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Voices: Dr. Mike McGovern (UK)

Abridged transcript of interview with:

Dr. Mike McGovern (UK)
Placement: Madwaleni Hospital, Eastern Cape
Dates: 2015 – 2017

For as long as I can remember I wanted to be a doctor.

And a large part of the reason I wanted to be a doctor was that I wanted to go abroad and work in a less-resourced setting, where I’d be able to make a difference.

When I got to the stage where I could go abroad, and was considering where to go, word of mouth led me to AHP. I heard they were recruiting doctors to work in South Africa – and hearing that there was an organisation that would help me through the process of recruitment and job application, and all the bureaucracy, was a draw for me.

Another draw was the fact that the rural areas of South Africa are quite undeveloped, but at the same time there’s a functioning healthcare system, where you’re likely to get better training than if you were in central Africa, for example, on your own.

I was also drawn by the fact that it was paid work, which isn’t too common in other similar settings.

It’s difficult now to remember what exactly my expectations were before I got there. But certainly, as someone who had never been to South Africa before, I remember being a little shocked at the state of the hospital where I’d been placed. I’d been to other places in Africa – Uganda, for example – so I’d worked in the Third World; but being in South Africa, you somehow expect things to be better than they are in rural areas.

At the same time, I was amazed by the doctors there. We had an incredible team of people who were really quite junior in their profession, who hadn’t been doctors for much longer than I had, but who were light years ahead of me in terms of their knowledge, their procedural skills, just how clued up they were generally; not to mention how welcoming they were and how warmly they treated me.

So I had an amazing experience there. I learnt so much about things I would never have got a chance to learn about in the UK. As a junior doctor here, your job consists of mainly nine-to-five work on specific wards. So you’re dealing mainly with old people: lung disease, heart disease, etc. And you work in one ward, where you see similar patients coming in. And then, you’ll only be doing medicine, or you’ll only be doing surgery.

Suddenly you get to South Africa and you have an incredible variety of work. In one shift you might deal with a severely malnourished child; then you might deliver a baby by caesarian section; then you may get a trauma patient coming in; car accidents; stabbing victims. I didn’t quite realise what a range of things I’d be seeing, and how quickly we would learn to deal with situations we’d never encountered before.

I’d never dealt with any maternity stuff, for example; I’d never seen a patient with HIV before – and within a few months of being there, and after having done some training, I was running each of those wards, and dealing with those things relatively comfortably.

Something else worth mentioning about the AHP placement is the opportunity you have to do quality improvement and research work. That’s important for British doctors. When you go for interviews for future jobs back home, having worked to improve your hospital counts enormously, especially if you’ve managed to go to a conference to present your work, as there’s plenty of opportunity to do in South Africa. Because there’s often so much room for improvement in small hospitals, it’s relatively easy to do something that has a major effect on patient care.

For example, I instituted a checklist in the operating theatres in my hospital – something that had been introduced in other places and had reduced mortality by as much as half. I interviewed all the staff beforehand, and again afterwards. Which gave me a comparison I could then use to build a project presentation. And I went down to a doctor’s conference – with a lot of AHP people, actually – and presented it there.

I am definitely thinking of a career where I work abroad again – perhaps working for Doctors Without Borders, for example, or other aid organisations. Having worked in South Africa is definitely seen as a big plus for those sorts of groups. You gain all sorts of practical skills that you wouldn’t otherwise.

Even for going back to working in the NHS in the UK, it’s excellent work experience. Not only did I manage to do the quality improvement project and present it at a national conference, I also kept a log of all the procedures I was doing – caesarian sections, anesthetics for them, as well as various other procedures around the hospital – all of which a doctor at my stage could never get a chance to do in the UK.

At the same time, of course, it was hard work. You would never do a 36-hour shift in the UK, and here you have do that sort of thing. You’re knackered by the end of it, but you really learn a lot about yourself. You learn to be resilient, to work under pressure, and deal with things that would otherwise have been outside your scope.

For example, in my hospital, many of the nurses had been there a long time, and had seen a lot of doctors come and go. There’d sometimes be friction between the doctors and the nursing staff – different approaches to care, that sort of thing. In these situations I learnt a lot from the hospital manager, who was doing incredible work as a doctor and at the same time had taken on this leadership role.

It impacted me quite a lot to see how he negotiated those moments of conflict – never blaming people. It was an interesting learning curve for me. It taught me a lot about myself – not just strictly clinical skills, but also more professional skills; and in other ways too, that are not that easy to describe, but that I know have made me a better doctor.