TRAUMA STUDENT ELECTIVES

Institution		Tygerberg Hospital, University of Stellenbosch, Cape Town
Country		South Africa
The Unit
Description		The Princess of Wales Trauma Unit at the Tygerberg Academic Hospital is the teaching hospital Level 1 (equivalent) Trauma Centre for the Northern Suburbs of the Western Cape, South Africa. It is situated in the Tygerberg Hospital, a 1400 bed multidisciplinary teaching hospital. It is a "trauma only" emergency unit separate form the other hospital emergency units. The unit consists of a 6-bed Major Trauma Resus unit (C1DR), a mid-level severity evaluation unit of +/- 30 trolley beds (C1a Trauma), and a General Trauma Service post-operative ward of 26 beds. Intensive Care is provided in the General Surgical ICU (10 beds) or the Respiratory Critical Care unit (7 beds). We also house the regional burn centre (25 beds, including 3 ICU beds) and have a Paediatric Surgical service and ICU. Presently the General ICU is due for upgrade to 16 beds and 12 high care, and the Trauma unit will gain its own 6 bed ICU in the near future. EMS is provided by state and private services, and the Red Cross Air Mercy Service helicopter and fixed wing retrieval service. The hospital serves as the referral centre for approximately half of the Western Cape Province and sees 22500 trauma cases per year, of which between 1000 and 1500 are Major Injury arriving intubated and ventilated. We manage some 700 trauma laparotomies, 300 vascular trauma cases and around 450 penetrating neck traumas per year. The average ISS is between 12 and 25. The unit is staffed by full-time Medical Officers (GP in fulltime government hospital practice) who work on a shift basis and referrals are made to the on-call registrars of the various in-house disciplines. The unit is headed academically by a Principal Surgeon (Dr Daniel Du Toit) and the Operational Head Dr Tim Hardcastle. All staff are ATLS certified or equivalent, and most have some post graduate qualification in addition to their basic degree. The registrars from the General Surgery Trauma Service coordinate the day-to-day patient care under Dr Du Toit and Dr Hardcastle.
Learning opportunities		Students will be expected to do daily ward rounds in the Trauma Unit and ward, become involved with ward work and attend departmental academic activities (Trauma Academic Program and the General Surgery X-ray meeting), as well as doing self study in the University Library. Practical experience will include watching and assisting the Trauma Surgeons in the Trauma Operating theatre, assisting with patient care in the Trauma Unit and helping to suture minor wounds. Daily student tutorials with senior registrars or consultants and sessions in the clinical skills laboratory are also available. Exposure to orthopaedic Trauma care, management of head injuries and burn care will be encouraged. It is expected of students to do calls with 24hr availability in house, for assisting with surgery. In the future it may become possible for students to spend some time with the EMS services as observers, as the Regional EMS Training College has recently relocated to Tygerberg Hospital Campus. The opportunity exists for research projects to be undertaken as part of the team, while on rotation at Tygerberg but prior arrangement will be required. We presently are engaged in an exchange program, whereby resident surgeons from the Karolinska Institute spend three months working in our unit.
Elective Details
Number of students accepted		2 per session (Total of 4 per session in General Surgery)
Duration of elective		Can be from 2 weeks to 4 months
Accommodation		Overseas student residence on Tygerberg Medical Campus
Fees payable		Must register as Special Student with the Medical School
Applicant requirements		Fourth to final year medical student or post graduate (Visitor Status) and must register as foreign student with HPCSA. Post graduate students should contact Dr Hardcastle directly
Contact
Contact Name		Undergraduate: Rika Bosman, rbosman@sun.ac.za Postgraduate students: Rachel Pullen, crp@sun.ac.za
Address		Tygerberg Medical School PO Box 19063
City		Tygerberg
State		Western Cape
Postcode		7505
Telephone		+27 21 938 9549
Fax		+27 21 933 7999 (Dept. Surgery)
Email		rbosman@sun.ac.za
Webpage		www.sun.ac.za/surgery/
Alternative contact		Dr T C Hardcastle MBChB(Stell); ATLS(I); FCS(SA); MMed(Surg)(Stell) Consultant General Surgeon (Trauma and ICU) Dept of General Surgery University of Stellenbosch / Tygerberg Hospital PO Box 19063, 7505 SOUTH AFRICA
Student testimonials		James Brewin, London UK I spent 4 months working in the Trauma Surgery department at Tygerberg Hospital. Tygerberg Hospital is a large government hospital on the outskirts of Cape Town and is part of the University of Stellenbosch. As a government hospital it is under funded and understaffed when compared to the UK which meant it was busier and I got more experience working here than compared with the UK. As an academic hospital there is good senior support, teaching and good academic facilities available at the medical school. In South Africa a large proportion of the emergency surgery workload is a result of trauma, consequently there is a separate trauma firm in the surgery department. There is a high incidence of penetrating trauma as well as a large number of multi-trauma patients from road traffic accidents (South Africa has a very poor road safety record). My experience As a trauma Medical Officer I started working as a trauma Medical Officer in the “Trauma” area which is the equivalent of UK Accident and Emergency but only treats patients suffering from trauma (orthopaedic, neurosugical, cardothoracic and general trauma). I worked a shift rota with the other MOs who were of various seniorities so could provide support and teaching as needed. I gained experience assessing minor injuries, evaluating penetrating and blunt trauma and resuscitating severely injured patients. My ATLS skills were considerably improved and I feel I will remember them much better having gained practical experience in most areas of trauma. The trauma MOs also run a short stay ward for patients with intercosotal drains, wound infections, etc. Part of my job was to go on daily ward rounds and decide on the care/discharge plans for these patients. With the Trauma Firm After working as a trauma MO for a month I worked as a supernumerary registrar on the trauma surgery firm. The trauma firm cares for patients with abdominal trauma, vascular limb injuries, neck trauma and co-ordinates the care of multiply injured patients. Initially I shadowed the team and assisted in theatre but gradually, as I gained more experience, I did more work unsupervised. I assessed and resuscitated patients, went to theatre and assisted/operated and then helped manage the patients on the ward. The surgeons also run their own High dependency/resuscitation area where they manage intubated/ventilated patients and patients on inotropes, which gave me experience in this area which I would not get in the UK. Overall I got a clinical experience that I would never get working in the UK both in the initial treatment of patients and in the operating theatre. There was good teaching and supervision throughout. Advice to Doctors wanting to work at Tygerberg • When working in the Trauma department the busiest times are the weekends and Mondays (with the left over theatre cases from the weekend). I found I got the most out of my time if I worked at the weekends and took a couple of days off during the week. The weekends are also the times when the doctors are busiest so appreciate and extra pair of hands. • I found that working as a trauma MO initially gave me a good general experience of trauma before working with the trauma surgeons. • Try and find out when the registrar teaching sessions are as these were really helpful. • I enjoyed living in Cape Town and commuting to the hospital (30mins in rush hour). • The posts are unpaid as the government hospitals do not have the funds to pay supernumerary staff (it is very difficult to get a working visa anyway). I had to save up but living costs are much cheaper than in the UK. • It takes a long time to register with the HPCSA (SA medical council). I sent my documents 5 months in advance and they were not ready in time despite lots of pestering. You can check their website for information. James Brewin London UK
Updated		01.11.2005 (10:11)