My elective as a medical student in South Africa

Okay, long time no post here – sorry for that! I was busy, as always 😀

My extension here is finally confirmed and I’m really happy about it. Not only because I can keep learning, but also because I don’t have to spend another 8 weeks in a far less exciting surgical setting, my final year is shorter and i can do some holiday in Cape Town!

Since I’m staying longer, I tried to shift my focus a bit more towards ward work and sometimes joining procedures in theatre. Honestly, I don’t enjoy either – the ward is an even bigger mess than the ER, and theatre just doesn’t feel like my vibe. But I’ll keep going there, because I don’t want to pretend in my final report that I did a full surgical rotation without proper theatre time. On the ward things are crazy anyway – the nurses literally lock sutures so no one can “steal” them. So whenever you have to remove an ICD, you have to ask a nurse for a suture each time… I don’t even have words to describe how much that annoys me. Some days ago an intern wanted me to write a 12 channel ECG, which i probably did 500-1000 times in my life, and she ended up changing the location of every single electrode – resulting in exactly 0 difference in the ECG and just annoying me. Ah and she was unsure about the interpretation, while i was not, but to say thankyou i just didn’t say anything and left her alone with that problem……

Maybe shifting my focus is not the worst idea though, because we are now way more students than before, and the competition for procedures is becoming a bit too much. I’ve placed 6 ICDs by now – the last 5 went very smoothly without any intervention from supervising doctors. My learning curve with the “standard student stuff” is getting flat. I’m introducing all the new students to everything, because I’m by far the most experienced one here. To be honest, I’d really like to do a lot more “doctor” work, and in the past days I got a bit sick of being stuck in the student role. I keep telling myself: “Just 5 more weeks and you’re done with the final year.”

Looking back, I have to admit that my final year was actually very good – every rotation I did. But I think it’s time to graduate and finally introduce myself as a doctor. South Africa is still testing me in ways I’d never experience back home, but I’ve grown a lot in the past weeks. Right now there’s not much more progression left – but I know my time here will play an important role in my confidence once I’m working as a doctor.

What I’d love to do is intubate more and place central lines. But we have new doctors here who get to do all the procedures – and I’m getting a bit sick of just watching. I can’t wait to be done with med school so I can finally just do it myself.

Besides that “negative” part, I’ve still been working a lot as always: participating in polytrauma CPRs, putting in large-bore IVs, doing CPR, raising ideas and concerns in team time-outs. I saw a patient with a 20 cm knife sticking out of their head, completely covered in blood and running around on drugs naked in the ER.. I’ve seen dozens of gunshot wounds, probably even more stabbings, diagnosed pneumothoraces and hemothoraces myself – and of course, placed countless IVs. A few days ago someone asked me how many large-bore IVs (grey and orange) I’ve done here. My estimate was around 300 – and I think that’s actually pretty accurate. My suturing improved a lot as well, i kept on suturing a lot including large lacerations in the face. I did about 50-60 sutures by now and i could have a lot more if i really wanted to – i am just not as motivated anymore. Also i brought patients to CT that were actually unstable, used midazolam, ketamine and morphine on my own for sedating and analgesia.

At the weekend i also experienced a movie like scene: I was chatting in front of the entrance of the ER with an Austrian doctor and paramedic. After some minutes a white car was driving very quick to us, the driver jumping out of the car and shouting „my friend got stabbed“. I went to the backseat of the car to find a barely awake patient, covered all in blood, dyspnea, very cold extremities and no peripheral pulse. The stab was in the left chest. We got a stretcher, lifted the patient on it and went into the ER. I ended up putting in 2 Large bore IVs on an actually fat patient and just needed 2 attempts in total. That made me proud! Afterwards i put in the ICD. After a few hours the patient got instable. And instead of panicking i picked up the ultrasound and found free fluid in the abdomen on FAST examination. That’s how things are supposed to go, he ended up going to theatre.

Another patient at Saturday night arrived with a stab neck, turning out to have pneumothorax. I did the ICD while 10 or 15 people watching me – including students and other doctors. I stayed calm, focused and just did it.

Before I came here, I was so worried I wouldn’t succeed – but I definitely did. I’m so lucky to be here. The exposure is unmatched. I even found a study investigating the benefits of doing an elective in South Africa – and I can say it’s 100% true. https://scielo.org.za/pdf/samj/v109n3/16.pdf