Casual Competence; First impressions from medicine in a South African township.

Cape townians are a relaxed bunch. In fact some of the most consistently chilled folk I have met in my life. This attitude did not changed when faced with life-threatening emergencies, many many life-threatening emergencies.

After attending badem conference about a year and a half ago I had been itching to come and work in South Africa, an increasingly common choice for British junior doctors wishing to expand there experience beyond what can be offered by U.K training. After a head banging extensive administrative process, putting my life on hold and selling my motorbike I had made it here, to Mitchell’s Plain District Hospital; which serves a community of 350 000 odd in a deprived suburb of cape town.

I quickly got used to the the laid back uniform policy, with the doctors often rocking a jean, scrub top and jacket look. However, there is other things about working here that are harder to get used to.

Africa Time

Say what you will about the U.K 4 hour wait target, it gets shit done. Here, the wait to see a doctor is several hours, requests to get a patient round to XR takes about four and the current record for waiting to get home after discharge was 6 days.

I have partially re-calibrated myself, adopting the laid back approach of my new colleagues. Things that clinically can wait; can wait. In many ways this is liberating, back home, being rushed by nurse in charge to see minor injuries and mild conditions because they have been waiting 3 and a half hours can be frustrating.

The acuity

This laid back attitude became much more understandable once I saw the patients who really needed urgent critical care. Hypotensive stab wounds to the chest, gun-shot wounds to the head and patient’s with GCS 3 being wheel-chaired in by families.

This is when the skills of the doctors trained over here come into shining view. The chest drain gets inserted easily by the intern, the medical officer pulls a bougie out of their back pocket and intubates the gunshot to the head and CPR is started as soon as the unconscious patient is hauled onto a trolley. Help is not required and no nervous beads of sweat appear.

The resources

Working in a government hospital, albeit one of the better ones in the country there were good resources to hand but these have to be managed wisely. Things we take for granted such as a intravenous co-amoxiclav or CRP blood test require consultant sign off.

More difficult to get used to was that lack of upstream resources. Primary PCI was not available at our unit and CT scans only available in the daytime. This led to lots of waiting (see Africa time) or some out of hours transfers which are less than ideal.

However, these limitations, working with a metaphorical hand tied behind your back, makes for great doctors. The skill set of those trained here are unbelievable. After few more months I hope to develop the relaxed attitude of strolling into a critical situation because you know -you’ve got this. Acquiring this casual competence will be well worth the effort require to get here.