Day 61 - Cape Town

Today I met with my Infectious Diseases class for a field trip!  Our first stop was Tygerberg Children’s Hospital, where we met up with representatives for Hope Cape Town, a program for education, prevention, and treatment of HIV/AIDS and tuberculosis.  For those that don’t know, South Africa has more people living with HIV/AIDS than any other country, somewhere in the realm of 5.5 million people (18% prevalence).  This figure is probably understated because most people refuse to get tested.  The most striking thing for me was all the urban myths the program had to counter.  Most people simply go to an herbalist for treatment, or refuse testing and treatment entirely because they don’t look or feel sick; others believe it is only a black disease.  The former president (Thabo Mbeke) denied any link between HIV and AIDS and hindered efforts to distribute medication.  The current president (Jacob Zuma) slept with an AIDS activist without protection, but claimed immunity because he took a cold shower right after.

After a very informative presentation and intense questioning, we switched hospitals.  Our next stop was Groote Schuur Hospital, where the first heart transplant took place by Christiaan Barnard in 1967.  I could talk all day about the details of the operation and Barnard’s life, but I’ll try to stick to the main points.  We were given a tour of the original operating rooms where mannequins depicted the scene with all of the original equipment.  The operating theatres were 20 feet tall, as this was before sterile air conditioning, and all contaminant were expected to rise with the heat and escape through vents at the top.  There were even displays of the first three donor hearts and the first three diseased recipient hearts preserved in formaldehyde.

A few interesting points: Barnard was a skilled surgeon and was granted a scholarship to research at the University of Minnesota.  The Americans were ahead on cardiac research and were already transplanting hearts between dogs.  Barnard returned to South America for another 6 years of research, then gathered a team and got permission to perform a heart transplant.  They picked a terminally ill patient as a recipient, then waited around for months for a suitable donor.  The first potential donor that came along was declared brain dead, but then rejected because he was colored.  Barnard did not agree with this form of discrimination and rarely listened to authority, but he realized that if the operation using the colored man’s heart failed, his career would be over.  (Later, Barnard himself set the policy that if you want to choose the race of your heart donor, you will not get a heart at all.)  The heart was rejected, and the wait ensued for another month.  After the operation was deemed successful (the patient lived for 18 days and died due to pneumonia, not heart problems), the Americans were furious.  They accused Barnard of performing the surgery before enough research was done, among other claims.  The Americans were determined to keep up, and a heart transplant epidemic ensued in the following year with a 100% failure rate.