TES Ambassador Exchange Soweto: Day Six: Soweto and thyroid US

This morning we took a tour of Soweto.

We started off at the Regina Mundi (Queen of the World) Church, which was an important gathering place for the people of Soweto, especially in the years during and after apartheid. On the day of the Soweto uprising, (June 16, 1976) people estimate that about 6,000 people fled to the church.

Regina Mundi church

Inside of the church

A sample election ballot

We then took a city bus into one of the poorer areas of Soweto, where government RDP (Reconstruction and Development Program) houses stand side-by-side shanty homes. The RDP homes are small but have electricity and running water inside and outside the house. The shanty homes are made mostly of corrugated metal and other supplies like cardboard or sheets of plastic. They have no electricity or running water, although the government has recently installed modern latrines near the shanty homes. Many of the people living in the shanties have come from the remote townships looking for work. Unemployment is quite high in Johannesburg, some official figures state it is almost 40%. However, many people in Soweto have unofficial businesses - selling fruit, alcohol, opening up barber shops, or beauty salons.

We met one of the women who lives in a shanty home. She is a 26 year old who came from the Eastern Cape with her seven year old son to join her husband, who was looking for work in Joburg. She has been living here for the past six months. She has no running water and uses the outside water from the neighbors who live in the RDP houses. The water is currently free, but the government is going to start put meters up and charging for excess usage, so this situation is likely to change.

Shanty houses

New latrines outside the shanty houses

Inside a shanty home

I have always felt that it is important to understand where patients live and the "social context" of their disease. I often went on home visits to patients starting in medical school. Seeing people's living situation and learning about what their jobs (or lack of employment) entail, demands of daily life, and stresses can put things such as med non-adherence, no-showing for clinic, failure to follow up for recommended testing in context. Although simple knowledge of these things does not change the situation, it can be a starting point to understand how important a patient's disease (especially an asymptomatic, chronic disease) is in his or her daily life and can allow you work out a treatment plan that is easier for patients to follow through with.

Names of the students killed during the Soweto Riots in 1976.

Our next stop was the Hector Pieterson museum, named for one of the young boys killed during the Soweto Uprising. After learning about the student riots, we walked down Vilakazi street to see Nelson Mandela's former home and Desmond Tutu's home. Two Nobel Peace Prize winners living on the same block....

Dr. Mandel and I outside of Nelson Mandela's home.

This area of Soweto is much more prosperous. We took a Kombi van (the major transportation system in the city) back to Bara (our fourth form of transportation for the day: car, bus, walking, Kombi!)

Practicing the Kombi hand sign for Bara -
looking at this photo, I'm not sure exactly where I would have ended up!

A Kombi driving by the Soweto towers.

In the afternoon, Dr. Mandel spoke to the radiology and endocrine division about the US evaluation of the thyroid nodule. Eight patients from the endocrine and surgical clinics were evaluated during the session. We discussed their clinical cases and Dr. Mandel pointed out the salient imaging features. We evaluated several patients with thyroid nodules, a pre-op patient with medullary thyroid cancer and extensive lateral LN disease, a patient with Bx proven anaplastic carcinoma, correlated two sestimibi scans with US for patients with primary hyperparathyroidism, correlated a RAI uptake scan with US for a patient with hyperthyroidism, evaluated a post-operative neck US for residual LN in a patient with PTC.