The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why


If you’ve been paying attention, working hours of doctors (especially junior doctors) have been getting some good airtime over the past few months. The Province of the Western Cape has committed to actively reducing maximum continuous working hours for doctors to twenty-four, the HPCSA has promised to “look into it” (not that we have too much confidence there), and our biggest representative, SAMA (South African Medical Association) has come out in our support.

One of the things to come from all this is the launching of an armband campaign. This has its origins, I believe, from a similar campaign in the UK – although I have not been able to find any source to this link.


Junior doctors (all doctors?) are to wear colour-coded wristbands to indicate the amount hours they have worked during their shift. This is something I support because it raises awareness not only among our supervisors, but also our patients – who, as I’ve shared before, are appalled when they realise the extent of our hours.

My problem lies not with the campaign, but the structure of the colours.

Doctors who have worked anything up to 24 hours wear green, between 24 and 30 wear orange; and if a doctor has worked more than 30 consecutive hours during their shift, they wear a red wristband.

This means for all means and purposes, the backers of the campaign believe that working for 24 hours straight is “safe” – not only for the doctor, but the patients she treats.

Those hours seem completely arbitrary. And I’m being kind, because what I want to say is that they seem completely ignorant.

Let us remember that peer-reviewed research has shown that being awake for 24 hours straight is comparable to being inebriated:

“…after 24 hours of sustained wakefulness cognitive psychomotor performance decreased to a level equivalent to the performance deficit observed at a blood alcohol concentration of roughly 0.10 %[double the South African legal driving limit] .

-D. Dawson and K. Reid, Nature 388: 235, 1997.

So a doctor is too impaired to drive, but here, have a patient. Save this guy’s life, please; just try to walk in a straight line at the same time. Here is an orange wristband for your efforts; we all know that when drivers see an amber traffic light they take it very seriously and stop immediately (not).

By starting a red wristband at 30 hours, SAMA is implicitly agreeing with the 30-hour limit placed by the HPCSA. If they were serious about condemning 30-hour shifts, they would start the “red” zone at 24-hours of continuous service, and NOT at 30 hours.

With these constraints, the campaign does not bring about much change. It just gives us a false sense of being heard.

Do I think the campaign is a great idea? YES!

Do I support its category-guidelines? Heck no.


Abortion Care: Did I Provide My Best?


It’s funny how sometimes, long after the fact, you start questioning your levels of care and competence.

During my first rotation of internship (last year), which was Obstetrics and Gynaecology, I was one of the few interns willing to do pregnancy terminations. (For the purposes of this blog, the matter is not up for debate – I have been pro-choice for nearly half my life, and have thoroughly evaluated my own beliefs.)

Just recently I’ve found myself thinking back on those four months and wondering if I did everything I could, and if I was empathic enough.

OBGYN was a high-stress environment. Delivering babies was gratifying, but being responsible for two lives in a single case scenario is always tough. The infection-risk is high because bodily fluids splash during delivery. The patient load is huge.

And we got stressed. And some days I was not my kindest self. And I’m certain that some days, my levels of empathy were low.

I saw a lot of patients who wanted to terminate their pregnancies, so it stands to reason that I saw some of them on my “tired” days.

I know that my behaviour towards my patients was beyond reproach. I was never rude or insensitive. I know that my clinical care was good because when I did not know what to do, I always involved a senior (which was regularly because I was very junior).

But I think back and I wonder, “Did I do enough?”

Did I make sure my behaviour was such that aborting women knew they had a supporter in me? Did I ensure them that they were not being judged? That they did not need to explain themselves to me?

When they left my consulting room into a world where they most likely could not tell anybody of what had happened, did they leave knowing that at least one person was in their corner?

Most importantly: did they leave feeling empowered?

Because choosing to terminate is not just a matter of discontinuing an unwanted pregnancy. It’s not just a matter of choice, of a right hard-won. It’s a matter of being empowered to make decisions about one’s life and one’s future; and in this way it signifies the control she can take of other aspects of her life, too.

Did my patients feel empowered?

I don’t know.

But this single thought has me wishing I could go back, and do those four months again.


Does It Have To End?


c4e635ecb89b5ed4844f087dca6580b1My four-month stint on the paediatric service comes to an end this week.

I enjoyed paediatrics in medical school, but never as much as this. How wonderful it was to be excited about work, to enjoy it so much that I willingly and eagerly read up more about all my cases.

It may have been one of the most challenging rotations – and it was good to see myself growing in confidence and ability.

There is so much work to do in paediatric healthcare, especially because you inadvertently treat the caregivers as well. And women are another group so sorely neglected in our environment.  Continue reading

Ten Things Books Have Made Me Want To Do


You know that saying about readers having many lives through the books they read? I love it, because there are so many things I can’t do, but would love to. Then there are some things books have inspired me to do… or at least to dream about.

I’m linking up with Top Ten Tuesdays to bring you (some of the) things book have made me want to do.

