My elective as a medical student in South Africa

I’m done. Final year is over. Twelve weeks at Bara — over.

Where do I even start? It’s been one and a half weeks since I got back home, and everything feels a bit numb. Life was so intense, so stimulating, that it almost feels strange to just… exist in normal surroundings again. I don’t really understand certain everyday problems anymore — I guess that’s what happens when you’ve spent months staring at the darker side of humanity.

Before I came to South Africa, I was terrified of so many things. I reread my very first blog entry today, and it feels surreal — because every single thing I was explicitly worried about turned out so much better than expected.

I mastered ICDs to a level I could never have imagined (of course, there’s always room to improve). But if I ever find myself in a situation where my patient needs one — I’ll do it, without hesitation. In total, I did 14 ICDs, and honestly, it could have been a lot more. Towards the end, I started sharing or supervising the procedure, because it’s really not that difficult once you understand it. After the first few, it becomes almost “simple” — in fact, I think IVs are harder to master.

Speaking of IVs — I did well over 300, probably close to 400–500, mostly large bores (grey and orange). I was told multiple times that I’m the best IV taker in the ER, including among the doctors — and I think that’s a massive personal win.

I also did over 100 sutures — starting with small scalp lacerations, and slowly building confidence. By the end, I was suturing ears, lips, facial wounds, layered closures of chest injuries, and much more. I came to Joburg as a total beginner and somehow left with a solid skill set. Another huge win.

But the most important skills weren’t the technical ones. I learned to assess critical patients on my own, to speak up loudly when I was worried, and to insist on supervision when I needed it. Sometimes I got tricked by patients — but more often, my assessments were right. I learned to trust my gut.

I gained confidence in high-stress situations, pushed my limits, and — when necessary — asked for help. I took around 15 ventilated patients to CT, about half of them unstable, some with ventilator issues that forced me to make immediate decisions. And somehow, it worked. I’m a bit afraid that my confidence might now be too strong for someone who isn’t officially a doctor yet — but I don’t feel like I ever crossed a line. Everything I did was within my skill set and training.

Safety was another big concern before coming. In the end, I had maybe one or two sketchy moments in twelve weeks. Other than that, I felt safe — though I was constantly on high alert. It feels oddly unfamiliar now to walk through a city without checking who’s behind me every few minutes.

And yes, there was potentially traumatic stuff — probably daily. But I don’t struggle with flashbacks or nightmares. When I think back, I only feel joy and gratitude. I was way outside my comfort zone, but I knew what I was getting into and was prepared for most of it. The only things that truly stuck with me are the burn patients — especially those with >50% body surface burns, or the ones doused in petrol and set on fire. Those memories will never fade. It’s controllable — but unforgettable.

All in all I think I have seen about 250 Gunshots, way more stabbings, amounts of MVAs and PVAs that are just mind-blowing, many burn patients – including kids :(. Many many dead and dying patients. Procedure wise I saw 7 sternotomies or thoracotomies, 2 lateral canthotomies. The ONLY two procedures I “hoped” to see which I didn’t see were surgical airways and clamshell thoracotomies. Other than those two, I have seen basically everything that emergency medicine has to offer.

HIV was another big worry. And yes, I’m still on PEP. I had two real and one minor needle stick injury. I’m very sure I didn’t contract HIV, but I’ll get tested again soon. I never missed a single dose — and adherence is everything with PEP. I’d estimate that 30–50% of my patients were HIV positive, based on how often I heard, “Yes, I’m on ARVs.”

Language turned out to be the least of my worries. My English improved more than I ever expected — not just medical English, but through endless deep talks with people from all over the world. That’s another unexpected win.

Before leaving for Joburg, I was terrified. My mum told me the night before that she’d never seen me that nervous — not even before major exams — and she was right. But somehow, everything I learned and experienced before came together.

Yes, there were days I hated everything — when I was exhausted, frustrated, and sick of being “just” a student. But overall, these twelve weeks were the best time of my life. I grew into my role, I found friends I never expected to find, and I discovered what kind of doctor I want to become.

I think I can confidently say: I won.

What’s next for me?

I’ll probably start in Internal Medicine, ideally moving towards Emergency and Intensive Care later.
And in ten years? Maybe Doctors Without Borders or a similar organization. Doing what I always wanted to do: being the best doctor I can be, never stop learning, and truly listening to my patients.

Working at Bara prepared me for a lot — hopefully also for my first months as a doctor in Germany. Let’s see how that goes.

Thank you all for following my journey through these weeks — this is my final post on this blog.
And in 30 years, I want to come back, reread this, and show it to my kids. ❤️

Depending on how things go, this might be the last post on my blog. My last shift is Friday night – which also means my last shift as a medical student. Ever. I can’t quite believe how fast time has passed.

