Kate! Thank you so much for taking the time to share your experience with us. We are super excited to find out more about your hospital, and just Hoedspruit in general. From your social media, it looks like you’re having quite an adventure!
Q: So just to give everyone a bit of background info, can you touch on where you are from and where you studied?
A: Thanks for chatting with me! I absolutely love it here in Hoedspruit – so always happy to talk about it. I’m originally from Cape Town, and after living in the UK for a year, I came back home to study medicine at Stellenbosch University.
Q: Where was your first choice for internship and why? Then, where did you end up going and what was your experience there?
A: My first choice was New Somerset Hospital in Cape Town. I really wanted to work at a secondary hospital so that I could get more hands-on experience. I always dreamed of living in Green Point and walking to work via a coffee shop or taking a stroll on the promenade at the end of a busy day. After surprisingly getting placed at New Somerset Hospital and then moving to Green Point, I got notification from the Western Cape Health Department that, unfortunately, too many interns had been allocated to New Somerset Hospital and I was being reallocated to Tygerberg Hospital.
Despite my initial devastation, Tygerberg Hospital was the most amazing place to complete my internship. I managed to learn from the top consultants, got exposure to interesting conditions and was able to join academic discussions and meetings, which is often lacked at non-tertiary hospitals. There are many interns placed at Tygerberg Hospital and therefore, not only did I create some amazing friendships, but I got to rotate through both general and speciality departments and worked very reasonable hours. Tygerberg is a hospital where, as an intern, you get out as much as you put in. I feel as though my knowledge, clinical skills, confidence as a doctor and love for medicine grew exponentially in those two years. I honestly enjoyed the majority of my internship and in hindsight, should definitely have put it down as one of my options from the start. I would really recommend any final year student to do the same.
Q: Did your internship experience influence your choices for com-serve placement? Where did you apply and where did you end up being placed?
A: In the back of my mind, I always wanted to go somewhere rural, somewhere I would never choose to live if it wasn’t for medicine and somewhere that would push me out of my comfort zone and allow me to have stories for years to come. But after working in the Western Cape and experiencing such a phenomenal health care system, when it actually came down to applying for com-serve, I once again chose the WC as my first choice. I applied to Worcester Hospital, Eersterivier Hospital and Knysna Hospital, as well as Emmaus Hospital in KZN and Madwaleni in Eastern Cape.
In the end, I was never actually placed anywhere. I just received a message on ICSP saying, “Allocation not available – we are unable to release your allocation due to lack of funding.” I tried to contact anyone and everyone that I could think of to rectify the issue; numerous phone calls to ICSP, tickets logged, emails sent to the Department of Health in each province and phone calls made daily. But, towards the end of December, I had still heard nothing.
Out of the blue, I received a WhatsApp from an intern working in Gauteng, whom I barely knew, asking me a question about something completely unrelated. Through the conversation, (because com-serve placements are always a topic that intern doctors talk about), I found out that she had been placed at a military sickbay in a little town called Hoedspruit, in Limpopo. She really wanted to stay in Gauteng and was, therefore, just not going to arrive on day one of work. This gave me the idea to fly to Hoedspruit and see if I could take her place, hoping that they would still need a com-serve doctor. So that is exactly what I did. With nothing to lose, I bought a one-way ticket from Cape Town to Hoedspruit on the 3rd of January. It took a lot of paperwork, a lot of phone calls, a lot of administration, a lot of driving and a lot of patience, but eventually I got all the documents finalised and was registered as a community service doctor at Health Centre Hoedspruit Military Hospital.
Q: Can you take us through your experience so far this year? From the hospital to staff and colleagues, to the surrounding area?
A: Although it is officially called a hospital, I would say that it is more like a clinic here. Patients can walk in between 7:00-9:00 for acute conditions but otherwise, they book appointments in half-hour slots from 10:30 -14.00. I see emergencies too, and we have a small ward where we can admit patients overnight for IV antibiotics or fluid resuscitation, as necessary. Our resources are limited though as we do not have finger prick HB, a gas machine or any urgent bloods, we also do not have access to some medications and special investigations and therefore we tend to transfer sick patients quite early on. There are many differences working for the Department of Defence, as opposed to the Department of Health, the main one being the fact that we only see military personal and their dependents. Our closest military hospital to refer patients to is 1 Military Hospital, in Pretoria, which is about a 6-hour drive away, and so we refer most of our emergencies to nearby private hospitals instead. I call from home too, which is just the cherry on top.
