Working in O&G in South Africa

Dr Dorcas (Dee) Obeng shares her observations working in a hospital outside Johannesburg

• What: Working in antenatal outpatient clinics, labour and post natal wards, basic facilities
• Where: Tambo Memorial Government hospital in Boxsburg and Clinix Private medical centre in Vosloorus, outside Johannesburg
• Time: Two months
• Demographic: Deprived rural ‘townships’

Although I was born in Crawley, West Sussex to a family of six, my parents are from Ghana, so I’ve had a strong African influence in my upbringing. I’ve been lucky enough to visit Africa and love it and all its flaws – that’s why I wanted to work in a deprived area in South Africa, helping women deliver babies. 

It was an eye opening experience, one that I will take with me going forward as an obstetrician.

Medical conditions

I was able to witness pathology I’d only read about in text books; our medical system is better financed and free of some of the socioeconomic issues that South Africa has to bear.

Witnessing eclampsia with HELLP syndrome, miscarriages and foetal death due to preventable causes, really opened my eyes. Due to a higher uptake of cervical screening in the UK women are treated early on at a precancerous stage, in contrast women in SA were not offered routine screening and would present later when the only treatment available was palliative.

It has one of the highest prevalences of HIV in the world. I observed many pregnant women on the wards with tuberculosis, PCP and other AIDS defining illnesses. Women of all ages and walks of life were presumed to be retroviral disease positive until proven otherwise.

I will never forget a nurse saying: “You could be negative today and positive tomorrow” and a doctor remarking: “I used to read the obituaries every day and 90% of the people would be under 25.”

Paternalism

There was a paternalistic relationship between healthcare providers and patients. Doctors would not introduce themselves or even explain their examinations. The patients would rarely question their doctor or their management. Many did not know the names of their medications or even what they were for.

Midwives would shout at women if they made too much noise or were perceived not to work hard enough during labour. I was told “you have to be tough on these women or they become spoilt and will refuse to push.” The absence of kindness, empathy and positivity, was surreal for me. Although the midwives never physically harmed the women it felt barbaric.

The midwives truly believed that their approach was effective, as it would force the women to work harder, ending labour sooner. In a hospital where epidurals were non-existent and pain relief was rationed, I began to understand their thought process, even if I didn’t agree with it.

Gender inequality

My biggest inspiration in life is my mother who is a vivacious and successful woman despite being brought up in a culture where gender inequality often stifles females. I noticed the obvious gender inequality in the hospitals, eg, only the patient’s male partner, would be addressed by the doctor.

A doctor I shadowed told women not to tell their husbands they were having a hysterectomy because their husbands would not allow the procedure due to a myth that it would feel different for males during sexual intercourse. I met women who refused the Mirena coil (IUCD) because their husbands did not like the idea.

Gratitude

We’re all guilty of having a grumble about the state of the NHS, but we’re so lucky to have free healthcare. Children who should have survived die in SA due to poverty, poor facilities, HIV and a lack of education.

There was one evening when the power cut so no surgeries could be performed. Women who could not afford the transport to the hospitals would go the full length of their pregnancies without ever seeing a midwife.

There were only two neonatal incubators, which were hopeless on the day 21 births took place. And then there was always the question of the children that did survive. What chance did they have of being able to afford an ultrasound scan, medication or doctor’s appointment when they fell pregnant?

Respect

What I revelled in most was observing how alike we are as humans. The 43-year-old woman, who hugged me when I confirmed her pregnancy after numerous miscarriages; the wail of the child who was delivered by emergency caesarean after an abruptio placenta, and holding and crying with a woman who lost a baby – these scenes will never leave me. I have huge admiration for the women here and the hardships they suffer.

Lessons learned

I learnt to use a glove as a tourniquet, to line my syringes with heparin before attempting ABGs and to not expect women to know their gestational age. I hope that having the invaluable luxury of time allowed me to make patients feel important and cared for during one of their most challenging and vulnerable times.

I was extremely lucky to have had the opportunity to visit and work in such a beautiful, diverse and culturally rich country and hope to use my experiences to improve my practice in the future.

Dr Obeng is a foundation doctor in Birmingham.

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