So, what happened at work? Honestly, I’m way past the point of what you normally experience as a student. There isn’t much of a learning curve left anymore. Last weekend, I even gave away several opportunities for chest drains to newer students. My goal had been to get confident with the procedure – mission accomplished. I’ve done fourteen now, way above what I had originally planned.

Besides the usual stabs and gunshots to head, neck, chest, abdomen, or extremities, I’ve ended up doing some pretty fancy suturing. I basically reconstructed a three-quarters amputated ear after an MVA. Plastic surgery didn’t want to do it, so my doctors asked me – apparently, I somehow got a reputation as the guy who does good sutures?! No idea how that happened, haha.

Then there was a lady with a lip laceration after her boyfriend hit her with a glass bottle. I repaired it – and on rounds, the consultants asked who had done the sutures. My heart nearly stopped because I expected to get roasted. Instead, they told me it was an excellent repair and that I should consider changing my career path. Definitely not the feedback I had prepared for.

I also placed my first central line here – just a femoral one, but still. Central line is central line, and it was a hard-fought opportunity to finally get one.

And yesterday morning we had a guy with a 2L hemothorax who crashed into hypovolemic shock. I pointed out that he might need a large-bore IV. His veins were not the best, and in shock they never get better. I grabbed a 14G, hunted for a decent vein, and got it in quickly. My reg was standing next to me and said, “I don’t know how you do this, but this is mad impressive – I don’t think I could do this myself.” Coming from probably the coolest reg I’ve ever had, that kind of compliment just makes you really, really happy.

Now that I talked a lot about the positive stuff, I should also mention the bullshit. Students here are apparently not allowed anymore to use the sonar machine (I’ve done somewhere between 200 and 300 eFASTs on my own, placed multiple IVs with sonar and more) because a DOCTOR broke a part of the machine. Officially, we’re not even allowed to use it under supervision anymore, which is just mindblowing. Funnily enough, I regularly get asked by junior doctors to do an eFAST for them because they don’t feel confident using it.

And in the past one and a half weeks alone, I took eight ventilated patients to CT, probably half of them far from stable, and I had to use every bit of knowledge I have. I changed the vent settings on every single one because some of the settings were horrifying – a 60 kg woman doesn’t need a tidal volume of 900 ml, a pO₂ in arterial blood of 350 mmHg doesn’t need an FiO₂ of 90%, and so on. Now there was an official letter from the bosses saying vent changes are only supposed to be made after calling the consultant on duty. I don’t know if this is my fault, but if it is – I honestly couldn’t be happier to leave.

Don’t get me wrong: the surgeons here are probably among the best in the world. But some of them have zero clue about pharmacology or ventilators – at least less than me. And when I talk to international doctors, intensivists or anesthesiologists, they all agree.

In the last weeks, the general mood in the department shifted and became a bit toxic. Students got critiqued for all sorts of random things, while nobody seemed to care that we pay a small fortune to be here and that 60–80 hours per week is not exactly standard for students back home. Suddenly there were all these new bullshit rules.

To be this close to my last shift ever as a med student is probably the only thing keeping me sane. It is time for me to graduate – and it has never felt more like the right time than now. I had the best time of my life here, I learned more than I ever would have back home – but for me, it’s time to leave.

I honestly don’t even know where to start. Last weekend was payday – and I ended up working about 38 hours out of 48. And holy smokes, that was pure madness.

Friday night started off quiet, almost suspiciously quiet, until around 5 AM we suddenly got completely flooded. Eight patients from an MVA (motor vehicle accident). EMS told me that at least five had already died on scene – we got the rest. One of my patients looked absolutely fine at first glance. But when I did the full body check and rolled him over, I found a 10 cm deep laceration across his thoracoabdominal flank. His eFAST showed a massive hemothorax – so I put in the ICD :)) Another patient I had to manage completely on my own (all doctors were busy) had fallen about two floors. He was stable, eFAST negative, no neurology – but later turned out to have a C2 fracture. On rounds, the consultants asked me about the exact mechanism of injury. All I could say was: “All I know is that there was alcohol involved.” They all laughed – and honestly, that probably sums it up.

Saturday night though… was the most insane shift I’ve ever experienced here. I thought I’d seen a busy ER before – turns out I hadn’t. There was a local football match that evening, and around 1–2 AM we got flooded. “Warzone” is honestly the only word that fits. At one point we had 25 patients crammed into an area meant for 15 critical beds. I did two ICDs that night, countless eFASTs, assessed more patients than I can even remember. At one point a patient rolled in with blood in the airway – acute A problem – and we simply had no ventilators left to intubate him.

By morning the ER was still overflowing, and instead of leaving, I just stayed on. What was supposed to be one night turned into 26 hours straight in hospital – without a second of pause. In that time I personally assessed MVA, PVA, mob assaults, stab chests, GSW chests – and placed three more ICDs. That brought me to my 10th chest drain in total. And honestly, I’m very confident with the procedure now. From incision to pleura is maybe 60 seconds, sometimes less. Smooth, clean, controlled. That was one of my big goals here – and I nailed it.

