General Surgery In KZN South Africa

Andy spent 7 months working in South Africa (SA) at Ngwelezana Hospital in Kwazulu Natal in General Surgery…

DESCRIBE YOUR REASONS FOR MOVING OVERSEAS IN 4 WORDS?

Travel. Culture. Surgical Experience. Opportunities. Sun

DESCRIBE THE MOST MEMORABLE CASE YOU MANAGED WHILST WORKING AT NGWELEZANA HOSPITAL. WHAT DID YOU LEARN FROM IT?

I came to the surgical department in Ngwelezana hospital to gain operating and trauma experience.

There were countless individual cases that will stay with for many reasons, quite apart from the isolated clinical scenarios which themselves are a relative rarity in UK surgical departments.

The most unstable patients, often as a result of violent trauma, typically presented during the night, at which time staffing for the surgical department consisted of myself and one intern (FY1 or FY2 equivalent) when on-call.

KZN2A classic example would be a young man from the Zulu community who had sustained a stab or gunshot wound to the abdomen. These type of patients presented most nights, often several times a night. Unequivocal clinical signs would necessitate a unilateral decision for immediate exploratory laparotomy. Assisted by the intern, the two of us would open the abdomen and proceed according to our findings.

Throughout my time at Ngwelezana I encountered a wide variety of abdominal pathology involving the majority of the intra-abdominal contents at some point. There are many cases which specifically spring to mind, but I will recount the very first trauma laparotomy I did alone as it is fairly typical.

A young man had been shot in the abdomen, was peritonitc and taken to theatre. I opened his abdomen which initially looked relatively unremarkable. There were no small or large bowl perforations, just a modest amount of free fluid. I followed the bullet tract which was quite high up and saw what appeared to be free gastric contents. I had to extend my incision up to the xiphi sternum for adequate access and found an anterior and posterior defect in the stomach wall. I contacted the Surgical Consultant on call and received telephone advice on how to proceed with repair of the perforation. I carried out these repairs, finished the operation and closed. The patient did well following a stay on ICU.

This case typifies our work on a night shift. I used skills I had quickly learned in the preceeding weeks to perform this operation.

WHAT KIND OF POPULATION DID YOU TREAT?

The patient population was almost entirely Zulu. Many speak very little English which presents its own challenges, and the nursing staff were often relied on to translate. I found the Zulu people a very rewarding patient group to treat. Compliance with longer term medical therapies for chronic conditions seems to vary. The difficulty many patients have with attending a clinic appointment or getting themselves to casualty should not be overlooked.

WHAT ADVICE WOULD YOU GIVE TO DOCTORS WHO ARE PLANNING A YEAR OUT OVERSEAS?

Do it. The experiences you get cannot be taught. The independent and autonomous nature of much of the work achieved, has certainly developed my theatre and clinical maturity.

HOW DID YOU FIND APPLYING FOR A JOB IN THE UK WHILST WORKING OVERSEAS?

Working overseas we were slightly out of the loop when it comes to applying for jobs back in the UK. A lot of people got together in groups and helped each other with interview practice. I don’t think our applications were particularly hindered despite preparing for interview from overseas.

WHAT WAS YOUR BEST EXTRACURRICULAR ACTIVITY AND WHY?

Travel. I didn’t get through anywhere near all the places I wanted to visit in Kwazulu-Natal.The local area provided excellent safari, beaches, views and coastline. South Africa provides a rich outdoors lifestyle.