Global Healthcare in South Africa 

Global healthcare, particularly when it comes to visiting doctors in South Africa, reflects a dynamic and multifaceted system influenced by various socio-economic and cultural factors. South Africa boasts both public and private healthcare sectors, with private healthcare being more advanced and easily accessible for those who can afford it. The country is home to a network of highly trained doctors, many of whom are internationally recognized for their expertise. However, disparities between urban and rural healthcare services persist, with rural areas often facing challenges such as limited access to healthcare professionals and resources. 

During my third year of emergency medicine residency at Weill Cornell University in New York, our trauma rotations were held out of state. This decision stemmed from the dramatic decline in trauma cases due to stricter law enforcement and more efficient policing under Mayor Giuliani. The rationale was that better trauma experiences could be found outside New York, specifically at the Shock Trauma Center in Baltimore, MD, and the Medical College of Richmond, VA. However, both third- and fourth-year residents discovered that these rotations were less than ideal due to surgical residents also requiring trauma exposure. 

I proposed to the administration at Weill Cornell University that a global health experience in South Africa could be beneficial for the residency, as it would reduce conflicts of interest with other surgical specialties. The administration reviewed the proposal, and I became the first fourth-year resident to participate in this global health experience. As part of the rotation, I was asked to give a Grand Rounds presentation after my time in South Africa. 

The clinical rotation site was the Chris Hani Baragwanath Hospital (CHBAH) in Soweto, South Africa, regarded as one of the largest hospitals in the world. The academic affiliate is the University of the Witwatersrand in Johannesburg. This area, located west of the city of Johannesburg and adjacent to the N1 highway, is home to one of the largest public hospitals globally, with 3,800 beds. Chris Hani Baragwanath occupies 173 acres and is named after Chris Hani, a leading figure in the African National Congress who was assassinated in 1993. During World War II, the hospital was used as army barracks. The facility boasts 42 operating rooms and employs 6,760 staff, including 476 physicians. 

My first experience at CHBAH was in September 1999 as a third-year emergency medicine resident. I flew directly from JFK in New York City to Johannesburg. The entire rotation lasted approximately three weeks, with one week allocated for vacation. I arrived on a Monday during the first week of September around 3:00 PM. Due to the time difference, I was jetlagged. My accommodations were with friends near a township called Thembisa, and I rented a car, which became my primary mode of transport. 

This rotation is not for the faint of heart. The hospital handles approximately 3,700 to 4,000 trauma patients each month, with 80% of them being cases of penetrating trauma. I worked a combination of day and night shifts, each lasting 12 hours, for three weeks. This was perhaps one of the most mentally and physically exhausting experiences of my life. Despite the overwhelming trauma volume, the learning curve exceeded anything a surgical resident would experience during five years of training in the United States. 

I compiled a library of slides documenting the trauma experience at the Chris Hani trauma unit. This rotation surpassed any trauma rotation at Shock Trauma or the Medical College of Richmond, VA.

Upon my return, I presented a Grand Rounds on my experience at CHBAH. This trauma and global health experience has since become an ongoing program with Weill Cornell’s Department of Emergency Medicine. There continue to be opportunities for global health experiences at Groote Schuur Hospital in Cape Town and at the University of Stellenbosch’s Tygerberg Hospital. 

In future blog posts, I will discuss the specifics of the rotation in greater detail, including images of the hospital.