Oliver Fuge visits South Africa to work at one of the world’s most renowned trauma units
Groote Schuur Hospital’s trauma unit treats over 1200 patients a month with an array of problems ranging from minor to severe, complicated injuries. This is where I decided to spend my elective in May 2010.
Pictured: A warning sign greets patients at Groote Schuur's trauma unit entrance
During my six-week elective I was supervised by Professor Pradeep Navsaria and given the freedom to move between the emergency medicine part of the unit and to assist the on-call trauma surgeon. I also had opportunities to join the resuscitation team and after a day or two of my elective I felt privileged to be given the responsibility of managing my own patients. This included clerking and examining, taking bloods, ordering the relevant imaging and being the first to review the x-rays when they were returned to the unit. Initially, this was rather daunting, however there were always helpful, friendly doctors on hand to supervise and consult if required.
"Dealing with death, especially on such a regular basis, was a new and difficult experience for me to come to terms with"
As well as building on my previous skills, I also learned a number of new procedures. I performed a number of fracture/ dislocation reductions and applied many POP casts. It was incredibly satisfying feeling for the first time the click of a displaced bone popping back into its rightful place and then reviewing the x-ray which confirmed that the intervention was successful. The subsequent relief evident on the patient’s face after the brief shock of the manoeuvre was also extremely rewarding. I sutured hundreds of stab wounds, inserted chest drains and regularly assisted in theatre.
Dealing with death, especially on such a regular basis, was a new and difficult experience for me to come to terms with. This was particularly hard as the victims were often so young and the mechanisms of injury leading to death so preventable.
I am aware that I witnessed a skewed side of life but nevertheless South Africa is extremely violent; the country’s incidence of violent crime is the third highest in the world. In addition to the positive experiences, it is no exaggeration to say that I left South Africa with somewhat mixed emotions.
The violence was not just between young, male drug addicts and gang members, as I may have expected. Middle-aged and elderly people were also the perpetrators and victims of aggressive acts of violence, as were young women. In some areas it seemed to be perfectly normal for young women to carry screwdrivers around in their handbags for use as a weapon. Victims of community beatings were also commonplace on the unit and in every case I witnessed this punishment was significantly worse than the initial crime.
Disturbingly, many of the victims of these beatings were only children. For many of the people I encountered, the injuries were brutal and shocking and I was often left with a deep sadness at the seeming lack of respect for human life.
If you are a student considering an elective and desire a relaxed experience this probably is not for you. I worked long and hard hours and found myself giving up several Saturday nights to be present on the unit; but it was definitely worth it in terms of what I experienced and learned.
My South African elective certainly confirmed my aspiration to pursue a career in surgery. At times it was like a scene out of a war film, but very much an educational one! Anyone seeking an elective with a mix of emergency medicine and surgery in what is unarguably an inspiring setting should definitely consider heading to the trauma unit at GSH in Cape Town.