Cape Town is a gleaming example of the dichotomy that is South Africa. A small portion of its population resides in the metropolitan city and suburbs however the majority of the 3.5 million people living in the area reside in informal settlements and townships outside the city center in an area known as the Cape Flats. During the height of apartheid, families were forced by law to relocate to the Flats based on the color of their skin. Since the end of apartheid in the mid 90s, there has been a dramatic increase in the migration of people from other parts of South Africa, particularly the Eastern Cape, to townships in the Cape Flats. Now this area has one of the highest populations of people per square kilometer in the world. The medical system in South Africa is a mix of public and private, with only the wealthy being able to afford private medical aid and the right to seek medical attention at the facility of their choice. The remainder of the population must be seen at the public medical facilities as designated by the government based on geographical delineations. The hospitals that serve the people that reside within the townships in the Cape Flats and the impoverished areas close to the downtown city bowl are the hospitals that we worked in. These hospitals offer an invaluable opportunity to see how emergency medical care is delivered in areas of limited resource, for clinical experience within this environment, and to maintain the relationship between the emergency medicine program in Denver and in South Africa.
Assault-related trauma is the most common diagnosis at GF Jooste Hospital in Cape Town, South Africa; therefore, penetrating chest wounds are a relatively common occurrence. This area of the Western Cape also has a 50% prevalence of tuberculosis (TB) and a 30% prevalence of HIV. It is suspected that treating patients with TB and/or HIV with a thoracostomy tube may have a higher incidence of complications compared to the general population. This novel study is a retrospective chart review performed on 500 charts (n=100) from 2004 to present to determine if incidence of complication is indeed higher for these patients.
We focused on two projects: the first is studying the utility of the use of ultrasound in hypotensive patients with penetrating torso trauma, the second is evaluating how preparation for mass gatherings (such as the Democratic National Convention in Denver and the 2010 FIFA World Cup in Cape Town) can affect underlying healthcare infrastructure and resources.