1. Go to Boarding School

A la Malory Towers by Enid Blyton, Spud by John van de Ruit, Looking for Alaska by John Green and even Harry Potter, to name but a few.

5000b1238115345bee19d12384791a68625445af06153537b90254460bebb0df Continue reading

What If Slavery Never Fell: Underground Airlines [Book Review]


I’ve been on a bit of an alternate-history kick recently, which has led me to believe that it is possibly one of the most challenging genres an author might tackle. Call it the Butterfly Effect or Domino Effect or just plain Jenga, but changing a single event in history causes a cascade of changes, and if the author misses even one of those, the book loses its believability.

23208397Underground Airlines by Ben H. Winters is an alternate reality in the present day where slavery was never outlawed in the USA, and is still practiced in four major states. It is a horrifying thought and an important topic in light of current race-relations in the USA and much of the world.

World-building is important in alternative-history fiction, but must be subtle. If the world is different to the way we know it, the reader must be able to understand why that is. Winters did this fairly well, in referring to trading sanctions which, for example, result in CDs not yet reaching American markets.

Elaborating on the events in your alternate history is also difficult because the reader does not want to be told so much as shown where history deviated from the plot, but sometimes it is so elaborate that showing is difficult. Winters tends to err on the side of telling in this regard, and it sometimes seems as though our MC is lecturing to someone who does not know the history. To be fair, I have not yet seem an author pull this off in an alternative history.

The purpose of an alternate-reality novel is not just to point out the differences between our situation and the what-ifs, but more jarringly to show the similarities. And that is what I found to be the value (and the horror) of Underground Airlines, because as I read I found myself asking, “But how is this REALLY any different from what black Americans are dealing with in our reality?”

Is Winters suggesting that the prejudice faced by persons of colour today is as bad as though slavery was never abolished? I think that is one of the most important discussion-points stemming from this book. The kind of systemic prejudice facing the free persons of colour in Underground Airlines is not so different from many situations today: you are free, but don’t wear a hoodie or look dangerous. You are free, but don’t carry a weapon if you want to live. You are free, but businesses and places of employment are also free to discriminate. 


In terms of pacing and dialogue, I definitely felt that the novel could have benefited from more editing. It seemed as the majority of the novel was busy “setting up” for the plot, but the plot struggled to gain momentum. It was a whole lot of planning and back-story and double-agenting, and then the twist came before any plotting really occurred.

In terms of character development, I was told that the protagonist felt anxious and desolate, but I was never really offered the opportunity to get in his head; as though he were too far for the reader to fully grasp. This may be tactical on the author’s part, because Viktor is a mystery to everyone, including himself. Is he a good guy doing bad work? He closes himself TO himself in an effort to avoid the terror of his past and his guilt; but even so, I needed to be able to connect with the MC more.

My biggest problem was the “twist”, which suddenly turns Underground Airlines into more sci-fi than alternate contemporaneous. If you read the blurb you knew there was a secret, but tension in this regard never truly mounts – the tension is always about freedom and not about secrets. It is such a wild twist that it is incongruous with the rest of the novel, and it is jarring in a bad way. It almost feels as if it were an afterthought, and afterward little is done with it. It threatens the integrity of the entire novel.

One of my favourite hot-points suggested in Underground Airlines is that of the “couch activist”. Those who are so privileged that they can side-step dealing with the problem. From Father Barton who says, “I have spoken on it and will continue to speak on it, but speaking is all I do,” to people who won’t buy products of slavery but still benefit from the economic successes thereof.

Its issues in spite, this remains a book I would like to see read in schools and universities to open up robust dialogue. Underground Airlines may well be one of the most “woke” books that has been published this year.

Disclaimer: I received a free eARC via NetGalley and Mulholland Books in exchange for an honest review. 

Preparing for the Next Step: 2017


The year has passed into its second half, and so I am nearing the beginning of my last rotation of internship. Nearly twenty months of working now, and I’m still a baby-doctor, but I’ve grown so much in confidence and skill.

After the two-year internship comes a year of mandatory community service as a medical officer. Because of a scholarship agreement I am contracted to work in the Western Cape (not an altogether bad thing) for the CosMO year, and four more beyond that.


A little something-something about my future place of residence😛

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Ten Books Set Outside the USA (and Canada and the UK)


I love this week’s topic for Top Ten Tuesdays! As a South African, I’m acutely aware of the importance of reading local and international books, but our market is mostly saturated by books from the USA and the UK (I love you guys, but representation matters!)

I have two prior lists with more or less the same topic (links provided at the end), so I will mention different books here. And also, I’m not selecting any South African books because I have a whole list of them here!

1. Ink and Bone by Rachel Caine (YA, sci-fi)

Setting: Egypt (mostly)

A book set in an alternate reality where the Great Library was never destroyed. I felt the book had some problems with character development, but I did enjoy it – especially the setting, and the fact that it was ABOUT BOOKS!!!

library collage Continue reading