South Africa offers great opportunities for trainees
Authors: John Rocke
Publication date: 21 Mar 2016
An eight month stint in two Cape Town hospitals gave John Rocke huge amounts of hands-on surgical experience
Many young doctors in the UK are taking time out of training to work abroad. Australia and New Zealand are popular choices, but an often overlooked destination is South Africa. It has a pleasant climate, most patients speak English, and UK doctors are exposed to a range of diseases rarely seen at home, including trauma cases.
I chose to work in two public hospitals in Cape Town, where I was appointed as a registrar in ear, nose, and throat (ENT). I had just finished my foundation programme and came with little surgical experience, but after eight months I had performed or assisted in over 200 operations.
I lived in a shared house in the hipster filled suburb of Vredehoek, which backs on to Table Mountain National Park. My house had a swimming pool, sea and mountain views, and welcoming South African hosts. The public hospitals were a short drive from this wealthy suburb, but their patients’ lives were a world away.
My first rotation was in the Red Cross War Memorial Children’s Hospital, the largest paediatric hospital in Africa. Every year the hospital handles around 260<thin>000 patients, most of whom are very poor. Our ENT clinics were always overflowing with patients who had arrived early to get to the front of the first-come-first-served queue.
I came with no experience in ENT outside medical school but was helped by a large team of consultants and the other nine registrars rotating through the department. I was soon seeing children—with symptoms such as hearing loss, otorrhoea, and obstructive sleep apnoea—in my own clinic.
I learned procedures such as adenotonsillectomy and grommet insertion, and after the first month I ran my own half day lists two or three times a week. I assisted the consultants and senior registrar in more complex paediatric procedures, as well as working with the intensive care unit to manage patients who needed tracheostomy and other forms of airway management.
My second rotation was in head and neck surgery at Groote Schuur Hospital, where the world’s first successful human to human heart transplantation was performed by Christian Barnard in 1967.
Core surgical training in the UK has been dubbed “core service training” because many trainees believe it does not provide enough surgical experience. At the southern tip of Africa, I felt I was being taught to operate, not to just watch and hold retractors. My commitment and progression were judged on hard work and merit, not on how many courses I had attended.
Professor Johannes Fagan, the head and neck consultant and department head, operated four days a week and provided a wide ranging theatre experience for trainees.
I looked forward to Mondays, where a case would be planned with the plastic surgeons, usually a tumour removal and reconstruction. The ENT team would remove the patient’s primary tumour, which was invariably metastatic. It usually required extensive resection that left large defects that our plastic surgery colleagues would reconstruct. I became confident in performing split thickness skin grafts to the donor site.
I worked on the on-call rota covering the three hospital sites, and handled referrals from primary care and the secondary hospital network. For 24 hours I would respond to calls from the emergency and trauma departments as well as advise doctors further afield. It was during this on-call period that I was exposed to the management of neck and airway trauma caused by gunshots or stabbings.
So what are the negatives?
Many senior clinicians in the UK discouraged me from taking a year out of training, warning it would damage my career and would be viewed negatively. I still cannot understand why that should be the case.
I worked for eight months without pay: the South African government does not pay foreign doctors to work in the Western Cape as it says that it has enough home grown doctors. But the experience I gained was worth it. The other provinces of South Africa, however, do pay foreign doctors, and Africa Health Placements can help doctors to find a post.
Coming home has been a culture shock. The waste in the UK is extraordinary. In South Africa, theatre gowns were washed and sterilised for re-use. Sutures and ties were only opened when needed, and used to the very end; swabs were completely soaked in blood before being discarded; and “single use” otoscope speculums were never binned.
I have also had less responsibility, which is largely due to the drive towards a consultant led service—but I worry that this is at the expense of training.
I did not want to come home. I am now back in the north west of England undertaking core surgical training, but I plan to return to the southern tip of Africa in the not too distant future.
• Africa Health Placements: [Link]
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.
John Rocke core surgical trainee year 1 Pennine Acute Hospitals NHS Trust