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UCT Social Day.

This morning, Maritz and Nick had a great agenda planned for the day, but it required a bit of an early start. He met us with a van and driver, we caffeinated ourselves, and off we went. The day started misty, and it seemed as if the day would be cold and blustery. We started by driving down the eastern side of the cape peninsula, then crossed over to the west side.

We went to Boulders, and made the acquaintance of some penguins. There the weather started to break, and we knew that the day was looking up already.

As we continued to drive through Table Mountain National Park, we went to Cape Point, and walked out onto the rocks. There we saw ostriches, surfers, and amazing views. It was peaceful and gorgeous. The weather was perfect, with sun and a moderate breeze. Blue skies and verdant water mixed with the ochre of the rocks.

We walked back to the van for a spectacular drive to a restaurant at a winery for a sit-down lunch and wine-tasting.

The food was delicious, including my braised springbok shank. We quickly climbed back into the van for the return drive toward Cape Town past breathtaking vistas and stunning drops to the ocean hundreds of feet below.

One more stop at the famous Klein Constantia winery was necessary so many of us could send wine home. This winery is known for its antiquity, as well as for being the source of Napoleon’s favorite dessert wine, the Vin de Constance.

Maritz then left us back at the hotel amidst much gratitude and we adjourned to rest. Dinner ensued and we went down to the waterfront and walked through the tourist malls for some souvenirs. We had dinner in a nice harborside restaurant and left a chair open for our missing fellow, Brett. We got email confirmation that he arrived safely in Minnesota while we ate.

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Missing Brett.

 

Throughout the day, as my day progressed, I was simultaneously excited and saddened by the end of this tour. I can’t wait to return to my family and my practice, but the learning, camaraderie, new friendships, and the overall expansion of my experiences has been transcendent. As a result, I find myself uneasy at the fact that tomorrow the rest of us will catch planes home.

When I was selected for the ABC, I was eager to learn new things and meet new people. I was prepared to experience new things, and see the way that other systems taught registrars and managed patients. I did not totally expect the bond that grew between myself and my co-fellows. I know that our travels have made us lifelong friends, but the  rapport, as well as the inside jokes and the clever wit, that we established over the last five weeks will be missed. Over the course of this tour we have each at times needed to be picked up and we have all taken turns helping each other. Consequently, I know that I have six more people in my life who I can count on to help me in times of need. I think they know that they can also ask any time.

Respectfully,

Jon Braman

 

Transfer to UCT and University of Cape Town Academic Day

We arose early and transferred from Tygerberg to University of Cape Town. At 06:15, we had a wonderful group of boxed breakfasts by our great hosts at the hotel, and then hopped in a series of Ubers to get to the Red Cross War Memorial Children’s Hospital. There we met up with Maritz Laubscher, our host, and Stewart Dix-Peek (ABC 2010) who took us on pediatric trauma rounds. We saw several post-operative patients and then worked through the plan for the theatre today. We were surprised to learn that they are primary on many children and even manage the workup of sexually assaulted children and those who need to have abdominal trauma ruled out. Any children who require abdominal surgery are on the pediatric general surgery team.

Following this we had a tour of the hospital and the simulation lab where much of the surgical training occurs for all surgical disciplines.

We had a nice cup of coffee and conversation with Prof Sharon Cox, one of the pediatric general surgeons who talked to us about simulation, the interdisciplinary care of traumatized children and their unique care of burned children.

We had a breakfast, then drove by the Cecil Rhodes monument for a view of the city from above, and went to the other ward of this hospital. Interestingly, this is in another building about 4 km away.

It was worth the trip, since it is one large ward, in the shadow of Table Mountain, and there were dozens of children in this ward, many in skeletal traction for their long-bone injuries.

We then went to Groote Schuur Hospital. This is the famous hospital where Christian Barnard performed the first human heart transplant. We had a tour of the museum that is situated in the original operating theatre that housed this incredible surgical team. We had an animated tour guide, and watched a movie. It was clear to me during the movie how closely linked my home program (University of Minnesota) is to UCT. Barnard got his Ph.D. with Dr. Wangensteen at the UMN and was close. When he finished his Ph.D., he left Minnesota with a heart-lung machine and grant funding to begin his dog lab in South Africa. When I saw the original operating room, however, I was transported home since even the tile is the same color as good-old Room 12 at the UMMC campus. IMG_0784

After this we did our academic day, and I gave a talk on internal vs. external impingement for the first time in our tour. It was well received and generated discussion. All of the topics were lively, and the UCT faculty and registrars were involved and interested. Nick spoke to us about his work with currently unavailable new technologies.

Following this, we dashed home to change, got freshened up, then adjourned to the hotel lounge to say goodbye to Brett. He is being deployed next week so he is flying home today. We had one last drink, one last photo together, then departed to dinner as he went to the airport.

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The last group photo of the tour.

