Groote Schuur Hospital, Cape Town
St. Apollinaris Hospital, KwaZulu Natal Province

I organised my elective through the Groote Schuur Hospital, Cape Town, South Africa. Groote Schuur is a large teaching hospital and I was able to spend time in both emergency and trauma departments. However, I was also able to spend time studying General Medicine in a smaller district hospital situated in a township on the edge of Cape Town within an area called Cape Flats.

I also had the opportunity to work in voluntary student run mobile clinics, which go into the townships in the evenings, and are the major source of primary health care for this population. I particularly enjoyed the opportunity to observe health care from several different angles.

The political and social structure is in many ways different from the U.K., but there are also similarities. These parallels and differences are reflected in the health care systems and in the medical problems I encountered. Groote Schuur hospital is similar in it's structure to a large teaching hospital in the U.K. The differences are seen in the health problems encountered and the resources available to manage them.

A large number of patients had TB related problems - in fact Cape Town has the highest incidence of TB anywhere in the world. This is attributed overwhelmingly to the cramped and unhygienic conditions in which many people must live in the townships surrounding Cape Town. There are also a lot of violent injuries resulting from gunshot wounds or stabbings, and the prevalence of HIV is relatively high and rising quickly.

Attending the mobile evening clinics into the townships provided me with an insight into the provision of primary health to an underprivileged community using very limited resources.

I am pleased I went to South Africa on a medical elective for several reasons. Firstly, I became familiar with medical problems I would rarely experience in the U.K. I also feel I gained insight into the effect of the social structure and problems on health and society more generally, and the challenges the new government faces in attempting to address these problems.

Sophie Peters, 1997

If you fancy an elective where you will learn lots and have lots of opportunity to do stuff yourself, then this is a good elective placement. We had plenty of support and supervision when we needed it, but were also left to get on with things by ourselves. I was the only doctor on the paediatrics ward for two weeks, during which I did the ward rounds, admitted and discharged patients, wrote their TTO’s and discharge summaries, as well respond to four crash calls (this being the first time I had been given the chance to put basic life support skills into practice on a human being rather than a dummy). The rest of the time was spent on the other wards, in theatre and in outpatients. The range of conditions we saw was very different from the UK: children with heart failure due to cardiomyopathy, lots of TB and HIV, as well as snake bites, meningitis and lots of obstetric complications.

The hospital has 60 beds and is staffed by 6 doctors, who are always grateful for an extra pair of hands. We were very well looked after - a three bedroomed, air-conditioned bungalow for the 2 of us. We soon made use of the kitchen when were told that the menu in the staff canteen often served black tripe for dinner!

If you are considering an elective in South Africa, don’t be put off by the HIV/AIDS situation. Yes, it is a major problem (40% of our patients were positive), but fortunately our hospital were very realistic about the problem, for example, 2 pairs of gloves were worn for all procedures and prophylaxis starter pack were available in case of needle-stick injuries. But my impression was that this was not the norm, so I would suggest contacting any hospital before accepting a placement.

I also ought to warn you that the hospital is on a hillside, 14km by dirt track from the nearest twon (which consists of a petrol station, a shop and an hotel), so we ended up not leaving the hospital for 2 week stretches at a time, so don’t expect a really wild social life while you are there and take plenty of books to read!

Katherina Khan, 1999