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R E F L E C T I O N S   F R O M   O U R   R E S I D E N T S

S O U T H   A F R I C A :

"In the emergency department itself, the types of patients I saw were similar to those that we see here in the United States. There were a good number of refugees, and there was a high prevalence of TB and HIV. While we see a lot of HIV patients here, the ones I saw in South Africa were further along in their disease and at a younger age. It was a bit difficult for me to get used to, the worst case I saw was a 22 year old girl who had both HIV and TB, who died from a respiratory infection within 20 minutes of getting to the ER. There were also lots of trauma patients, ranging from car accidents to stab wounds, again, very similar to what we see in the US. Interestingly enough, however, there is a higher prevalence of stab wounds as compared to gun shot wounds because it is economically more efficient to use a knife.

Outside of the types of patients I was seeing, I was observing the functions of the ED I was working in. And that is really where I noticed the biggest difference in the practice of medicine. The only tests that were ordered were the ones the physician deemed really necessary. For someone who was suspected to be anemic, just the hemoglobin was ordered, and if it came back low, then the type and cross. For the patient with a cough, a chest xray was ordered and you held it up to the xray box to take a look. For the trauma patient that might need a CT scan, they had to be transferred to another hospital or managed based on their clinical status. And for every order that you wanted, its price was written next to it on the order sheet. It made me wonder how the cost of medicine would change if we had this system. On the flip side, however, having the technology so readily available to us and when used appropriately, does help us provide good care to our patients, especially the imaging. Its nice to be able to get a CT scan of the head at our institution versus having to transfer someone who you think might have a serious head injury.

Overall, my experience in South Africa was great and very valuable. It was cool to see that management of disease is so similar even though the environment and its resources that the medicine is practiced in are different. Educational exchange was one of my goals and it was definitely met. I learned just as much from our colleagues in South Africa as they did from me. Furthermore, I left with a better understanding of public and global health, its needs and discrepancies, mainly in infectious disease, and I hope that as I pursue my career in international Emergency Medicine, I can help address some of these issues, even if at a local level. In South Africa particularly, HIV is a huge public health issue and burden. Until recently, the government had ignored this issue, not recognizing that the country has one of the highest HIV infection rates in the world. A good project through emergency medicine would be doing HIV testing and referring them to appropriate outpatient treatment centers and educating them in the ED about the disease and prevention." -DR. BRIJAL PATEL



P A R T N E R S H I P   W I T H   S O U T H    A F R I C A



The State University of New York at Downstate Medical Center (SUNY), EMEDEX International in partnership with The New York Institute for All Hazard Preparedness (NYIAHP) conducted a web-based Long Distance Table-top drill (LDTT) designed to identify vulnerabilities in safety, security, communications, supplies, incident management, and surge capacity for a number of hospitals. The tabletop simulated a stampede and crush type disaster at the Green Point Stadium in Cape Town, South Africa in anticipation of 2010 FIFA World Cup. The LDTT, entitled "Western Cape-Abilities", was conducted between May and September 2009 and encompassed nine Hospitals in the Western Cape of South Africa.

The main purpose of this exercise was to gather information about the emergency preparedness status of both the individual hospitals and the region as a whole. Players in the exercise were expected to respond to a particular stimulus on a weekly basis. The stimulus was tied to a specific scenario that would prompt Health Care Centres to integrate and practice emergency response plans and protocols specific to the stimulus. Evaluators monitored for efficient management of critical physical plants, personnel and material resources. Another goal was to test the feasibility of a long distance virtual tabletop exercise and its ability to assess emergency preparedness.

In developing the exercise objectives, important capabilities were selected for evaluation: Communication, Equipment, Major Incident Plan, Public Relations, Risk Communications, Patient Care Capacity, Surge Capacity, Safety and Security (Supplies and Fire). These activities were approved by the Exercise Design Team and trusted agents and form the basic framework for this exercise. This report will summarize the objectives of the exercise, how the players of the