Infectious Diseases

Clinical Responsibilities

Helen Joseph Hospital – State Academic Practice – Infectious Diseases Unit
  • In-patient service – 40-60 ward patients reviewed daily. Approximately 5-10 new consultations daily Monday – Friday. Patients seen in general surgery, orthopaedic, psychiatric and medical wards. Rounds begin at 11h00 and end at 15h00-16h00 each day (5 hours) Medical officers and registrars start seeing patients from 08h00.
  • Outpatient service – approximately 4-8 new and/or follow-up patients seen once a week in the ID MOPD clinic: 10h00-13h00 (3 hours).
  • Procedures – the ID Fellow spends two months per year in the Microbiology Laboratory of the Helen Joseph Hospital. During this time, he/she also works in the specialist laboratories (virology, parasitology, epidemic investigation unit etc.) of the National Institute for Communicable Diseases (NICD).
  • Outreach
    • ID ward rounds at Leratong Hospital on the West Rand one afternoon (2 hours) every second month.
    • ID (HIV) clinic rounds at Alexander Clinic in Johannesburg (1 hour) once a month.
  • Friday: Weekly infectious diseases (ID) teaching/training from 08h30-10h00. Once-a-month Friday morning Masterclass in HIV Medicine viz. specialist level HIV teaching. Weekly Grand Ward Round Friday 10h30-12h00 with bedside teaching from ID consultant. Weekly “Third-Line” Antiretroviral Treatment (ART) Clinic 12h00-13h00: specialist discussion of genotype resistance test results in patients (3-4 weekly) failing second-line ART.
Teaching and Training:

Post-graduate teaching within the University of the Witwatersrand (Wits) Medical School programme:

The Fellow and the medical registrar/medical officer(s) are taught during the paper and bedside rounds on a daily basis. In addition there is a two-hour weekly training session every Monday afternoon. The first hour is given to didactic and systematic topics in general Infectious Diseases. A monthly 2-hour Masterclass in HIV Medicine provides up to date teaching in major aspects of the diagnosis and care of people infected with this virus. (See attachment). This is given on the first Friday of the month.

Undergraduate teaching (Wits Medical School):
The consultants and ID Fellow participate in GEMP III and GEMP IV undergraduate teaching.Dr Spencer does 3-4 post-intake ward rounds per month (approx. 2-2.5 hours) at which final year medical students present cases and receive teaching. Dr Spencer teaches GEMP IV students on Thursdays 11h00-13h00 (two hours) on topics relating to HIV medicine. These seminars and bedside tutorials occur twice every six weeks. Dr Spencer provides didactic (formal lectures) teaching of Wits medical students 2-3 times a year.

Supervision of M.Med thesis:
Dr Jeremy Nel (Thesis: White cell count and CRP values in Pulmonary TB Patients). Dr Nel is currently an ID Fellow at the Helen Joseph Hospital. He is engaged in completing this thesis at this time.

Supervision of M.Med thesis:
Dr Spencer is a member of the hospital’s Infection Control and Antimicrobial Committees. These meet every two months on Tuesday and Thursday respectively, usually from 12h00-14h30 (2.5hr). These committees provide the hospital with policy and guidelines concerning antibiotic usage, infection control etc. Dr Spencer meets monthly with the Infection Control nurses of the hospital (07h15-08h30 the last Thursday of the month) to discuss significant microbe cultures, infectious disease outbreaks, hospital cleaning, etc. Dr Spencer sits on the hospital (HJH) and Gauteng Pharmacy and Therapeutics Committees that provide direction for the hospital and province regarding drug usage and outbreak management.

Recent Research Papers and Projects:

Articles:
Dhana A, Howell P, Spencer D. When smear and molecular diagnosis fails: identification of tuberculosis in advanced HIV infection using the newly developed urine lipoarabinomannan lateral-flow assay. BMJ Case Reports 2014; published online March 2014

Dhana AV, Howell P, Sanne I, Spencer D. Identification of Mycobacterium tuberculosis from pericardial fluid using the new Xpert M.TB/RIF assay. BMJ Case Reports 2013. Doi:10.1136/bcr-2013-200615

van Hougenhouck-Tulleken WG, Papavarnavas NS, Blackburn L, Govender NP, Spencer DC, Lippincott CK. “Diagnosis and treatment of two cases of HIV-Associated Opportunistic Emmonsiosis in Johannesburg, South Africa.” Submitted March 2014.

Project:
Electronic database of all infectious diseases consultations seen since January 2013 when Dr Spencer took over as head of ID at the Helen Joseph Hospital. Commenced 2013, currently approx. 1000 patients entered.