical Education

At UFS, there are two classes for medicine—Afrikaans and English. Both admit 80 students each year. However, the group of third year students we are currently shadowing has 50 English and 72 Afrikaans. This is due to students either failing or dropping out. If the students fail, they are allowed to repeat twice. The same year cannot be repeated twice though. During the second year, the students study anatomy, and most perform a clinical research study. For example, one group of students studied children who were admitted to hospitals and clinics around Bloem after car accidents to see what percentage was wearing seatbelts, since it is now a law for children to wear them. The entire medical education is five years, followed by a two-year internship and a year of community service. If they want to specialize, it can take another five years. At this point, they are called registrars.

The past two days, the fifth year students have been taking their final exams. They have both long and short exams. In the short ones, the examiner tells the student the patient’s complaint or an area of the body that has an abnormality. Then, the student must examine the patient and make a diagnosis in fifteen minutes. For the long exam, they must take a complete patient history and do a physical exam to make a diagnosis in thirty minutes. All of the students looked so stressed! The hospital was also very busy as there were examiners from all over the country there to administer the exams.

Community Engagement!

We started our community engagement program yesterday and were able to see various nonprofit organizations and clinics around Bloemfontein. Our first stop was MUCPP, which stands for Manguang University Community Partnership. This clinic is in the township and was set up by the Health Department, the University of Free State, and the Manguang community. When we walked inside, there were patients everywhere. The waiting room was full, and there were lines of people outside each department. While they send patients with very serious ailments to another institution, the clinic can provide most services. They even deliver babies there and have a physiotherapy center. All of the services are free, just like all public healthcare facilities in South Africa. Another interesting program offered is called LoveLife. Youth from the township come into the clinic when they have free time to be trained in HIV/AIDS prevention education. Then they go into their community to educate others. Not only does this program increase awareness about HIV/AIDS, it also gives these youth something to do with their free time rather than getting into trouble or involved in crime.

We returned to Lebone village to get a better understanding of what they do. They house 42 orphans who are affected or infected by HIV/AIDS. They transport the kids to school each day and provides nutritious meals for them. After school, they offer afternoon classes and homework help. The village even has a computer lab to ensure the children develop necessary skills to secure a job. Lebone village also has a large farm of vegetables, a chicken farm, and a greenhouse of flowers. They use this food to feed the children, feed other poor families in the area, and then sell for a small income. We stayed for a long time to just play with the small children who were not yet old enough to go to school. They were so cute and brought us so much joy!

Next we went to Heidedal, a colored area of Bloemfontein. We toured the facilities of a program called REACH. They offer life skills training, such as computer skills and hygiene classes. In addition, they provide HIV counseling and an afterschool program and nutritious meals to children ages 7-18.  On the way home, we passed Palonomi hospital in Heidedal. It was interesting to see that the public hospital was right beside the private one. It was clear that the private one was much nicer and newer than the public one.

Today, we visited Free State Care in Action. This organization provides a daycare three days a week. In addition, they have a soup kitchen on Wednesdays and Fridays. Pick n Pay, a supermarket here, donates produce to the organization. Therefore, they are able to provide fresh foods to the poor families. The kitchen staff there packs parcels of basic foods for 80 people and their families each week. They also take clothing donations from the community and distribute them to the families that come in daily. Finally, there are social workers on staff to help families apply for grants to help with the financial burdens they face.

Welcome to Bloemfontein

I arrived to Bloemfontein on Sunday afternoon after two weeks of traveling around South Africa. We were welcomed by Louise Steyn, from the International Office at UFS. She showed us to our hostel (dorm), which she had stocked with food and other essentials. We quickly unpacked and headed to dinner with the other ASU students, UFS students, and some professors from both universities. I sat with the four UFS medical students that were there. They were all third years and preparing to take their final exam. Here in South Africa, students begin clinical rotations after this exam, so they were all very excited and ready to start seeing patients and doing rounds at the hospital! The girls seemed very nice, and I am looking forward to spending more time with them when we start shadowing them next week.

The rest of this week, we have been getting adjusted to living in Bloem. Monday, we were given a campus tour and went to the Mimosa Mall to get cell phones, buy some food for the week, and do a little fun shopping. Tuesday we went to the Waterfront, which is another large shopping center. We tried rum and raisin gelato, which we've been told is a very popular flavor here.

Wednesday, we went on a city tour! We began at the Anglo Boer War Museum. Unfortunately, the exhibits were closed for rennovations, but we were able to see various memorials outside and watch a documentary on the war. There was a specific memorial dedicated to women and children who died in concentration camps during the war. We even learned about Emily Hobhouse, the woman for whom our dorm is named. She was an Englishwoman who came to South Africa to expose what was happening in these concentration camps and is buried a the memorial. Our tour guide then told us about the relationship between the Anglo Boer War and apartheid. He argued that the homelands and townships were similar to concentration camps. Therefore, it is important to learn about history so we don't repeat the same mistakes. It was an interesting parallel that I would not have considered on my own.

After that, we drove through a township nearby. In some places, there were homes built for the people living there by the government. However, there were still shacks next door. The families living in the homes rent these shacks out to immigrants or refugees from other countries in Africa, since there are 8-9 million immigrants in South Africa. From the township, we drove into a historically colored part of Bloemfontein. This is an artificial race classification for those not distinctly black or white. During the years of apartheid, various tests were used to determine the race of these people. One specific example is the pencil test, in which a pencil was placed in the hair of the person. If the pencil fell out, the person was considered white. If it did not, the person was considered black. This often separated children from parents who looked different.

We also visited an art museum that had many unique sculptures, an exhibit on African music, and paintings ranging from very traditional to abstract. Later, we drove to Naval Hill. We saw zebras, ostriches, giraffes, antelope, and a wildebeest. Finally, we visited Lebone Village, an orphanage for children who are infected with HIV or affected by it in some way. The village also has its own woodworking shop, bakery, and textiles shop. These both raise money for the children and provide a skill for the children to use later in life. We will be volunteering there toward the end of our internship, and we are all very excited to go back!