UBT for South Africa: Let's Begin in Cape Town

Having spent twelve days in South Africa, this blog post is way overdue. The delay in communicating my reflections can be attributed most to the array of experiences I had in my time in Cape Town and my struggles with documenting them succinctly, for they are so wide and varied.

First off, let me explain what I am doing in South Africa. I am here to study the processes involved with incorporating the uterine balloon tamponade (UBT) into the policy guidelines of the South African health system for the management of postpartum hemorrhage (PPH), with data for this research being gathered through key informant interviews with National Department of Health officials, medical device manufacturers, researchers and clinicians. I am conducting this research through an internship with an American non-profit organization called PATH and it is a privilege to be a part of this extraordinary team.

My week in Cape Town commenced on an overcast Sunday with a tour of this enthralling city. I was lucky to venture out into the city on Sunday because we had a packed schedule for the rest of the week. One of the many highlights of my stay in Cape Town was interacting with experts at the Stellenbosch University. It was heartening to see their excitement at the possibility of instituting UBT into management guidelines, given its need and life-saving potential. To strengthen the UBT's case to policymakers, they argued, it would be imperative to conduct a case series in South Africa to prove that the device is useful, necessary for South Africa and does nothing to harm the patient. Despite the numerous studies that have proven the UBT's efficacy, the experts said it was essential to perform the case series in South Africa so that policymakers are convinced that it is, in fact, needed here.

The infrastructure of the medical school and other parts of its campus, as I would witness over the next few days, was also admirable. Also in the picturesque university town of Stellenosch was Sinapi Biomedical’s manufacturing plant, where I saw fascinating designs of the UBT and the machinery that would produce it. Key factors in any UBT design are the material used for the balloon, the mechanism to control the pressure while the balloon is in the uterine cavity and the length of the tube that connects the balloon and pressure-controlling device.

While much of Cape Town bears resemblance to parts of Europe, I had the opportunity to visit a maternity health center in a lower-income area of the city. Greeted by an affable administrator who had been working at the clinic for the last two years, she narrated tales of ‘gangster-ism’ in the area, with one specific instance involving men with guns creating a ruckus at the facility (they were thrown out eventually). She was a skilled raconteur to be able to convey a rather perturbing scenario like that with humour. The purpose of my visit to the clinic was to ask health workers about the mechanisms used in the facility to treat postpartum hemorrhage. Their responses indicated that postpartum hemorrhage was rare in the maternity clinic because of timely management during childbirth and access to uterotonics such as oxytocin. These interviews took place in a maternity ward, which was also where most of the deliveries in the facility took place. When I walked out of the ward after I had received my responses, many people seated on the benches outside congratulated me heartily because they assumed I had become a father.

A striking feature that I repeatedly noticed was the fitness culture in Cape Town. Throughout the week, I spoke to numerous people who casually stated that they run 90 km marathons, cycle 100 km or participate in astonishingly demanding triathlons. To prove that we also belong to the fitness bandwagon, my colleague and I have decided to embark on a 40 km hike on the Num-Num trail in Mpumalanga. If you don’t hear from us for a couple of days, you know where to find us!

Last but not least, I would be remiss if I didn’t write about my visit to the Newlands cricket stadium. It was surreal to be standing on the turf on which many of my cricketing heroes had produced match-winning performances that defined their legacy, with the view of the Table Mountains adding to my joy of being there.

All in all, my first time in Cape Town was the ideal beginning to what I believe will be an enriching learning experience.

With the adventures in Johannesburg having begun, there is more to come!