As part of the fifth year of my medical degree I was given the opportunity to spend four weeks studying paediatrics in a foreign country. Together with a fellow medical student we managed to arrange a placement in Pietermaritzburg, South Africa, where we could travel between three different hospitals and see paediatrics practised in a variety of settings.
On our first day in Grey’s Hospital we stood in the grand colonial hospital entrance, whilst busy nurses in white aprons and starched lace caps hurried past us, and a security guard lounged on a plastic chair with a shotgun across his lap, looking quizzically at us. We had focused so hard on getting to this point that we hadn’t thought about how to find the ward once we arrived at the hospital! An orthopaedic surgeon stopped to help us and seemed to set a theme that the whole trip would take on; everyone was happy to help and extremely welcoming. The doctors and nurses were working extremely hard and treating far more patients than their resources seemed to allow. However, the answer to the question everyone asked “ninjani?” (how are you? – zulu) was always “ngikhona” (I’m just fine!”).
The experience of paediatrics in South Africa was invaluable. We saw a many of the paediatric conditions also seen in Britain such as epilepsy, malignancy, and premature birth, but also saw a huge range of other conditions, such as tinea capitis, TB, and worms. We spent a week in the outpatients’ clinic at the regional hospital, Edendale, where they easily see over 150 patients every day between five or six doctors. The doctors were keen for us to see our own patients and ask their opinion only when we had formed a differential diagnosis. I gained skills in the examination of children whilst avoiding screaming and asking the right questions of worried parents. I also realised the value of the specialist services and schools for children with learning difficulties in the UK. With this help disabled children in S.A. are often excluded from over loaded schools for being disruptive, and are carried around on their mothers’ backs for years without mental simulation.
Part of the education of doctors in South Africa involves spending one or two years after foundation training doing community service in a rural hospital, where it’s difficult to recruit other doctors to work. The Red Cross runs a programme where consultants from the big hospitals in Pietermaritzburg are flown out to these rural hospitals on a fortnightly basis. Once there, they conduct a full ward round, run a brief outpatients’ clinic and most importantly to give some moral support to the junior doctors. I was lucky enough to join a neonatal consultant on one of these trips. Although the rural hospital was not able to provide all the services offered in Pietermaritzburg, I was amazed and inspired to find a small team of junior doctors competently running a large neonatal intensive care unit with only very occasional supervision from consultants.
I always knew that paediatrics was an area I was interested in, but coming back with the knowledge of how rewarding it can be to work with children and the opportunities there are in paediatrics across the world, I am far more motivated to follow a career in this field. To those who supported my trip “siyabonga” (thank you!).