Planning your elective - South Africa
Andrew Brent recommends a country of extremes
South Africa boasts some of the most
beautiful landscapes in the world, a
wealth of cultural diversity, and a
unique and fascinating political climate. So
varied and full of extremes, it is the perfect
elective destination, offering insight into
black and white, first and third world, and
urban and rural life.
Medical training in South Africa
South African medical training is very similar to our own. In the first year postqualification doctors usually do a mixture of
medicine, surgery, obstetrics and gynaecology, and sometimes paediatrics. All doctors
are required to do 2 years' "community service" in a rural hospital after this intern year.
This scheme, designed to ensure that these
rural posts are filled, has proved unpopular
owing to the inevitable delay in career
advancement and the lack of senior support
and training in some places. As a result, and
because of the changing political circumstances, more and more doctors are leaving
to practise abroad, some of them coming to
the United Kingdom.
The healthcare system
The stark contrasts of South Africa are evident in the healthcare system. At one end
of the spectrum are the highly developed
hospitals, such as Groote Schuur Hospital
in Cape Town, where Christiaan Barnard
carried out the first human heart transplant in 1967. The other extreme is a
network of mobile clinics and small bush
hospitals that provide basic health
education and primary care to a dispersed,
rural population, often with very limited
resources.
Visas and other information
Arranging an elective in South Africa
requires a few official documents. Firstly, a
work permit, which doubles as your visa and
can be obtained from the South African
Embassy in London. A 90 day permit costs
about £90. Secondly, you must register with
the South African Medical and Dental Association, which costs £30. Details can be
obtained from the embassy in London.
Thirdly, you must register with the university affiliated to your hospital. Medical
indemnity is provided by the medical protection society and medical defence union
to members at no extra cost. No specific
health checks are required.
HIV and AIDS
HIV prevalence in the community is frighteningly high, and inevitably even higher in
hospital populations. The usual precautions
are essential when dealing with sharps, etc.
This includes wearing gloves, and some
advocate "double gloving" in theatre. The
risk of transmission following a single
needlestick injury is about 1 in 300. If you
get a needlestick injury, immediately wash
the affected area and seek expert help for
prophylaxis. No randomised controlled
trials have been done yet, but current
research does suggest that postexposure
prophylaxis with triple therapy, such as
zidovudine, lamivudine, and indinavir, is
beneficial. Steps should be taken to determine the potential risk/HIV status of the
source.
Health and safety
Hepatitis A and B and typhoid vaccinations
are recommended in addition to tuberculosis, polio, and tetanus. Malaria is endemic in
many parts, so consult your general practitioner or travel clinic about the recommended prophylaxis for the particular area
to which you intend to travel. Prevention is
better than cure, so avoid being bitten by
covering up at dawn and dusk and using
nets and insect repellent.
Bilharzia (schistosomiasis) is also widespread, so avoid swimming in fresh water
where it may be present.
Crime figures are high, but remember to
keep this in perspective: the vast majority of
people who visit South Africa have no problem. Avoid flaunting wealth, visiting crime
"hot spots," or going off the beaten track on
your own.
Andrew Brent, surgical house officer, Royal United Hospital, Bath
Email: andrew_brent@hotmail.com
studentBMJ 2000;08:259-302 August ISSN 0966-6494
