Another world: Working as a public health system employee overseas

Jane Fleet

Dr Jane Fleet

Ouside Mosvold Hospital

View from water tower

I remember when I went for my medical school interview at McMaster University in 1990. I described to the interview panel how I was interested in doing international medical work at some point in my career, most likely with Médecins Sans Frontières—the only non-government organization I knew of at the time.

In 2002, however, my husband (a South African physician) and I started work at Mosvold Hospital in South Africa as employees within the public health system. I write this to make Canadian doctors (who tend to think of overseas work as volunteer-type work) aware of this alternative. By working as an employee, you have a very different view of the rewards, challenges, and frustrations that a particular country’s medical system might offer.

Mosvold Hospital is a 250-bed hospital in Ingwavuma, KwaZulu-Natal. Ingwavuma is situated right on the Mozambique-Swaziland border. It is in the “bundu” (boonies), as the South Africans say. Mosvold Hospital serves a population of approximately 105 000 people. There are 10 doctors practising at the moment—half are international and half are South African. We are on call 1 weekend and another 3 or 4 weekdays each month, with another doctor available as second call.

The area is supported by 10 primary health care clinics. These are staffed with very competent primary health care nurses who refer patients to the hospital based on various policies and protocols. We refer patients to regional or tertiary care hospitals as needed. Ngwelezana Hospital in Empangeni (3 hours away) provides tremendous support through various hot-lines. Complicated patients can be transferred by ambulance (with basic paramedical staff) or occasionally, if weather and daylight allow, by air.

Before arriving in South Africa, I had done very little surgery, some anesthesia, and lots of obstetrics. My experience in obstetrics, however, was limited to GP, Canadian-style obstetrics where complicated cases are handed over to obstetricians and cesarian sections are performed by surgeons. I had limited experience with patients with tuberculosis and even less experience with patients with HIV, all in a tertiary care setting with all the tools for investigation available.

I learned on the job in classic South African fashion—see one, do one, teach one. I’ve now done well over 200 cesarian sections and many tubal ligations, managed ectopic pregnancies, per formed lymph node biopsies and skin grafts, administered spinal and general anesthetics, etc. I find myself discussing the idiosyncrasies of snake bite management with junior community service doctors and advising on HIV viral load interpretations.

Female ward

In the nursery

The national antiretroviral program started rolling out in 2004 and I have had the pleasure of helping develop Mosvold’s antiretroviral program for the past 3 years. This has allowed me to work closely with the team of HIV nurses and counselors that work in the hospital and out in the clinics.

There has been the cultural challenge of working in the Zulu language with a population that often uses western medicine as a last resort; traditional healers are usually the first port of call. Yet despite a few obstacles, it has been so rewarding and has offered me the continuity and fulfilment that working in a small hospital anywhere in the world can bring—so much satisfaction in medicine while living in an absolutely stunning area of the world.

We came to Mosvold to work for 1 year and after 5 years we leave, contented.

Resources

To find out more about working in the South African public sector, contact

The Rural Health Initiative (www.rhi.org.za), which helps facilitate the paperwork and applications for overseas doctors wanting to work in South Africa
Dr Hervey Williams at Mosvold Hospital by e-mail ( hervey.williams{at}kznhealth.gov.za) or by telephone (011 27 35 591-0122)
KwaZulu-Natal Department of Health (www.kznhealth.gov.za)
Rural Doctors Association of Southern Africa (www.rudasa.org.za)