Community Service Reviews

CMSA Accreditations: None

Rural Allowance: Yes

Doctors Quarters:

• No comments yet.

Academics:

• There is no teaching. Any learning is self-driven via additional reading or courses.

Supervision:

• The clinical manager provided no support or supervision. He was often not reachable. If there were any clinical concerns the best option was to discuss with the relevant department at Paarl Hospital. The MOs at Paarl were for the most part really helpful, and were happy to give advice for patients even if they weren’t accepting them.

Clinical Exposure:

• There were a variety of cases – medical, surgical, paediatrics, obstetrics and psychiatry. However, they are very few in number. So you won’t achieve proficiency. There were also not much resources available in terms of work-up so if patients needed further work up you would have to refer on to Paarl or Tygerberg.

Departments worked in:

• “There are no departments. You will be practising general medicine. No theatre available.
  Mornings are spent doing ward rounds – on approximately 20 patients (male, female, paeds, obs).
  Then the rest of the day is either spent in casualty or in the clinic. “

Social Scene:

• Non-existent. Porterville is a very small town with very little do. The area is beautiful, so great for more outdoors oriented people – nearby hiking trails, great for cycling etc. I often spent my weekends off exploring other areas of the Western Cape – Franschhoek, Paternoster, Citrusdal etc, so it was great to be in proximity to these areas.

Additional Comments:

• “Lapa Munnik is a very small district hospital that receives referrals from nearby clinics. It has about 15-20 beds – and admits medical, simple surgical (eg. Limb cellulitis), paediatric and uncomplicated obstetrics patients. Although it is small do not be fooled, it is not a chilled comm serve post, the doctor-patient ratios are still similar to those in the bigger hospitals, so you still end up working really hard.

The casualty has one bed. There is an iStat machine for blood gases (not always working) and X-rays during office hours. Patients could be sent to neighbouring Radie Kotze Hospital for urgent ultrasounds. No ultrasound machine at Lapa. NHLS blood results take 24 hours. A lot of diagnoses will be made on clinical assessment for example on weekends we would have to clinically diagnose pneumothoraxes and insert ICDs without X-rays. You will have to perform emergency procedures on your own with only telephonic advice from Paarl MOs to assist you – intubations, thrombolysis of STEMI’s, cardioversions, anti-venom administration, delivery of breech/twins etc.

There were only three doctors – two comm serves, and the clinical manager (who ded overtime, but was in a purely administrative role during the day). The clinical manager was not great, offered no support or advice, and did not practice good quality medicine in my opinion. You call every three days. You call from home – the nurses can manage straightforward cases on their own eg. STIs, URTIs, uncomplicated deliveries, but will call you if they have any concerns. There is no post-call despite sometimes being at the hospital for majority of the night. You call the entire weekend – Friday afternoon to Monday morning, no post-call which was really rough. You will be on call for one weekend a month.

I really struggled with the lack of an academic environment. I did a lot of courses to try supplement knowledge. I found the year very mentally and emotionally challenging.

In terms of finding jobs afterwards it is possible to get an MO post in your desired discipline, you will just have to put in a lot of effort to strengthen your CV (courses, primaries etc) in order to make up for the lack of experience. Getting a reg post straight away will be unlikely.

If you are unfortunate enough to be placed there – make friends with the nursing staff, they will be your greatest allies and will really affect your enjoyment of the year. They are not the most experienced, but they really care and are great company. I still keep in touch with a few of them. “