It starts with Nescafe

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It's tough to get these entries written in 1-hour internet sessions! I will put some pics of trips to beaches I have taken in a couple days, but I wanted to give a bit of an overview of day-to-day life as a doc here. This is actually my last week in South Africa, before traveling for about three weeks and ending up in Malawi, so I can also reflect and analyse. I imagine this will also be an evolution.

The complex I am at is called Bedford Hospital. It is the orthopaedic hospital associated with a large complex in Mthatha called Mthatha General or Nelson Mandela Hospital. Bedford used to be a private missionary hospital, but the site has been taken over by the government. All of the orthopaedics in the region is done at this hospital, none is done at Mthatha General. This makes for some logistical problems in dealing with multiply-injured trauma patients, as many times orthopaedic injuries that should be dealt with immediately are delayed until they are otherwise stable.

There are 3 inpatient wards and probably around 120 beds. In the male wards, 50 patients are lined up in three medium-sized rooms without dividers. Since many patients are admitted and lying in bed for weeks to months, it seems like the perfect setting for a grand social experiement, or, in America, a reality TV show.

We start our days at 8 am, the latest I have begun a day in five years. There is an initial intake where the consults from the ER the night before are presented, this is similar to the states. We then do ward rounds and get to the ORs (there are three) at 930 or so. The anesthesiologists are on hire from Mthatha general to arrive at 9, and typically appear around 10. They are more punctual when it comes to leaving, and operating rooms are rarely active past 3. After this, there are no anesthesiologists at the complex and the ORs are effectively shut down for all nights and weekends. Every Wednesday we see a big, seemingly never-ending clinic.

A five-hour OR day is a somewhat foreign concept, there are some definite similarities to our county system. Placing time restrictions in medicine seems strange. Regardless, that is the way this place runs. It certainly has been somewhat frustrating. It also has a detrimental effect on the mind-set of the surgeons. There is such a push for volume, to get as many operations done as possible, I feel that quality is compromised. It is understandable if limited resources leads to some interesting improvisation, but I can't accept sloppiness.

Overall the experience in South Africa has been "OK." I have certainly gotten more comfortable operating, and it is fun and interesting to figure out how to do something that you have never done before. My position as "not a resident but without any other experience" has left me in limbo between teacher and student. A major goal of this year is to figure out how to make a real impact in the third world during my career. Like any other mission of discovery, the lessons that show you how not to do things are as useful as anything. With that, I look forward to some R&R (those 7 hour work days really take it out of you) and onto the next experience!

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Comments

[Mir Ali]

Ben, your blog is interesting reading. Wish you the best and keep it safe.

[Rob Gray]

County-style
It sounds startlingly like County. Do you guys have implants? Because at County, since they haven't paid any vendors in a year (Synthes is owed over $800K), we no longer have any Synthes or Stryker implants. Most of the small frag sets are missing screws of the most commonly used sizes and there is no more Synthes locking. I am told that this will be rectified next week when the new contracts are signed, but we will see. It is another wrinkle in treating 6-7 week old ankle fractures.

[susan]

hard
Any time I'm overwhelmed here, I think, "It may seem hard, but it ain't surgery in Africa." So true.