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My Elective - Blog 3

By James Lee

My Elective - Blog 3

Everyone has something to say when you say you're going on elective to South Africa. "Don't go alone" they say. Being behind a fence with armed security in the compound was a daunting thought, one I'd rather not face alone. I am so happy I didn't travel alone - thanks Amy!

Before arriving in Johannesburg, I had been given some more advice:

  • If you're mugged, give your things over.
  • If you're driving at night, don't stop at traffic lights.
  • If you hear gun shots, duck and run.

What they don't tell you is what to do when you're in the dining room eating dinner when you hear gun shots. What they don't tell you is what to do when you're in the car park about to go home and you hear gun shots. Naturally, we went back into the trauma department and awaited the arrival of a gunshot wound less than 10 minutes later. Later in our break when we mentioned to registrar that we'd heard the shots he replied, "This is Africa". I heard this daily.

Another time I heard this was after clerking a young woman who had fallen backwards from a stationary truck, who was complaining of generalised spinal tenderness. Mentally checking off an A to E assessment, having recently done my OSCEs, when I arrived at "C" for circulation I quickly felt the abdomen and asked if there was any pain.

The abdomen felt different in consistency from right to left and being of fertile age I asked if she could be pregnant. She looked extremely baffled that I had even asked, despite her not taking contraceptives and not using condoms. She told me she had bled the previous month and could not possibly be pregnant. I have felt pregnant abdomens before, and this definitely felt like a pregnant abdomen.

We were given some paperwork at the start of our elective about when to escalate patients to resus, and a pregnant patient was a trigger for escalation. The patient appeared shocked, even when showing her the baby's heart beat on the ultrasound: a successful diagnosis of pregnancy.

This woman's reaction was not a happy one. The look on her face sharpened and she demanded that we do not inform any of her family who were currently waiting outside the cubicle, and that she wanted an abortion. Laws in South Africa mean that an abortion after twelve weeks is illegal without special circumstances and an ultrasound scan estimated the foetal age to be seventeen weeks and six days.

Despite my efforts to advise she visit her local antenatal clinic, I fear that this patient will soon become a patient once more, risking her life by attempting to obtain an illegal abortion. This is Africa.

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