Currently, there are 4 doctors working here; 2 permanent MO’s and 2 community service doctors. We have an amazing group of nurses, a dentist, and a multidisciplinary team including a dietician, a physiotherapist, a biokineticist, a social worker and a trauma councillor.
The town of Hoedspruit, or maybe I should rather say, the two roads that make up Hoedspruit, have everything that one would need. There’s a Pick’n’Pay and a Spar, a gym (that could give Virgin Active a run for its money), hairdressers and beauty salons, restaurants and coffee shops, a health shop, a butcher, upholsters, a nursery – you name it and you will find it here! Not to mention the amazing nature that we are surrounded by. Hoedspruit is in the Greater Kruger area and only a short, 40-minute drive from Kruger National Parks’ Orpen Gate. We are also surrounded by an array of private game reserves and stunning bush lodges. The beautiful Blyde River Canyon and Panoramic Route, with God’s Window and the Three Rondavels, are also on our doorstep – it really is an amazing part of the country to live in.
Q: If you had to list one or two special characteristics about the hospital or the area, what would they be?
A: How absolutely amazing the nurses are! As an example, if a patient comes in after-hours with a history of typical chest pain, the nurse on duty will usually do the vitals, start oxygen, give aspirin and nitrates and then WhatsApp me the ECG and give me a call (as I call from home, as mentioned) to discuss the case. They are incredibly proactive and are always eager to learn. We’ve created amazing relationships, both professionally and socially. I think that is what’s special about living and working in a very small town.
Oh, and of course the fact that we get to fly in helicopters! Air Force Base Hoedspruit is home to the helicopter unit of the South African Air Force.
When it comes to this area, the ‘special characteristics’ are literally endless, as I touched on previously. I live in a wildlife estate in Hoedspruit town and my house is always unlocked, which is such a contrast to high walls, electric fences and alarms in the city. The only noises I hear at night are those of hyenas in the distance or a kudu eating from the tree in my garden and my most fearful intruder is a group of monkeys stealing my food. My stress levels have never been as low as they have been this year.
Q: From a professional point of view, do you believe this placement offers the opportunity to develop certain important skills or traits that will benefit you as a doctor going forward? If so, can you describe these?
A: I am a firm believer that one can learn from every single situation one is thrown into. I am definitely a lot more confident in making independent decisions with regards to patient management, as we see patients 1-on-1 with no seniors to bounce ideas off or ask an opinion of. I have also had a lot more exposure to the private sector, as we consult regularly with private laboratories, private hospitals and private specialists. On the other side, I do not do many clinical procedures, as the nurses do all our bloods, drips, pap smears, vaccinations etc and run all the chronic clinics – therefore I often feel as though my practical skills are going down the drain. We are also not accredited to do any diplomas, however, with our flexible hours, we have more than enough time to do a multitude of courses – this year I have done numerous online courses, ACLS, PALS, ATLS, PoCUS (Point of Care Ultrasound) course. I have also been able to volunteer at Tintswalo Hospital and nearby rural clinics, which is something I absolutely love. Doctors that have done com-serves here previously have even had enough time to complete a masters degree. One of the most important things I have learnt this year is to have balance. Getting nearly every weekend off and not doing nightshifts, has been such a blessing. It has allowed me to be able to pursue my passions, both within medicine and out of medicine, in my own time, without added pressure.
Q: Many doctors are hesitant to venture into rural placements. What would your advice be to someone who is considering a rural placement but concerned about safety / the state of the clinic or hospital?
A: I think you have do their research first, talk to previous doctors or people who know the area. One’s own safety is paramount and, especially as a single, female, I would not compromise on that. The state of a hospital or clinic is, unfortunately, not in the community service doctors’ control. But I would ensure that I, at least, live in a safe area, even if it means driving further to work each day; living in a house with other health professionals could also be an option.
Q: If someone were to join your hospital, or somewhere very similar, what would be the best way of preparing for all that awaits them?
A: One can never really be prepared for such a big change. So the only advice I can give is to not overthink things; just go with the flow and take each day as it comes, be open to experiencing new people and new places. I learnt it as an intern at Tygerberg and again this year – the more you put in, the more you take out!
@thebush_doc
