News - Doing as the proverbial Romans do

Doing as the proverbial “Romans” do: My time spent at the VuMC- Amsterdam

Last year I was offered a fantastic opportunity to go and spend up to 3 months at Chris Mulder's unit in Amsterdam training in both basic and specialised endoscopy.

I was picked up at Schipol airport by a dear friend of mine, Thijs, whom I met early in 2007 when he did a clinical attachment at Groote Schuur in our department. After dropping me off at my apartment he was kind enough to come and fetch me again on Monday morning to take me to work. For 3 days I travelled to and from work with Thijs, on the back of his bike, clutching onto him for dear life and all the time concentrating on keeping my feet/shoes/trousers from being trapped in the rotating rear wheel/spokes of the bike. It was hard work!

Then Chris loaned me a bike to use for the duration of my stay, and as I had not ridden a bike since I was a child, I was looking forward to it. I wasn't in the least bit concerned, after all no one forgets how to ride a bike, right? Well, the first day I “rode” it home, I nearly killed myself, and not just once! Suffice it to say that on at least 3 occasions I nearly drove into the front, back or side of an oncoming tram. This excludes the other bikers and cars that I missed by a few millimetres. Somehow I couldn't apply the brakes timeously. I remember vaguely that I lost a shoe and some groceries along the way, and finally ended up pushing the bike all the way home (probably 1 kilometre) with my pants rolled up and walking barefoot. I felt like such a fool, and admittedly at that time I was nostalgic. The only consolation was that of complete anonymity!

The old adage “practice makes perfect” is certainly to be believed; by the third day, I had mastered the art of riding the bike and safely manoeuvred my way not only to and from work, but all over Amsterdam. Increasingly I found myself behaving like the Dutch, disdainfully buzzing tourists off the biker's lanes with my bell, and being able to ride while chatting on the mobile.

I was warmly welcomed by the entire staff, and it was seamless because I had already met Chris, Elly and Tim at previous meetings. The unit has a vibrant and yet relaxing vibe, much like out unit in Cape Town, as a result I felt at home almost instantly. I spent essentially all my time in the DBE room with Maarten Jacobs, Tim Schreuder, and Stijn van Weyenberg who taught me the art of performing enteroscopy. Although it's a long procedure that requires patience I thoroughly enjoyed it. As I understand Chris' unit performs possibly more DBE's now than any other unit in Europe, and so I am truly privileged to have trained there. On average we did 2 DBE's daily and the beauty of it is that I was allowed to perform these with supervision of course.


My other activities included:

a) Performing pH testing and manometry (every 2 nd Wednesday with Elly)
b) Doing a liver clinic with Tim at the St Lucas and Andreas Ziekenhuis (a hospital nearby the Vue, on Thursdays)
c) Watching Chris use APC to dissect a Zenker's diverticulum at least once a week. These sessions were famously known as Chris's cooking session.
d) In between the DBE's I did the odd gastroscopy, oesophageal dilatation, placement of feeding tubes (usually in patients in ICU) and colonoscopy.

   


e) Diagnostic ERCP's are rarely performed in The Netherlands and especially at the Vue, as a result only a handful of ERCP's were performed per week. These were performed by the resident registrars and/or consultants, but I was able to observe the majority of ERCP's done, and it has certainly helped to improve on my own skill in performing an ERCP.
I was exposed to so many other activities in the unit i.e. capsule endoscopy, endo-anal ultra-sound, to name but soon realised that to benefit maximally from my time there; I should stick to DBE predominantly.

In addition, there were clinical, radiology, and histology meetings throughout the course of the week, and although initially I struggled to follow, my Afrikaans came in very handy because by the second week I had little trouble understanding both the formal meetings and conversational Dutch.

My time there was quite eventful; it coincided with their Gut Club meeting which took place at a restaurant by the sea, in Bloemendaal . One forgets that even Europe has beaches! So it was pleasant and instantly reminded me of home. There I met other colleagues practicing in other hospitals in Holland. Furthermore, in October Chris sponsored me to attend the Dutch equivalent of our SAGES meeting, which took place in the south of The Netherlands (in Eindhoven, close to the border of Belgium). It was exciting to be able to compare the similarities and differences between this and our meeting, and overall the 2 meetings are essentially very similar.

Finally the 2 week post-graduate course took place during my stay there. This time there were 5 South Africans in the group, and meeting up with them was just the tonic that I needed in the dwindling days of my stay and within days of that our team the Springboks played in and won the Rugby World Cup! So to say that my days in Amsterdam ended with a big proudly South African bang is an understatement!

Along with the endoscopic and other clinical skills that I picked up there, the most memorable experiences I have are those of the many friends I made whilst there, some of whom I still have contact with. Everyone there from the consultants, doctors, nursing and support staff, to the research residents all made me feel very much like a member of the team, and went out of their way to make my stay as pleasant as possible both at work and outside work. To them all I say “ Haartelik bedankt !”

I would like to end off by formally thanking Chris Mulder, Elly Klinkenberg, SAGES, the Gastroenterology Foundation and Altana Madaus, as well as Gill Watermeyer and Karin Fenton for all their support in making this trip/adventure a possibility.

I have come away with a wealth of knowledge and skills that really cannot be paid for, and for this I am truly grateful.

Mashiko Setshedi
Senior registrar
Groote Schuur

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