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Letter from Ingwavuma Reflections • Réflexions Another World Working As a Public Health System Employee Overseas

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Letter from Ingwavuma Reflections • Réflexions Another World Working As a Public Health System Employee Overseas Letter from Ingwavuma Reflections • Réflexions Another world Working as a public health system employee overseas Jane Fleet MD CCFP DIP Obs (SA) DIP HIV (SA) remember when I went for my medical school inter- protocols. We refer patients to regional or tertiary view at McMaster University in 1990. I described to care hospitals as needed. Ngwelezana Hospital in I the interview panel how I was interested in doing Empangeni (3 hours away) provides tremendous sup- international medical work at some point in my career, port through various hot-lines. Complicated patients most likely with Médecins Sans Frontières—the only can be transferred by ambulance (with basic para- non-government organization I knew of at the time. medical staff) or occasionally, if weather and daylight In 2002, however, my husband (a South allow, by air. African physician) and I Before arriving in South started work at Mosvold Africa, I had done very little Hospital in South Africa as surgery, some anesthesia, and employees within the public lots of obstetrics. My experi- health system. I write this ence in obstetrics, however, to make Canadian doctors was limited to GP, Canadian- (who tend to think of over- style obstetrics where compli- seas work as volunteer-type cated cases are handed over work) aware of this alter- to obstetricians and cesar- native. By working as an ian sections are performed employee, you have a very by surgeons. I had limited different view of the rewards, experience with patients challenges, and frustrations with tuberculosis and even that a particular country’s less experience with medical system might offer. patients with HIV, Mosvold Hospital is a all in a tertiary care 250-bed hospital in Ingwavuma, setting with all the KwaZulu-Natal. Ingwavuma is sit- tools for investiga- uated right on the Mozambique- tion available. Swaziland border. It is in the I learned on the “bundu” (boonies), as the South job in classic South Africans say. Mosvold Hospital African fashion— serves a population of approxi- see one, do one, mately 105 000 people. There are teach one. I’ve now 10 doctors practising at the done well over 200 moment—half are interna- cesarian sections tional and half are South and many tubal African. We are on call 1 l i g a t i o n s , m a n - weekend and another 3 or aged ectopic pregnancies, 4 weekdays each month, performed lymph node with another doctor avail- biopsies and skin grafts, able as second call. administered spinal and The area is supported general anesthetics, etc. I by 10 primary health care find myself discussing the clinics. These are staffed idiosyncrasies of snake bite with very competent pri- management with junior mary health care nurses Photo top: Dr Jane Fleet who refer patients to Photo middle: Outside Mosvold the hospital based on Hospital various policies and Photo bottom: View from water tower 1978 Canadian Family Physician • Le Médecin de famille canadien VOL 53: NOVEMBER • NOVEMBRE 2007 Letter from Ingwavuma I learned on the job in classic South African fashion— see one, do one, teach one Photo left: Female ward Photo right: In the nursery community service doctors and advising on HIV viral load interpretations. The national antiretroviral program started roll- ing out in 2004 and I have had the pleasure of help- ing develop Mosvold’s antiretroviral program for the much satisfaction in past 3 years. This has allowed me to work closely with medicine while living in an absolutely the team of HIV nurses and counselors that work in stunning area of the world. the hospital and out in the clinics. We came to Mosvold to work for 1 year and after 5 There has been the cultural challenge of working in years we leave, contented. the Zulu language with a population that often uses western medicine as a last resort; traditional heal- Dr Fleet is a Chief Medical Officer for Mosvold Hospital in ers are usually the first port of call. Yet despite a few Ingwavuma, South Africa. obstacles, it has been so rewarding and has offered me the continuity and fulfilment that working in a Competing interests small hospital anywhere in the world can bring—so None declared 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 over- seas doctors wanting to work in South Africa • Dr Hervey Williams at Mosvold Hospital by e-mail ([email protected]) 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) VOL 53: NOVEMBER • NOVEMBRE 2007 Canadian Family Physician • Le Médecin de famille canadien 1979.
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