Rob Melvin is a ‘city boy’ from London who ‘works hard and plays hard and likes the bright lights’. He’s just finished a six month post at a remote South African hospital and although he says he’s ready to move on, he’s extremely enthusiastic about his rural experience.
‘I’ve had a magic time. It’s a fabulous place to work and I would highly recommend it to anyone. There’s so much to see and do both inside and outside of work that the experience is well worth the risk. I came for the experience, and the experience has been incredible.’
Melvin, who qualified in 2003, visited South Africa the year before while doing a 6 month working holiday in Tanzania.
‘I had a good idea as to the beauty of the country and the possibilities here and I was really keen to do it again.’
While studying a Diploma in Tropical Medicine in Liverpool at beginning of 2007 he saw an RHI advert for placements in South Africa and decided to follow it up. After contacting the organisation he was placed at Nkandla, a small district hospital with 212 beds.
His latest African experience, despite being short, has been marked by a deep connection with local people that has given him an enviably full, wide-ranging experience.
‘I’ve tried to integrate myself as much as I can, being the only white person in a very black area. I’ve been really welcomed and people have always made the effort and been really nice and open and friendly. People within the hospital, particularly the admin staff, are always welcoming me around for a beer in the evening or to watch the football or little things like that. I’ve been invited to their family homes on a couple of occasions, and it was a real privilege to go and meet community elders. Some of the nurses have become quite good friends and have involved me in various social activities, mainly parties. And I’ve never felt out of place or like I’m just the token white guy there.’
But it was Melvin’s ball skills that really helped him to connect. Soon after arriving at Nkandla he joined some of the hospital staff in a soccer game. Afterwards one of the players asked to play in their team at a local stadium that evening.
‘I was introduced in Zulu to all these other young lads, was thrown a kit and put on the pitch. It was an amazing experience ‘ there’s me under the spotlights, running around, people watching all getting drunk, I vaguely pick up that some of the abuse is coming my way, but it was just a fabulous. And from there I’ve played with the team for the rest of the season.’
Melvin’s team won the local village league, and he’s been given the nickname Mandla (Power).
‘The majority of the guys who play are not from the hospital and it’s allowed me to get in with a much wider circle of people. When I go up to the village to buy something there will always be someone who’ll shout out my name and I can wave back. It’s been really nice that people know I haven’t just come to sit in the hospital and work. Getting to know the local people just gives you a better idea of what life’s like. When you talk to some of the guys, their English is limited, most of them have never worked. They come to play soccer but they don’t have any of their own equipment like shin pads, kit, boots; that’s all provided for them. They might not have eaten that day, or they haven’t had any water when it’s blazing hot. It’s a real reminder of the reality of life here.’
Nkandla Hospital is situated about 300 km North of Durban and serves a relatively sparcely populated region that contains about 100 000 people.
‘It’s a rural village, with mainly non-permanent structures. The hospital is the biggest area of buildings. People walk everywhere because very few people can afford cars. It’s an absolutely stunningly beautiful mountainous area quite unlike how you’d probably imagine Africa; it’s very green and it rains a lot. But it still has all the other things people imagine in Africa: young children playing by the roadside, people walking with big buckets on their heads, mud-huts. So there’s that contrast: the incredible scenic beauty with the incredible poverty.’
In his six months at Nkandla Melvin adapted surprisingly well to rural life.
‘I’m going to miss the outdoor life, and the openness here. There are so few people that you can go for a period of time without seeing anyone. Growing up in London I’ve never had that. That’s the wonderful thing about South Africa, you can go for a walk and just lose yourself and disappear, which is fabulous. The best part for me has been learning a little bit of Zulu and then being able to walk in most places I’ve visited and greet and be greeted by the locals there. You just can’t beat that. I guess growing up in London, people have got their heads down, they’ve got a focus, they’re going somewhere; it’s very individual, it’s very ego-centric, and it’s not very friendly. Here people have much less, but I think that means everyone can be so much nicer and more friendly, and they make you feel wanted and welcomed.’
He’s countered the potential monotony of rural life with frequent weekend trips around the province.
‘I’ve been able to get out and experience as much of KwaZulu Natal as I can. South Africa’s a beautiful country; there’s so much to see. I’ve put 10 000 kilometres on my car in six months but the reward is so worth it. I haven’t really had to think twice if people have suggested things.’
His best experience was tiger-shark diving without a cage at the Aliwal Shoal on the KwaZulu Natal South Coast.