Somewhere in the chaos, I found a patient in the “pit” who had been waiting for hours. Seven stab wounds to the back. He told me he was coughing more than usual – and within seconds of talking to him, I was sure he had a pneumo or hemothorax. eFAST confirmed: massive hemopneumothorax. Bad for him, but I was quietly proud that my doctor brain was still working after 20 hours straight. I put in the chest drain, it worked perfectly, then spent almost two hours suturing him up – back, arms, scalp, everything. He told me the attackers used a butcher knife.

And that wasn’t even it. Faces, eyelids, neck stabs, back stabs, scalp lacs – I sutured them all. Earlier this week I even saw a patient stabbed right in the cardiac box. Textbook Beck’s triad, unstable as hell. Within minutes he had a central line and was rushed to theatre for an emergency sternotomy. My third time watching one here. Unbelievable how skilled the trauma surgeons are – and he survived.

Last weekend I was also asked by another student to help transfer a ventilated patient to CT – apparently I’m “the only student confident with ventilators and meds in emergencies.” Their words, not mine. The patient’s MAP dropped from 70–80 in the ER to under 40 in CT. No doctor around – it was on me. I reduced the PEEP, pushed some adrenaline, stabilized him enough to finish the scan. I was never more glad to arrive in the ER than that and i needed a few minutes of silence after that. He’d been assaulted with a machete. The CT was horrifying: intraparenchymal bleed, multiple skull fractures. And when we exposed his head wounds, I counted four or five deep lacerations. Brutal.

So yeah – this is without question the best time of my life. I’m doing things I’d never be allowed to do back home – but always within the scope of what I feel safe and trained to do. And it’s an incredible test of how far my education and experience have taken me.

On the other side, I had one of the most frustrating moments of my entire medical life so far. There was this confused patient who kept changing his story – first it was “stab chest,” then “stab neck,” then suddenly “mob assault.” The physical assessment itself was fine, but when I did the sonography, I found an IVC dilated to about 3 cm. On top of that, the kidneys didn’t look good at all – basically just a big oval blob with no clear parenchymal separation. That worried me. So, I went to one of the interns. He wasn’t sure what to make of it and more or less told me he didn’t understand what my brain was coming up with. (Funny enough, most of them know that I actually like internal medicine a lot – and occasionally i even get asked by them what i think). Anyway, he suggested I should speak to a more senior doctor. So I did. And she just shut me down with: “I don’t take handovers or patient presentations from students.”That honestly pissed me off beyond words. And if I ever hear something like that again, I’m not sure I’ll be able to hold back. My reaction will be memorable, for sure. Because here’s the thing: I’ve got final-year blues. I feel like a doctor already. I want nothing more than to finally finish med school. I’ve never been this close to the goal I’ve been working toward for so many years – and I just can’t stand that level of disrespect anymore. Yes, I’m absolutely aware I’m still a student, not a doctor. But I want to be respected for what I can already do. I honestly believe my clinical judgement has never been sharper than it is right now. And when I say I’m worried about a patient, I think my colleagues should at least listen. Most of them do, to be fair. But not all. And that’s the part that cuts.

Thanks again for reading all of that, i really appreciate it!

Insanity. There’s really no better word to describe what’s going on here during night shifts – especially on weekends. I just woke up after my last one and the impressions are still intense. So many patients dying. One came in with multiple gunshot wounds to the chest – they opened his chest in resus for an emergency thoracotomy. They (as a student your not actively involved and join operating and so on, and that is good!!! I am not fit enough to do this and right now i also don’t want to do it) went on for almost an hour, using literally everything medicine has to offer… and then had to call it. Another one came in with a gunshot to the head, brain mass already outside, fixed dilated pupils – it was over before it even began. These are images you don’t forget, but honestly, that’s part of why I came here.

While all that was going on, I had to manage a patient with a GSW to the back. On the X-ray, the bullet showed up somewhere around C3/C4. Everyone else was busy, so I was completely on my own. I was seriously worried about neurogenic shock at first, but thankfully it didn’t happen. CT later showed the bullet ended up just millimeters away from the spinal cord. Still, the patient couldn’t move his arm – likely brachial plexus damage. The real problem though: we have nothing to treat neuropathic pain. So I gave large doses of fentanyl – helped for a few minutes. Thanks to my experience in anesthesia I knew how to dose and monitor it – because honestly, there was zero supervision. If I had messed it up, nobody would’ve caught it. When the pain came back, the patient was suffering badly. And every single dose of fentanyl? I had to go find a nurse, ask in person, wait. Sometimes they came quickly, sometimes it took forever. That’s just how things go here. Pain is almost never treated properly.

