South Africa: Pietermaritzburg and Durban
Sports Medicine
Running eighty-nine kilometers in one go during an elective might not seem like the most exciting proposition, but for anyone choosing to do a June elective in South Africa this is an opportunity to participate in the premiere road running race in the country and one of the most famous ultra-marathons in the world. The Comrades Ultra-Marathon began with World War I veteran Vic Clapham who was looking for a way to commemorate South African soldiers killed during the war and the first running of the race was on the 24th of May, 1921.
A unique medical experience that this provides is in the medical tent that is staffed by interns from Grey’s Hospital, the tertiary level hospital where I was doing my elective in A&E. Madly deranged electrolytes are common alongside simple dehydration and if you want practice putting up intravenous lines, this is the place to be. Sadly, in this year’s race two people died due to complications from running the race and one even after a successful initial resuscitation in the medical tent.
HIV/AIDS
The biggest challenges I found during this elective was an issue related to my personal prior experiences with HIV positive patients. Studying medicine in Ireland I have had essentially zero first hand exposure to patients with HIV/AIDS. I would mention this to South African interns who simply could not comprehend that I had seen just two patients with HIV infections over the past two years of college. In some hospitals in South Africa the situation is the complete opposite, seeing patients that are not HIV positive is the rarity. It did take time to adjust to this reality as the subliminal stigma I had grown up with regarding HIV/AIDS in Canada definitely still existed at the beginning of the elective. It does take time and I’m sure the experience will be different for all working in areas with high HIV prevalence rates when coming from areas without the same conditions.
The Red Cross 
A great opportunity not to be missed was the chance to tag along with some flying doctors to visit a rural hospital in the Eastern province of Kwa-Zulu Natal. A joint Red Cross and government program, it brings specialists to peripheral hospitals in order to supplement the care being provided by the doctors there. In my case, I worked alongside paediatrician and it was one of the most interesting yet depressing days during the elective. Cases of active tuberculosis, replete with night sweats drenching children’s bed sheets to the vacant eyes of infants with rapidly progressive HIV/AIDS. It is an experience that has to be viscerally experienced and illustrates the complexities and difficulties of providing care in rural settings, many times with rudimentary equipment and both personnel and infrastructure issues.
South African Elective Advice
In addition to the vast array of medical experiences that an elective in South Africa can supply are the many opportunities for exploration of a country with a rich but conflicted history. From the desolate Robben Island where Nelson Mandela was imprisoned for eighteen years to the safari opportunities, adding an additional week to your elective to travel is an absolute must. In terms of setting up an elective a major issue is applying well in advance as there are more and more stringent requirements in regards to registration with the medical governing bodies and don’t forget to check early about Visa requirements depending on your nationality.
Of all of my elective experiences the experience I gained working in A&E in South Africa has been among one of the richest I have had both socially and intellectually. It is an expensive flight to the southern tip of Africa but well worth it for an experience that will assuredly challenge your views on medicine and your personal limits.
Paul Dhillon
3rd year medical student
Dublin
paudhillon@rcsi.ie