In this post, Riki and I collate our thoughts about what we’d wish someone had told us before and during our elective, the kind of things we think would be frequently asked questions.
For more on what we got up to in Johannesburg and beyond, check out our other posts!
Before your elective:
Applying for and organising an elective can be a daunting task. There are so many options with so many pros and cons to each. Overall, we didn’t think that planning our elective was too stressful compared to what some people in our year had to go through which was definitely a plus. You can organise most things well in advance which means little to no stress during 5th year end of year exams.
Should I go on my own?
It’s difficult to say because I have only done the elective as a pair but there were numerous moments when it was definitely easier having two people. An extra pair of eyes when driving, someone to navigate and someone to drive, a friendly extra pair of hands when working, company to travel with, so while not essential it’s definitely useful! It also means that for some things like renting a car, and petrol, you can split the cost.
When and how to apply?
Getting a spot in Johannesburg can be competitive compared to other elective destinations but only because you should try and apply early: Everyone applies through the University of Witwatersrand elective officer. They can be pretty poor at responding to emails so often it’s more effective to phone them if you have any questions. We started emailing around halfway through 4th year and some people who applied a few months later found there weren’t any spaces left. That being said, we met some other students out there who had just pestered the elective officer 6/7 months before their elective and had got squeezed on to a placement.
Here’s the link to the Uni’s info page:
Should I do my elective in Johannesburg or somewhere else in South Africa?
Really the question comes down to Johannesburg vs Cape Town. You can do trauma in both but in Cape Town other areas of medicine seemed more popular including things like neurosurgery and ENT. Cape Town is without doubt a nicer place to go and in our opinion there was more to do there. This may be a biased opinion but it seemed to us that we were able to get more involved with the trauma in Johannesburg than our friends in Cape Town. So, if you’re looking for a more intensive elective, and don’t mind there not being heaps to do, then Joburg may be for you!
Should I apply to work in the trauma department?
There are two main hospitals in Johannesburg where elective students go, Chris Hani Baragwanath (AKA Bara) and the Charlotte Maxwell General hospital (AKA the Gen). Both these hospitals have trauma units which from what we can tell are pretty similar. Personally, I have an interest in Trauma and Orthopaedics but had not been exposed to very much trauma in the UK so wanted to gain a better understanding of what this involved and in this respect the elective was fantastic. There was also the option to do the elective primarily in orthopaedics which could have arguably been more useful but in my opinion would have been a waste of the volume of trauma and resuscitation situations you have the potential to be exposed to in Bara. Similarly, some other students did their elective in the emergency department and while there was some interesting medicine mostly to do with long term consequences of HIV and TB, they found that beyond this there was not a huge amount to partake in and they were hoping to spend some time in trauma. So in short, I think if you come to Johannesburg, you would be missing a great opportunity if you did not spend at least some time in trauma.
Where to stay?
When you get your confirmation of placement the elective officer should send you a list of popular accommodation options. We stayed in a place called Swanage which is the home of one of Bara’s internal medicine consultants (Alan) who rents rooms to elective students. While it’s a little further away from Bara than some of the other options, the facilities are great and you can get lots of insider information from Alan. He’s also a game ranger so took us on safari one weekend which was amazing!
Should I rent a car?
Driving in South Africa, if you ignore the minibuses that operate by their own set of rules, seemed relatively safe. You drive on the same side of the road as in the UK and there isn’t anything particularly challenging in terms of junctions. So long as you’re a confident driver it should be fine. Third party insurance cover is a little confusing because there’s something called the ‘road accident fund’ which supposedly covers all drivers but probably best to check with your rental company when you arrive.
What the hell is the HPCSA and do I need a visa?
The HPCSA is the governmental organisation that you will need to register with to practice in South Africa. If you go to Johannesburg you have to first go to the University, pick up some forms from them, get a copy of your passport certified and then drive or take a train to Pretoria (an hour away) to the HPCSA office where you have to wait to be registered and pay a fee. You have to do this before you go in and work at the hospital though no one ever actually checks that you’ve done it. We got a little bit confused about whether we needed a specific visa or not to actually go to South Africa for an elective but we didn’t get one in the end and no one ever asked for it so we don’t think (finger’s crossed) that we needed one.
Should I book my flights in exam week?
So we did this before receiving some very threatening emails from the clinical school saying we should not have done this and that we’d have to rearrange if any of the exam arrangements changed. Fortunately, no aspect of our exams had to be rearranged so we didn’t have a problem but it’s not something we’d recommend testing out for yourselves.
What do I need to bring with me?
