South African students are trained at public hospitals – which provides for a lot of frustration, but is also the only reason we get as much experience as we do.
1. A standard question you ask patients is, “Have you visited a traditional healer lately?”
…You know that if they answer yes, it may have major ramifications for your treatment plan.
…You know that if they answer no, they’re probably lying.
2. You have done emergency consultations in hallways because Admissions was overflowing.
3. You have performed at least one procedure that was beyond your scope of practice at the time, due to a lack of staff or resources.
4. Your patients regularly feign new symptoms so that they can have another night of warmth and free food…
…But other patients demand discharge to go “home” – the homeless shelter.
5. You have treated several prisoners…
…Prisoner patients are sent to hospital with frail old men has prison guards…
…And upon their entrance to the hospital, the guards undo their handcuffs. So safe.
6. You have special code-words for certain diagnoses (such as RVD for HIV) because of the lack of privacy in an overcrowded hospital.
7. The resuscitation area in Trauma is protected by guards and gates (because healthcare workers are not exempt from being threatened by criminals).
8. Your biggest fear at work is a needle stick injury.
… and you know the latest post-exposure regimen better than you know STD syndromic management.
…But if you have a needle stick injury, you know that you will have to pay for your own PEP.
9. Foreign doctors or medical students come to your hospital to learn about the “rare” diseases you see every day.
10. You know what a phlebotomist is, but you have never seen one.
11. You believe that resus teams are a myth. Your patient codes, you resuscitate them. You’re in a room where a patient codes, you help. Done.
12. You have been asked to refrain from using gloves for blood draws and other procedures, in order to save money.
13. You have worked in a flooded ward.
14. You have heard of hospitals with air conditioning, but doubt their existence.
15. You see TB patients every day, no matter which department you work in…
… yet there are rarely N-95 masks available.
16. You have had patients stay in hospital for an extra week because they did not have transport to get home.
17. You have had patients stay in hospital for several extra weeks while waiting for their socioeconomic circumstances to be managed.
18. Your tourniquet does not belong to you – you once had your own, which disappeared (was stolen) on duty. You found another.
19. You bring your own ophthalmoscope to hospital, the risk of it being stolen preferable to using the hospital’s shabby (or non-existent) equipment.
20. Your hospital has funds for RFID for babies, but not for CCTV in the rest of the hospital.
21. You have ordered blood for a patient, only to be told that the “machine is broken”.
22. You have learned to innovate…
For example making an eyelid retractor from a paperclip.
Litmus paper to test pH? No, urinary dipsticks will do.
You have catheterized a baby with an infant nasogastric tube, because infant catheters are too expensive.
23. One of the scariest parts of your day is taking the sketchy elevators.
24. Despite all these, you are grateful that working in a public hospital has taught you how to treat maximally with limited resources. You believe in evidence-based medicine, and you are grateful that you can practice it without fearing for your livelihood.