At dinner we were met there by Stephen Roche, Robert Dunn (ABC 2004), Anria Horn, and Maritz. IMG_0789.jpegWe had a wonderful dinner, and the company was excellent. After this, we walked a few blocks through a ridiculous display of police and military presence, to catch a cab home. We have an early start tomorrow for the UCT social day.

Respectfully,

Jon Braman

Stellenbosch Social Day

Today we rounded for fracture conference at the hospital after meeting for breakfast at the hotel at 06:30. The region has been hit with a prolonged drought, but today a light rain was falling. This made traffic worse than usual and made us a bit late. The good news is that when the Prof is driving, then you’re never late.

Fracture conference was interesting with complex trauma from last night reviewed. The registrars who had been operating last night did great work, IMG_0735and defended their treatments and provided plans for those patients who were not yet operated upon. Again, it was clear that there is a huge burden of trauma that threatens to overwhelm the system here. I learned that some of the dirtiest wounds they see are assaults from the panga, or machetes, that are common weapons locally.

 

We were then joined by Delmar, one of the senior registrars, and traveled to the prison from which Mandela was officially released for a picture.IMG_0737

Then, we went to KWV, a cooperative wine and brandy system that was started in 1918 by local farmers and still runs the same way. They have 680 stainless steel vats on the presmises for aging which each average 75,000 L of volume. They then finish in oak for their wines. They still have some of the original vats of oak including Big Bill that was made in 1843 and some huge sequoia vats that are over 200,000 L in size.

All of these large wooden vats are only of historical value at this time but were interesting to see. We toured their grounds, enjoyed the tasting, and headed to the Afrikaans Language Monument (Afrikaanse taalmonument). IMG_0752This celebrates the multiple contributions that led to the Afrikaans language.

We then went to another winery for lunch. There, at Spice Route Winery, we had dinner overlooking the beautiful views, and watched the sun burned off the mist from the mountains.IMG_6082.JPG-1

 

We returned to our hotel to catch up on work (or the blog, in my case). Dinner was a Braai at the Prof’s house. This included lamb as well as vegetables (chicken in this case). We had a great time sharing our experiences and mingling not only with the staff, but the community orthopaedists, some of the emeritus surgeons, and the registrars.

We returned home to rest for early (06:00) departure to University of Cape Town tomorrow am.

 

Respectfully,

 

Jon Braman

Stellenbosch Social Day

Today we awoke to the horrifying news of the Manchester bombing. We reached out to Prof Kay who said that his family and staff were fine. Prof Biant responded that she and her staff were busy with the wounded. Our thoughts are with them.

Then we rounded ourselves up for fracture conference at the hospital after meeting for breakfast at the hotel at 06:30. The region has been hit with a prolonged drought, but today a light rain was falling. This made traffic worse than usual and made us a bit late. The good news is that when the Prof is driving, then you’re never late.
IMG_0735.jpeg

Fracture conference was interesting with complex trauma from last night reviewed. The registrars who had been operating last night did great work, and defended their treatments and provided plans for those patients who were not yet operated upon. Again, it was clear that there is a huge burden of trauma that threatens to overwhelm the system here. I learned that some of the dirtiest wounds they see are assaults from the panga, or machetes, that are common weapons locally.

We were then joined by Delmar, one of the senior registrars, and traveled to the prison from which Mandela was officially released for a picture. Then, we went to KWV, a cooperative wine and brandy system that was started in 1918 by local farmers and still runs the same way. IMG_0736.jpegThey have 680 stainless steel vats on the presmises for aging which each average 75,000 L of volume. They then finish in oak for their wines. They still have some of the original vats of oak including Big Bill that was made in 1843 and some huge sequoia vats that are over 200,000 L in size.

All of these large wooden vats are only of historical value at this time but were interesting to see. We toured their grounds, enjoyed the tasting, and headed to the Afrikaans Language Monument (Afrikaanse taalmonument). This celebrates the multiple contributions that led to the Afrikaans language.

We then went to another winery for lunch. There, at Spice Route Winery, we had dinner overlooking the beautiful views, and watched the sun burned off the mist from the mountains.

We returned to our hotel to catch up on work (or the blog, in my case). Dinner was a Braai at the Prof’s house. This included lamb as well as vegetables (chicken in this case). We had a great time sharing our experiences and mingling not only with the staff, but the community orthopaedists, some of the emeritus surgeons, and the registrars. We returned home to rest for early (06:00) departure to University of Cape Town tomorrow am.

 

Respectfully,

 

Jon Braman

Transfer to Stellenbosch and Tygerberg Academic Day

We rose early, were greeted by FP and Prof Shipley, and taken to the airport. We traveled to Cape Town without difficulty, then were greeted by Cameron Anley (ABC 2016) and one of the registrars, Franklin Fortuin.

We quickly stopped by the hotel, where Cameron had kindly made arrangements for us to check in early (except for Brett, who got trolled by the rest of us).

We then went to the hospital where we had lunch with Prof. du Toit and started the academic session. He gave a great summary of the incredible volume of trauma that they see here. He spoke of the challenges of being in South Africa which he described as “Second World” which is balanced between the first world that we are used to in the US and Canada, but there is still the burden of HIV TB, and violence/trauma.