‘Me and a friend who I made at Crook’s Hospital in Scottburgh went with scuba diving gear and were in the water for over an hour with three massive tiger-sharks and about 30 blacktip sharks. It was one of the most exciting and potentially stupid things I’ve ever done in my life. We made a video of it, and it’s just amazing to think that I was in the water with these things. They swim right up to you, they check you out, so I was in arms reach of a tiger shark. I’m so glad I did that.’
The Clinical Experience (‘Bring a textbook’¦’)
When Melvin decided to come to South Africa, it wasn’t really about the clinical experience and he even considered the idea that he might be wasting valuable time at an early stage in his career.
‘I didn’t come with the intention to gain any one particular clinical experience here. I decided I would come and I would try a bit of everything. For example, when I first arrived I tried to do caesarean sections and got some training from the other doctors, but after a couple of weeks I decided that I wasn’t very good at it and so didn’t enjoy it. So I just let the other doctors do that, while I did the anaesthesia.’
It was while working in Nkandla that he realised he really enjoyed emergency medicine. When he leaves he will move on to training post in Melbourne, Australia to become an A&E specialist, a position he set up while at Nkandla. It’s now clear that the clinical experience will be extremely valuable.
‘The professional experience that I’ve gained here has been amazing and will stand me in very good stead, particularly for a future in emergency medicine. Some of the trauma you see here and what you have at your disposal to deal with it is a real challenge.’
When he arrived he had no experience with TB and HIV patients and couldn’t confidently deal with wounds and burns. That’s all changed completely.
‘The volume of TB patients here is amazing and continues to astound me. I’ve seen a lot of burns here, I haven’t seen that many gunshots, but I’ve become very competent managing patients with blunt knife-injuries. Many bush-knives.’
South African doctors typically undergo massive gains in clinical confidence because staff shortages ensure they will often deal with difficult cases on their own.
‘Working here I’m very autonomous, which is different to at home where there’s a much more hierarchical system. We have a meeting in the morning where we can discuss difficult cases, although realistically, nearly every patient here is a difficult case and there’s no time to discuss everyone. The diploma in Tropical Medicine I did really helped because it gave me a good clinical grounding in the things that I might see here.’
‘A couple of cases that I’ve seen here’¦ I’ve just been scratching my head, just really, really thinking hard, saying ‘how can I help this person?’ And I’ve gone away and I’ve read up on what it could be. It’s really re-ignited my interest in clinical medicine, because you find in the West and the UK and Australia that you’re now so reliant on tests that you rely less on the clinical examination and history. Here that’s really interested me and its something that I’ll miss because going to Australia, if someone comes in with even a mild head injury they immediately get a CT scan of the head. Whereas here the CT scanner is 2 and a half hours away, so you can’t do that.’
The types of patients that Melvin deals with are also very different to what he was used to.
‘Everyone here has multiple problems. They’ll come here with a cough, and a fever and diarrhoea and they’ll maybe be confused. And there’s so many things that could maybe cause all these symptoms together, so after a while you start to decide, ‘well this is the biggest problem’, or ‘that is most serious’, or ‘this is what I can address, because I can’t address everything’. So you address what you can, and one of things I’ve found is to address what is the patient’s biggest problem, which in your eyes might not be their biggest problem. I’ve just found that if I focus on what they patient wants, or what seems to be upsetting them it seems to work.’
The new environment has turned Melvin into a better doctor both directly and indirectly.
‘I’ve got much better at it. I know that I’m far from perfect so I’ve also done a lot of reading in the evenings to try and improve my skills. I’d advise any doctor coming over to bring a good textbook, because there’s always going to be lots of interesting things to learn and read about.’
But Melvin says the best part of working in South Africa is the sense of job satisfaction he gets here.
‘You can make a difference to people who have very little, which is very rewarding. Often in the UK people don’t know how lucky they are, so obviously you can help them but it’s just to a very different degree. I think if you come and you say, ‘I’m going to do the few things that I can, and I can make one or two people’s lives better’, then for me, it’s so rewarding. A couple of times patients have travelled a long way just to come in and say thank you for what I did for them two weeks before. And that’s really nice. If you just show that you’re making the effort, even if you can’t always help, the effort is really appreciated.’
It’s this feeling which he says will bring him back in the future.
‘I would love to come back here and work here again. I really feel there’s some people here who are fabulous to work with and the people here really deserve better. So I would love to come back just to try and help. There’s a shortage of doctors here, particularly rurally, and there’s a huge number of patients that need to be helped.’
‘I would recommend South Africa as a fantastic place to work to further your experience as a clinical doctor, to work with some fabulous people, and also to work with some of the poorest people in the world. I would thoroughly recommend it to someone who is thinking about working in Africa.’