My year at the QEII hospital

I’m sat on the futon in my cousin’s house in Pretoria and reflecting on my year working in internal medicine at QEII Hospital.  We left Lesotho on Friday for the last time and I’m heading back to the UK and the NHS.  What has the year meant?  What have I been able to leave behind?  Has it changed me as a physician?  There year definitely had its ups and its downs, saying my farewells this week provided an opportunity for feedback, which was valuable.

Throughout my year, I was constantly worried that I was not going to have a lasting impact.  The situation was so dire, with over one third of the admissions to the medical unit dying and so many reasons for this, I wanted to try and have some impact.  This proved very difficult, because the majority of reasons for the high mortality are not in the departments control.  This feeds a sense of futility and apathy amongst the staff, which makes what little change we can manage hard to achieve.  I even noticed myself slipping into the mentality, so I can fully understand where it comes from.  A few initiatives were taken, but they required so much energy to try and get off the ground, and then often this was not enough. 

One of the nursing sisters said something very positive on my last day.  She thanked me for the input I had had with her patients, said that she found my enthusiasm for the job was infectious and this had had a positive impact on her approach to her work.  This is not something that I had been particularly aware of before, so it was really great to hear.  So perhaps I will have left some sort of legacy in the hospital and amongst its staff.

What about the impact the year has had on me?  I have gained a lot of experience in HIV and TB, which was one of my objectives.  My colleagues on the ward used to joke that I could smell cryptococcal meningitis, which is a fungal infection HIV patients can suffer from!  I was given a lot of responsibility and gained confidence in my decision making.  I had to make diagnoses and feel confident about them, without the comfort of the tests I was used to in the UK.  I have undertaken a study in to the microbiology of TB samples which hopefully will show some helpful and interesting results.  Another study, into smoking in TB is ongoing.  The staff at the TB clinic seemed enthusiastic to carry it on in my absence.

In summary I have really enjoyed the challenges of my year, and feel I have taken a lot from it.  I may even see the benefits more clearly when I am back in the NHS.  Unfortunately, I have not had as much opportunity to improve the service at the hospital as I may have hoped. 

Hopefully the link between Wales and Lesotho in Health can grow stronger over the coming years, and will very much like to assist it where I can.  The great unknown of the next year is what impact a new private-public partnership hospital is going to have on things when it opens in September.  I would love to go back and see for myself one day!