For example, they see 30 open tibia fractures a month, and simply have more trauma than they can manage with patients often waiting days for debridement and weeks for definitive treatment. For example, they see 78 gunshot wounds that require operative orthopaedic treatment per month. This does not include those that simply must be washed out and sent home. This is the number that required surgical stabilization. As a result of this as well as because of the massive volume of neglected injuries that they see, they use a significant number of fine-wire fixators. Joe was in his element.

Our sessions were intermixed with cases by Nando Ferreira showed the power of this technology, with deformity correction, sepsis management, and bone defect regeneration and treatment. It was humbling for me to see the work that is done here.

After this session, we returned quickly to the hotel for a freshen, then off to dinner. We were met by Dr. Adrian van Zyl and his wife Karen who are just finishing off their tour on the Carousel since he is completing his term as the South African Orthopaedic Association President.

The restaurant had statues that seemed to represent the “stages of the ABC Fellowship.” We had a wonderful dinner and came home. Erik, Nick, and I went to a local casino and won big before coming home early for our social day tomorrow.

 

Respectfully,

 
Jon Braman

Bloemfontein Academic Day

A drive from Letsatsi to Bloemfontein proceeded without difficulty. We checked into our hotel and prepared for our afternoon academic session. It was held at the home of Gerhard Greeff, one of the sports medicine surgeons who has lovely home that was built in the mid-1930s as an estate, fell into disrepair and was used for multiple things including a nightclub prior to him rescuing it and making it into his homestead.

The academic session opened with a wonderful summary of the ABC Traveling Fellowship and its history by Prof. Shipley, then alternated between our talks and case presentations from the surgeons in the Bloemfontein community, including some who had flown in from 500 km away for this afternoon meeting. Dr. Kobus Fourie had a challenging complication of a clavicle fracture after CC ligament reconstruction where the suture seemed to have sawed through the clavicle. Fortunately, the patient did well after bonegrafting of the defect and removal of the suture. Dr. Greeff showed an excellent case of a difficult Type C glenoid treated with bone grafting and reverse total shoulder replacement followed by a case by Werner van der Merwe who managed an MCL injury during total knee with a hamstring reconstruction in the LaPrade fashion. The intraoperative videos were amazing. The meeting ended with gracious thanks from Dr. Steven Matshidza, the head of department for our time visiting.

Dinner proceeded with great entertainment including live music (pan flute) and excellent company. We returned home knowing that we were going to have to proceed to Stellenbosch tomorrow morning.
Respectfully,

 

Jon Braman

 

 

Letsatsi Game Preserve

In the morning, we had a quick cup of coffee, then most of us went on a game drive on the preserve.

This is a hunting preserve that specializes in antelopes of various kinds. There are no predators on this preserve, and it is managed actively. The terrain is very different from that at Hluhluwe. Rather than the rolling hills with dense vegetation, this has a savannah feel to it. There are high buttes as well as scrub brush intermingled with blowing knee high grass. We saw ground squirrels, springbok, emus (non-native), Red Lechwe, and one lonely giraffe on the top of the hill thanks to the eagle eyes of Brett.

We transitioned to another hunting park where we saw rhinos again and David proved that electric fences carry electricity. We were also able to get views of a lion and some lionesses bringing us to 80% of the big five.

We saw Cape Buffalo (non-native), various permutations on the bleisbock, springbok, orix, and other antelope – some with genetic variations such as white coloring. These animals had been previously bred for a hunting market that has since collapsed. They are recessive genes, and are not well suited for survival in the wild. This was evidenced by the fact that they were sure easier to spot for us.

We then went on a hike to a cave that had aboriginal cave paintings. Johan gave us a short didactic on these paintings and others in the area. These are from the bushmen, who have lived in this area for at least the last 2000 years. These paintings are relatively unknown, difficult to access and so are in good condition and rarely visited. There are themes that are frequently seen in cave paintings throughout the region. These were painted by a shaman who was in a trancelike state, often to try to bring about the rain gods to favor the land. They commonly feature the rain animal, baboons, and a mantis god. The views of the surrounding grassland were expansive and the hike was incredible despite the grass seeds that kept getting lodged in our trainers. No other travelers had to be medically evacuated, so it was an improvement over Helvellyn.

We returned to the tent camp for much needed showers, WiFi, and dinner. On the way we saw an aardwolf. We found a new friend (Old Brown Sherry) and they were able to access some more for us after we became well-acquainted as a group last night. We were also introduced the Mampoer, also known as “white lightning” which is a “privately brewed” beverage whose “alcohol content is unknown.” Prof Shipley toasted quite elegantly about the role that visits like ours played in keeping the local orthopaedic community interested and up-to-date. It was very traditional and we once again were overwhelmed by the hospitality of our hosts.

Unfortunately, I still find myself in the midst of a WiFi desert so no pictures.

Respectfully,

Jon Braman