My elective as a medical student in South Africa

So apparently everything worked out pretty well. The flight was smooth, I got picked up at the airport and my apartment is actually pretty nice. But what hit me immediately: it’s cold. Especially in the house – there’s basically no insulation. The windows are leaky and there is no heating. I usually sleep in a hoodie and sweatpants under double layered blankets, and outside of the bed I’m freezing constantly.

Left-hand driving works surprisingly well, considering I’ve never done this before. It already feels somehow normal. Even rush hour is okay – you just need to be careful. Especially taxis don’t care about traffic rules at all. Yesterday evening, a car door literally opened while driving because it was so rusty. A lot of cars are damaged in ways that would never be allowed on European streets.

In terms of safety so far, I haven’t had a single sketchy situation. People are very aware here, but I’ve felt completely safe up to now. South Africans are, honestly, super friendly most of the time. What really stood out to me is how different the general vibe is – like, everyone asks you how you’re doing. Doesn’t matter if you know them or not. And if you don’t do that in return, people think you’re rude. It’s just part of the culture – greeting, small talk, that “how are you” is a must. Even in the hospital.

Medical stuff is just insane. I’ve spent maybe 12 hours in the hospital so far and already seen stuff you might see once a year – or never – in European hospitals. Intoxicated patients crashing cars and showing up with TBIs (traumatic brain injury) – altered mental state, RSI with ketamine straight away. Medications like fentanyl or propofol are not used here. Lots of burn patients as well– especially kids. Massive burns in the face or torso.

Most adult patients have been assaulted in some way. A guy with a screwdriver in his face, walking around with it for hours. Rape cases. Gunshot wounds to literally every body part you can imagine – and weirdly, most of them are stable in terms of vitals, so you actually get time to assess them properly.

The medicine itself is intense, but not overwhelming. I don’t feel disgusted or emotionally overloaded. The general smell is really not nice. Hygiene is defined differently here – i found a cockroach today in my food box after i let it stand open for a while….. But when treating patients and once you’re in your doctor mode, you just work. You think, you focus, and you try to solve what’s in front of you. My assumption that those basal emergency protocols (ABCDE and so on) are something that i know by heart was correct – i felt confident assessing patients. The language is sometimes problematic, because of slang, different words and so on. But many told me that my English wont be problem at all, which is nice to hear. I already got to do some large volume IVs, sometimes just because you don’t find a properly sized one for the patient…Luckily most patients are young and have good venous state. Still, almost everyone is HIV +.

What I really didn’t expect to be such a big deal: everything is super unorganized. There are basically no computers, everything is on paper. If you want to insert an IV, you first have to run around for 10 minutes to find disinfectant, a catheter, gauze, tape, fluids – everything. More complex stuff takes even longer.

And if someone has bad veins? You go to the groin. Venous or arterial, doesn’t matter. And most of the time, there’s not enough disinfection. You just insert a needle in one of the dirtiest regions of the body – which feels completely wrong, but is absolutely normal here.

Once nurses are involved, things can get even more complicated. They’re fast and efficient when a patient is literally crashing and they are really really fit medical wise – still, most of the times things move very slow. And right now, there are new doctors rotating, so no one really knows what they’re doing yet. You have to ask around for every little thing – how to order an X-ray, where to get meds, how to fill out a form. Nobody was really able to introduce me and show how things work, which is really not a nice feeling. Even medications have different names, even though I know the meds by heart – i just couldn’t identify what i was supposed to order. I felt dumb more or less all the time.

To be honest, I felt like I wasn’t helpful at all. More like I was just creating extra work. The first day was overwhelming in a way I didn’t expect – not because of the patients, but because of how everything else works here.

Still, I think coming here was the right decision. Even this “quiet” shift already gave me a completely new perspective on medicine. And my general confidence in my own skills only improved, with a lot more weeks to go.

And almost everyone told me: what I saw today was normal baseline.