Mark Wilson gives essential hints for coping in a country that is not easy for travellers

As this month's elective report explains, Johannesburg is a dangerous place. This fact should not be dismissed willy nilly. I have seen people being shot at on a street corner there and seen many victims as patients in the Bara. Everyone knows somebody who has got caught up in the violence. Having said that, if trauma is your specialty, there is probably no better place to go.

The other issue with going to anywhere in Africa is HIV. Think seriously about the risk of needlestick injuries. Don't think that you won't do any exposure prone procedures. Being taken on as an elective student usually means they'll want you to work. You may have little choice. Remember the basic, obvious, universal precautions for everyone (double gloves, aprons, goggles). Also, talk to your occupational health department about postexposure prophylaxis before you go.

If you haven't been put off, South Africa is a fantastic place to do an elective. In addition to trauma there is a great deal of pathology to see. The regulations for applying to hospitals have increased greatly over the past 10 years. Most hospitals are in some way affiliated to a medical school (even the small rural hospital in Kwazulu Natal), and the official line from the medical schools is that you have to apply through (and pay) them. For some of the remote hospitals you can try to apply directly first of all. For the teaching hospitals you now have little choice but to go through the medical schools.

The University of Witwatersrand has plenty of information on electives on its website (www.wits.ac.za/fac/med/elective/ index.html)--but it can seem extremely off-putting. The current charge is US$200 (£129; a188) for an elective at any of their affiliated hospitals (including the small remote ones).

(www.wits.ac.za)--7 York Road, Parktown 2193 Johannesburg (tel +27 11 6447 1111; fax +27 11 643 4318; elective@chiron.wits.ac.za).

Jubilee Road, Parktown, Johannesburg--This is a huge hospital (although not as big as the Bara) (1800 beds), with the medical school next door. It has a very busy trauma department with a helicopter service. The transplantation unit and cardiothoracic unit serve the entire community of greater Johannesburg. Students become very much part of the emergency team, and there are plenty of opportunities for procedures. The South African students have a two week trauma attachment, and elective students can attend their lectures. For plastic surgery this is a great experience and there are plenty of opportunities for hands-on work.

(www.chrishanibaragwanathhospital.co.za)--PO Bertsham 2013, Soweto, Johannesburg (tel +27 11 647 1111; fax +27 11 643 4318). Known as the Bara, this is a massive hospital with 4000 beds, serving the three to four million people in Soweto. It is like no other hospital. The surgical pit in the emergency room is world renowned for the amount of trauma seen. It is like working in a war zone. The final year students (and yourself) basically do the job of a house officer. You must try to spend some time in the surgical pit. There are many local and elective students. Say hello to everyone, and you'll get loads out of it. Students get to do lots of procedures while the big boys remove the bullets. Fifty per cent of patients have stab or gunshot wounds. The hospital is very popular with German students. An elective here comes extremely highly recommended if you are interested in a trauma career.

Most citizens from the European Union, United States, Australia, and New Zealand do not require a visa to "visit" South Africa for up to 90 days, and many students have previously gone to remote hospitals without a visa. The official line, however, for elective students from the EU and US is that they require a study permit, for which a letter from the host institution and proof of acceptance from the Health Professions Council of South Africa is needed. The visa costs £90. In recent years this has been enforced more rigorously. If going to a university hospital you definitely will need it. Contact the South African Embassy, South Africa House, Trafalgar Square, London WC2N 5DP (tel +44 20 7930 4488; fax +44 20 7925 0367).

You should be covered for typhoid, hepatitis A and B, diphtheria, and tuberculosis in addition to routine childhood vaccinations. Malaria is a risk in some parts of South Africa. Contact your occupational health department for advice on this and postexposure prophylaxis kits for HIV.