"Bringing health workers into public service on the African continent"
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INTRODUCTION AND INSIGHTS
AHP conducted interviews with four foreign-qualified doctors to examine their thoughts on their experiences both in and outside the hospital.
Some of the main issues raised:
Foreign-qualified doctors said that it was quite difficult to cope with the high rate of HIV and TB as they do not see it as much in their home countries. Doctors said that they have more responsibilities and the clinical work is more diverse due to staff shortages. The lack of education on health issues was also highlighted – a UK doctor said that patients in his home country are more informed about their conditions because they do their own research on the internet. In South Africa he has to do a lot more education. The high number of trauma cases in comparison to other countries was highlighted. Language barriers were also stressed as a major challenge.
Doctors were generally very positive about South Africa. They have the opportunity to travel and explore the country and felt that people were friendly. The general red tape and bureaucracy were mentioned as challenges.
UK doctor working in KwaZulu-Natal for less than six months
AHP: What was your first day like?
Doctor: “I spent it in the casualty department. It was not so much of a shock as I thought it would be. You are expected to do more. You have to be able to anesthetise which only a specialist would do in the UK.”
AHP: Have you struggled to cope with HIV/Aids?
Doctor: “In the UK there is a lot less HIV and TB, but it hasn’t been bad. Whenever I’ve had questions, I could ask. I also attended a FPD course on HIV in my first two weeks which was really helpful. I would recommend that everyone do that.”
AHP: How different is working in a South African hospital compared to a UK hospital?
Doctor: “You are given more responsibility. In the UK you would have 50 to 75 doctors in a hospital working in different departments. Here you have 14 or 15. Everyone is expected to do a bit of everything. If you are willing to learn, there will be someone that will teach you.”
AHP: Often rural health workers are more than just doctors. In what ways have you gone beyond clinical work at the facility you work at?
Doctor: “A big problem here is education on health issues. It is quite poor. In the UK when someone has a condition they will look it up on the internet and know everything about it. Here you have to educate and it’s difficult to do it effectively because of the language barrier. Most patients speak Zulu. You don’t want your patient to come back so there’s lots of education to do.”
AHP: You mentioned language barriers. Has it been challenging to overcome that?
Doctor: “The nurses translate. Some are very good, but they are not trained to interpret. You want someone that is trained to interpret because you need someone to tell you exactly what the patient is saying. The main thing is that doctors should learn a bit of medical Zulu. That will help.”
AHP: Have you had the opportunity to travel much?
Doctor: “I’ve done lots of travelling, every weekend. In South Africa it’s quite easy to get to different places, because of the motorway system, especially in KwaZulu-Natal.”
AHP: What do you think about South Africa so far?
Doctor: “It’s been very positive. Everyone seems very friendly. There are lots to see and do.”
AHP: Do you think you will be a better doctor after working in South Africa?
Doctor: “The learning curve is a lot steeper. I’ve learnt to expect the unexpected and to think on my feet. You also have to communicate non-verbally, which helps. I think you will go back more confident in your ability.”
Dutch doctor working in the Eastern Cape for more than a year
AHP: How did you land up in rural Eastern Cape?
Doctor: “Since I started my medical training I wanted to work abroad and experience a different culture. I completed my tropical training in the Netherlands and decided to come to South Africa.”
AHP: You have stayed for more than a year. Why is that?
Doctor: “Most foreign doctors stay for a year, but you can learn so much more in your second year. In my second year it is much easier. The nurses know me and can talk to me.”
AHP: What has been the starkest difference between this position and your previous job?
Doctor: “I found it difficult to cope with the high mortality rate when I started working here. It was difficult to see all the patients dying. There are very sick patients in these areas. However, most things are treatable. If you have a good team of doctors and nurses you can do a lot.”
AHP: Was it difficult to cope with the high incidence of both HIV and TB?
Doctor: “I’m still learning. HIV and TB are massive, but I think we are getting somewhere. I think we are putting more people on ARVs than in my first couple of months here.”
AHP: What about staff shortages? Has that been a major challenge?
Doctor: “We only had four doctors at one stage last year and this made the workload very heavy. Now the hospital has eight doctors. As a result, patient care is improving and doctors can spend more time with patients.”
AHP: What type of person would cope well in a rural environment?
Doctor: “People who are naturally more optimistic and energetic will cope more easily in a rural hospital. It’s hectic to work here. You really have to be quite strong and you have to take care of yourself. You can get sucked into the hospital. There are always patients and you can stay there for 24 hours.”
AHP: What advice would you give to doctors that are new to rural health?
Doctor: “Try to maintain a balance between work and your private life and stay longer at a hospital rather than immersing yourself completely into hospital life and burning out within a couple of months.”
AHP: What has your experience been of relationships in and outside the hospital?
Doctor: “I love working here. It’s always nice to come home to the hospital. It’s very welcoming. The patients like a familiar face. You feel you mean something to the patients. You’re so appreciated. I feel very connected to the people and I don’t want to leave.”
Ukrainian doctor working in the Eastern Cape. He has been in South Africa for more than five years
AHP: Why did you come to South Africa?
Doctor: “It is a unique opportunity. There are wonderful hospitals. If you are looking for experience, or if you want to be supervised, you will find it here. If you want to work independently in a rural setting, you will also find that. If you want to feel patients needing you, you must please come. People are friendly. They are helpful and give advice.”
AHP: What has been the starkest difference between this position and your previous position?
Doctor: “I found it difficult to cope with the enormous amount of trauma patients. Doctors treat a lot of patients with gunshot wounds. You can’t compare it to Europe. In my country, you get one gunshot a year. In the Ukraine, I spent a lot of time on administrative duties and felt I didn’t spend enough time performing surgeries. Now I do a lot of procedures. My logbook [of surgeries] is beautiful. I am definitely a better doctor. I came to be trained and to do surgical procedures and I just stayed.”
AHP: What was your first week like?
Doctor: “It was a very interesting experience. It was shocking for me in a good way. I didn’t know much about rural health. It was the best year of my life.”
AHP: What about your experiences outside the hospital?
Doctor: “Before I came to South Africa I heard horror stories about South Africa’s high crime rate. The perception about crime in the country is completely wrong. I’ve been here for five years and I have never been subjected to any crime.”
AHP: What has your general impression been of South Africa?
Doctor: “I am enjoying it in South Africa. I’m happy. It’s a wonderful country. I would definitely come again.”
UK doctor working in KwaZulu-Natal for less than six months
AHP: Did you feel prepared?
Doctor: “I don’t know. I didn’t know what to expect. I don’t feel you can be completely prepared. The orientation team did a reasonable job.”
AHP: Was it difficult to adapt?
Doctor: “Things are done differently. There is a slight difference in equipment. You have to be aware of needle-stick injuries. Communication is quite difficult. The clinical work is fairly similar.”
AHP: What about HIV?
Doctor: “You’ve got that at the back of your mind, but it’s not been that difficult.”
AHP: What has been some of your biggest challenges?
Doctor: “Communication and language have been challenging. The guys we work with are good with translation, but a lot of our job is communicating and that is challenging.”
AHP: “What is your general impression of South Africa?
Doctor: “People are friendly. The admin is quite frustrating. You have to have everything signed and certified. There’s a lot of red tape and bureaucracy. Things happen slower. Everyone seems quite relaxed. It’s a nice lifestyle. We love life overlooking the sea. We’re at a well-resourced and well-supported hospital.”
AHP: Has crime been an issue?
Doctor: “If you are sensible it doesn’t seem to be unsafe.”