Journey in South Africa

I wrote this article in May and it's due to be published in IMU Alumni Newsletter in January 2012. It's an account of my journey as a medical student in Pietermaritzburg, South Africa, what I have seen and learned.

The dim light from the passageway outside the casualty unit cast long shadows over the few wounded souls in the room still awaiting medical attention. It was 2am in the morning. Streaks of blood on the floor only thickened the atmosphere of despair that seemed to suck the life out of the room. A half-conscious man with a traumatic head injury was pressing a rag against his wound while his wife tended to him anxiously; a woman who was bitten - not by dogs but by her deranged, abusive boyfriend - was writhing in pain; three very drunk young men with vicious stab wounds lay passed out next to each other, no one remembering who had struck first. Next to the room where I was suturing another man’s wound, a child was bawling at the top of his lungs because his mother had spilled burning paraffin all over his upper body while trying to kindle a fire in the cold winter night.

Traumatic head injury

Stitching a patient up

A boy who suffered a mixture of 2nd and 3rd degree burn

A man who was stabbed by his friend

 South Africa – the rainbow nation filled with people of all colours and ethnicities – is a great place to learn medicine. I arrived in Pietermaritzburg, the capital of KwaZulu-Natal, with great anticipation, knowing that I would be able to see for myself many medical pathologies otherwise found only in textbooks. This phenomenon can be attributed to some very fundamental problems that are unique to the region: poverty, unemployment, HIV, TB, promiscuity, lack of education, violence and disparity in social status across gender and colour lines. These things sound cliché and somewhat unreal, like statements one might encounter in books or on television. But immersed in the environment, witnessing the extent of the horror of it all, I began to come to the same question I’m sure crossed the minds of many before me: Why does nothing good ever come to the Black people?

Edendale Hospital, Pietermaritzburg

Edendale outpatient

An extremely ill man

I spent the first two months in the department of medicine and next two months in the department of surgery in Edendale Hospital – a hospital that caters mainly for the Black people. On the very first day of work, the head of department of medicine, Dr Wilson, told me, “This is South Africa. Don’t expect everything to be neat and organised.” At that time I was running around looking for the consultant to start the daily ward rounds. “Some of the American residents who came here for attachment had difficulty adjusting to the environment because they were so used to structured schedules back home. It doesn’t work here.” I understood his point right away. If I wanted to make my experience worthwhile, I had to make things happen instead of waiting passively for them. From then on, I was always busy running around the entire hospital seeking action. Early in the morning, I would get myself to the ward and start tending to the newly-admitted patients first.  Since the number of patients typically overwhelms the number of staff on duty, the registrars never minded an extra pair of hands. The consultant would then come at any time between 9-11am and we would start the round together. As soon as it was over, it would be time for procedures: blood-taking, cannulation, pleural taps, lumbar punctures, nasogastric tube insertion, biopsies, intercostal drain or even central line placement. In the afternoon, I would proceed to the outpatient department or other peripheral wards to look for more procedures that needed to be done or simply to assist the doctors in admitting new patients.

HIV and TB are endemic in the province of KwaZulu-Natal with a prevalence of 39.5% (i.e. 4 in10 people are HIV positive) – the highest recorded rate in South Africa. Patients usually see their traditional healers first for treatment, and when they finally end in the hospital, they are often in a terrible shape with very low CD4 counts and numerous other HIV- or TB-related problems such Pneumocystic pneumonia, Toxoplasmosis, Crytococcal meningitis, HIV-associated nephropathy, TB-meningitis, TB-abdomen etc. On one of my first few days there, I remember seeing so many sick people in the outpatient department that I felt utterly discouraged and despondent. Some of them had been lying there for days waiting for available beds in the admission ward; some of them had such badly scarred lungs that they were hyperventilating just to stay alive; while others lay in a semi-conscious state drenched in sweat – a clear indication that TB had taken a huge toll on their bodies.  

Dr Douglas Wilson, the head of department of medicine

A 15 yr old boy, minutes before meningitis took his life.

Circumcision camp!