You have to learn not to get emotionally involved. Do what you can, give your best – and then move on. I’m surprised how well I manage that now. You just put on your doctor glasses and function. I sutured three patients last night. One woman had been assaulted by her boyfriend – small laceration on the dorsal hand, which I stitched quickly. The deeper cuts were on the palmar side of her 3rd and 4th fingers, probably tendon involvement, definitely needs proper hand surgery. I explored the wound, could even see the joint spaces. To help with pain I did my first Oberst block – never seen one done before, only knew the theory, but it worked and the patient was super thankful.

Another guy got attacked with a broken glass bottle – they smash it first to get sharp edges and then use it like a knife. He was completely drunk, had deep scalp lacerations with significant tissue loss. I stitched him for almost 2.5 hours, probably 60–70 sutures in total. Started around 6 AM, left the hospital at 9. (And no new needlestick incident this time – lucky me.)

There was a lot more going on. Took tons of patients to CT, most of them drunk. Inserted countless large-bore IVs, did multiple blood gases – and that’s just the stuff I was directly involved in. I’m not even talking about the patients I didn’t touch… except the ones that died.

But honestly? This shift still felt less chaotic than the last one. Pay day is coming soon though – and when that hits, it’s going to be madness again. I’m starting to feel more settled now. I know most of the doctors, they know me, and even the rest of the staff recognize me by now. I’m slowly figuring out who’s who in the zoo. Organizing things is getting a bit easier, but I still spend way too much time running around just to find basic stuff. That’s probably the most frustrating part – and I don’t think that’ll change anytime soon.

It is for sure the first time in my life where i feel a lot more like a doctor and not really like a student anymore. My decision to do this as almost my last placement before graduation was definitely correct, otherwise i wouldn’t be able to survive here. So far i learned everything i wanted to learn initially, and probably a lot more….The learning curve is insanely steep. The biggest problem i see right now: I can’t really imagine going back into a low adrenaline environment again. The amount of (mostly positive) stress i get here really desensitizes me. So far my plan has always been to do internal medicine, but what if i want to do emergency medicine? As my main job!! Thoughts are flowing right now. I don’t think i will find the answer in my time here, but probably when i go back home. But even with so much adrenaline in my body, i think i am the calmest in emergency situations i have ever been in my life. And this is a feeling you can’t describe and nobody out of medicine will ever be able to understand. You have to feel it yourself.

It took me almost a week to get back on my feet again. Still not fully at 100%, but with ibuprofen and a bit of nasal spray I’m doing quite alright. I already did two shifts in the ER – and today I had my first flight in a helicopter.

It felt really strange at first, and I even got a bit motion sickness during the flight – guess I’m not exactly built for that in the long term. But the experience is definitely something I’ll never forget. The patient was actually quite stable, just needed some pain meds after being involved in a mine accident. The flight crew was super nice, explained a lot, and I felt really welcomed.

We dropped the patient off at a large private hospital – and wow, the difference compared to where I’m working right now is massive. Everything there is clean, structured, equipment actually works, it doesn’t smell bad… it honestly felt much more like a European hospital. Once again, I was reminded how brutally money/insurance defines your fate in this country.

Back in the ER, the shifts were actually pretty relaxed for South African standards. Especially in the mornings not much was going on, so I had time to show some new people around, have a coffee break, chat with the staff and just settle back in a bit.

Oh – and I did my first chest tube! Stable patient with a hemothorax. I took all the time I needed and had really good supervision – without that, I probably would’ve messed it up. The anatomy was tricky because of multiple rib fractures right where I placed the ICD, so it wasn’t exactly textbook. But the feeling afterwards was just amazing. You honestly start to feel more like a real doctor.

Really excited to keep improving and eventually get to a point where I can do ICDs completely on my own. That’s my goal – and I think it’s realistic. The only downside: chest tubes are quite popular among interns and regs, so as a student you’re usually last in line. But with 2–3 ICDs per day (and even more on busy days), there should be enough chances.

Besides that, I also did some suturing – including facial wounds and even one on the lip. I’m really improving with that, and it’s great to see the progress.

Every day here is out of my comfort zone – but i am here to grow and i think exactly that is happening right now!

It looks like that traveling for thousands of kilometers and then just working 7 days straight is not one the best ideas i had so far – after my night shift i kept sleeping for almost 2 days and developed a cold….even a bit of fever. So i am out for the next few days….its boring, i have not much to do – but i just stay in bed, drink as much as possible and watch stuff on Netflix & Co. I really want to work, but working in that condition at the hospital would be a bad bad mistake…..

Also: results from my first real needle stick are there – negative for everything!!! How lucky do i have to be, but ill still continue PEP for 28 days after the accident..False negative results and so on.

Looking forward to experience more here, and do more stuff. But first, i have to get healthy again 🙂