Clinical Elective in Trauma Emergency Department at Groote Schuur Hospital, Cape Town, South Africa.

Kelsy Greenwald, MD

Resident, Harvard Affiliated Emergency Medicine Residency

PGY 2 

Groote Schuur Hospital - a hospital situated in gorgeous Cape Town, overlooking one of the modern seven wonders of the nature. And yet, a violent area, with a homicide rate of 62 per 100,000, and in the poorest sub-district of Khayelitsha the rate is 120 per 100,000 people. For comparison, Detroit’s homicide rate is 40 per 100,000.

Groote Schuur Hospital is a government funded public hospital, where most patients pay little to nothing for their care. It is a tertiary hospital and is well respected for its trauma care.  Many visiting physicians come from around the world to train at GSH. The trauma center alone sees 1300 patients each month, with 50 beds in total and 10 high care beds. The trauma center sees both blunt and penetrating trauma, intentional gunshot and stab wounds and unintentional motor vehicle accidents. The number of gunshot wounds is high, averaging 70-80 per month.  Groote Schuur Hospital is the referral site for many of the surrounding hospitals as it is one of two hospitals in all of Cape Town with 24 hour access to CT scanner (though it is still at least a 5 min walk/run from the resuscitation area). 

Shifts in its trauma unit are run from 8am-6pm, and a night shift from 6pm-8am. Each shift usually has 2-3 registrars, or residents, and 2 interns. Attendings round with the residents at each shift change, but otherwise the registrars run the trauma center. Most registrars work roughly 50-60 hours per week. The trauma center is split into three sections: green (the most stable patients, left in chairs), yellow (those that require a stretcher), and resuscitation (those that require monitoring – codes, unstable vitals, penetrating trauma to the chest or abdomen, or those with Glasgow Coma Scales less than 14).

I spent my time doing 4 15-hour overnight shifts each week, from Thursday to Sunday, the times the most trauma occurred. I was able to learn from these incredible registrars who would see more trauma in one month than the residents in my home hospital would see all year. From crash chest tubes, to open skull fractures, hemorrhaging bleeds from stab wounds to the neck, and multiple chest and abdomen gunshot wounds, the registrars calmly and efficiently manage it all. I was incredibly impressed with the capabilities, knowledge, and courage of the South African residents.