Besides HIV and TB, Africa is an ideal place to learn how to manage trauma – anything from motor-vehicle injuries, to gunshots, knife wounds and burns. On the last weekend of every month when people receive their salary, many would spend exorbitantly on binge drinking. Under in the influence of alcohol, they would start fighting and stabbing each other in the street. For me, besides it being an ideal training ground for practicing suturing and managing such injuries, it gave me a chance to witness first-hand the complex social lives of Africans in poverty.

Blood and mess

A woman who was attacked by her boyfriend's other gf

Gunshot wound

Racoon's sign, signifying base of skull fracture

Two men who carried chest drain around the hospital

Sometimes, being overwhelmed by the sheer patient load and the ensuing emotional roller coaster, I found myself numbed to the cries around me. I realised that in order to survive, I could not just rely on my brains and physical strength to do the job. Needless to say, diligence is extremely important. That’s why I do not and never will fancy lazy doctors – especially in our generation where it has become more of a fashion to enter medicine as opposed to by passion or calling. Besides being diligent, it is also about knowing how to choose your battles. If you wanted to be a hero to save the world and solve all the problems in the hospital, exhaustion and disappointment are all that you will find. Therefore, knowing how to differentiate between the truly important and the seemingly urgent would help a great deal in a place where work never ends. Most importantly, you need to find joy in what you are doing. Medicine places you in a very unique position where you have the ability to influence lives for the better – be it through educating your patients, showing a simple act of kindness, or treating them as humans with real emotions rather than objects with diseases. Sometimes it even means risking your comfort and safety to have a true interaction with patients, especially when it entails allowing yourself to be vulnerable in front of them. It is this exchange of love and care that truly epitomises the real meaning of doctoring and which enhances the quality of lives of people around us – including our own. 

An extremely brave boy who touched my heart

 

Children in orthopaedic ward

Children in the eye ward

A boy who had a seizure and fell and hit his eye

A man who was diagnosed with lymphoma. He has massive splenomegaly (enlarged spleen).

Over here, I have had the opportunity to meet some extraordinary souls – the head of department of medicine of Edendale Hospital, Dr Douglas Wilson, for example. He is a leading specialist on HIV in the world, the main author of “Handbook of HIV Medicine” and a key researcher in TB in South Africa. One day I asked him, “Given your credentials, you can work anywhere you want in the world or in the private sector. Why did you choose to work in Edendale?” His reply was simple, “It just makes me happy knowing that the patients I am treating here are those who really need it.” That answer could not have had more volume. In a profession that is so tainted by greed, self-aggrandisement, cynicism and lack of compassion and ethics, his example made me realise that it is possible to be different and to set a standard that is distinct from the pattern of the world.

The medical team. Dr Wilson (second from right)

Dr George Oosthuizen, the head of department of surgery. He has a great sense of humour and is a great surgeon and father.

Dr Carolyn Lee, the only Chinese consultant (intensivist) that i met in South Africa. She is really intelligent!

The TB warriors who work tirelessly for the TB patients. I love being with them!

“Some say the world is a vale of tears, I say it is a place of soul-making.” So said John Keats, the first medical student to formulate these ideas about pain and suffering, shortly before he died. Being here for four months has changed my perspective of doctoring and of mankind in general. I found my inadequacies exposed, idealism challenged and compassion moulded. The entire process also strengthened and shaped me to become both a better doctor and a better person. I know beyond the shadow of a doubt that I came to the right place. The memory of the many souls I have encountered here will stay in my heart for a long time to come.

My host family - Aunty Floss and Uncle John (first two on the left), Uncle Tony and Aunty Diane (Middle two) and me

Dinner with my host family

Bubu, Kelvin, Ali and me (after watching Toy Story 3 together). They are great kids!

My German friends - Philip (left) and Michael (right)

Guy and Chantel (my host father's son and his gf).

A group of intern friends that i hung up with in South Africa

Bheki (right) - my good friend in South Africa

My other German friends (From left - Gerrit, Eico, Christina and Angela). I miss them!

An African lady in her traditional costumes

My room in South Africa

Rock climbing with friends

Fishing with friends