Here’s some of the less obvious things that you’ll need:
Original copy of your HPCSA form that’s been stamped by your uni - needed for your registration (though they may now be making you post this to them in advance)
Goggles - Absolutely essential to prevent splash injuries
Scrubs - If you work in trauma you should get given a set but they’re scratchy and it’s always useful to have spares
Some form of travel card - some of our friends had the Monzo card which was great and easily meant you could keep track of your spending
WARM CLOTHES - It’s winter in South Africa when Cambridge students do their elective. Houses don’t have central heating. It gets very cold so warm jumpers, a coat and a hat are essential.
An unlocked phone - Essential for whatsapping the trauma group, coordinating with fellow students, using as a sat nav, and for the all important elective instagramming. We also took some pretty old spare phones we had lying around the house and got a cheap sim card for them to use in emergencies.
During your elective:
Just some of the main points covered here, our email addresses are at the bottom should you want to get in touch with any questions!
Do I have to run every red light?
So how safe is Johannesburg? Joburg has a bad reputation and working in the trauma department, you see evidence of a fair amount of violence and accidents. A big chunk of these involve drunk locals attacking or crashing their car in to other drunk locals. While everyone has heard stories of muggings and car jackings we didn’t see any or hear about any that happened to anyone we knew. You have to be careful and learn which areas are not safe to hang around in and which red lights are safer to skip than to stop at, travel in groups, park as close to your destination as possible, generally be sensible. While it’s probably safe enough that I would say don’t let it put you, or your parents, off - few it seems are happy with their kids going to Joburg - it is something you should take in to consideration. There are definitely safer places to go.
What kind of patients do you see?
See some of our other posts for a feel of the kind of patients you treat, but in general, patients have either had accidents, been involved in some kind of car crash, been beaten up, or been shot or stabbed. It’s an amazing opportunity to do practical skills and learn to do deal with some of the (in my opinion) most scary situations that you could face as a junior. It has its drawbacks though, the guidance and teaching is quite variable, often there’s a language barrier that you need nurses to overcome, and dealing with drunk and disorderly patients can get very frustrating. If you think you can deal with all that, the kind of injuries you get to help manage are well worth it.
What is the healthcare system like in South Africa?
While we didn’t see a huge amount of the private sector, we are reliably informed that there is a huge contrast. That being said, the trauma unit for most things seemed relatively well stocked on the surface. There are significant issues with restocking and machines actually working but most of the time you can get what you need even if it takes a while and what you have to use in the end is suboptimal. Compared to the NHS there are huge differences both in terms of procedures but also hugely in terms of attitudes of the doctors and patients. We’ll let you experience these for yourselves but we’ve ranted about some of our frustrations in previous entries if interested.
What else is there to do in Johannesburg?
There’s a short list of touristy things to do including some great markets, the apartheid museum, lots of great places to eat, and some really interesting areas of the city to see. We weren’t particularly adventurous and there’s definitely more that we could have done. Near to Johannesburg there’s lots more that you can do including hiking in the mountains and of course, a must do if you’re going to Africa, safari.
Should I visit Cape Town?
Yes. Climb table mountain. Go surfing in Muizenberg.
How long are the shifts?
Elective students quickly become a useful member of the trauma team meaning that the doctors appreciate you being there to help out, especially on the weekends. We tended to do 12 hour shifts, starting off during the week when it was a bit quieter and moved to doing more nights when we became more confident. No one keeps track of you so it’s up to you to decide when to go in and the flexibility is great for any trips you might want to plan (e.g hiking, safari). Keep in mind that there’s often a variety of other students there at the same time as you whether they be elective students, from Wits uni, or paramedic students. We created a group on whatsapp and tried to organise who was doing what shifts so that things didn’t get too crowded.
What happens if I get a needle stick injury and do I need to take PEP?
A big concern given the high prevalence of HIV in the population and the fact that you are performing more practical procedures than you have ever done before. Riki (un)fortunately has knowledge of what happens should you receive a needle stick. In brief, it’s a pain. It will take most of a day to get sorted, you have to organise tests for the patient if they consent, open a file with the hospital, find the doctor to prescribe you medications etc. So ultimately it’s not essential as the hospital will (eventually) sort you out. We were fortunate in that the intern on duty was very sympathetic and helped Riki through the process, on a busier day with a less sympathetic intern I can see it being far from easy. Riki doesn’t think it’s necessary to get your own given how you can get it free from the hospital and to get it back home is quite pricey. Personally, I found it quite comforting having a spare box back at home given to us by some other students for use should there be any issue getting it from the hospital so really I think it’s probably a matter of personal preference.
Top tip: most of the doctors use the same needle they used on the patient to put the blood in to vials, we found it much safer to dump the needle as soon as possible and just remove the bottle caps.
And that’s it! The most important practical things to know before heading to Johannesburg. Hopefully someone found this helpful! Should you have any questions you think we’d he able to answer please don’t hesitate to get in contact with one of us:
Alex Butcher - alex300195@hotmail.co.uk
Riki Houlden - riki.houlden@btinternet.com
Enjoy your elective!!!!
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