After a few months working a 60 hour week here in mitchell’s plain, cape town I have got used to some of the lingo and ways of doing things. Initially you are confronted by the stark differences of working in an area with a high burden of poverty, violence and infectious disease. However, many of the problems we face are similar, it just here just the problems are scaled up.
More unwell people.
The presentations can be pretty similar, ectopics, sepsis, head injuries- things we are used to seeing on a day to day basis in the U.K. However the acuity is so much higher. The ectopic pregnancies are often hypotensive, requiring resuscitation with blood and fluids. Patients with sepsis are younger and presenting later than back home, with the immunity compromised by underlying infectious disease rather than age and we see many head injuries with low gcs on a daily basis.
More work to do
In the U.K due to time pressure limitations we have subcontracted much of our work to various specialist teams, from lip suturing (max-fax) to intubation (anaesthetics), I am sure this has led to better outcomes but it has de-skilled us as generalist somewhat. Here, the remit is to fix and refer only when fixed. This is necessary, especially for medical admission, they need to be fully stabilised as will be moving to a ward environment which will be comparatively unmonitored.
The doctors here, although seeming to have a roughly similar knowledge base to a comparatively experienced english doctors, however, theskill set there possess is vastly superior; intubations, complex suturing, suprapubic catheters are all within the abilities of juniors here. This is both due to the higher acuity of patients they see, and the increased hours they undertake; from medical school onwards they spend significant more time in the hospital than their British counterparts.
More stuff to do
I hope I have always appreciated my awesome colleges I work with in the ED in England. Now my appreciation is at another level, when left to undertake observations, take bloods and actively move the patients around the ward. This is both time-consuming and demoralising when you are actively trying to clerk patients with complex issues.
The above takes it toll. We have our fair share of it in UK Emergency medicine. There are many ways to spot burnout. The easiest is when you colleges state “I’m burnout brah”. This is understandable. The hours are long and tough and the rewards comparatively minimal. Battling the high disease burden within a system that works, but can be frustratingly inefficient at times. Again, these is not unfamiliar to a british doc, but the scale is logarithmically different.
More lessons to learn
All these challenges make for some adaptive physicians, able to deal with complex intensive care patients, polytrauma whilst undertaken routine bloods tests. This is the reason I put my career on hold to come and see how it was done. It is done magnificently.