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Voices: Dr Jonathan Hudson (UK)

Abridged transcript of interview with:

Dr Jonathan Hudson (UK)
Placement: Estcourt Hospital, Kwazulu-Natal
Dates: September 2016 – 2018.

Medicine lends itself to travelling; you can do the job anywhere. It’s a great way to go different places and be able to offer a service and contribute to the society wherever you go.

My desire to go abroad started on my elective at medical school, when I went to Uganda with another student. We worked for two months in a small rural hospital in southwest Uganda, and I absolutely loved it. I was completely out of my comfort zone and was perpetually challenged, something that at the end of the months I found incredibly rewarding.

We had an amazing time there, for various reasons, professional and personal. And from that point on, I knew I wanted to do something like that again during my career.

The UK training system is quite rigid and structured, but it does have natural breaks in it that allow you to take some time out of training. I’ve always seen travelling abroad as a great way to make myself a better doctor and to develop myself both personally and professionally.

Why South Africa? A large part of the reason I chose South Africa had to do with the very fact that AHP existed.

Initially I was just thinking, broadly, that I wanted to go somewhere in rural Africa. The medicine is different; the cultures are different; it was somewhere where I knew I would be challenged.

Essentially I chose South Africa largely because AHP existed, and offered such a good service. AHP exist to manage your application and place you in hospitals in rural South Africa. I really feel like they have managed to find me the exact job I was looking for.

If AHP had been working in Zambia or Botswana for example, I would have happily considered going there. Having AHP on the ground make the whole process so much easier to apply for jobs and to overcome some of the bureaucratic barriers.

It is a pretty long process, regardless. I started my application in October of 2015, and I probably didn’t know for sure that I had a job until August of 2016. So it can be a long process and one that definitely tests your patience.

A lot of my frustration at the time was projected on to AHP, but actually, now that I’m on the ground and see the reality of getting a job in South Africa – even for South African doctors, but in particular for international doctors – I recognise why it took such a long time. It’s tough. So now that I’m here, I actually feel very grateful to AHP and impressed with what they have been able to do for us.

There were three of us who all applied together, and AHP placed the three of us in the same hospital, which I think was a really good effort. It was exactly what we wanted. They have placed us in a hospital which is functioning; where we are challenged to work independently, but where we still have a degree of supervision. They’ve also sent us on a number of training courses.

I’ve been in Estcourt Hospital [in KwaZulu-Natal] since the first week in September 2016 – so about four or five months – and, overall, it’s been amazing.

If you’d asked me before I came what I wanted to get out of my time here, or what I wanted it to be like, it’s ticking a lot of those boxes – certainly in terms of getting the practical, hands-on clinical experience you don’t get in training in the UK any more (at least not at our level). There’s also a very different disease spectrum here, which makes the job really interesting and forces you to continue learning and revising things.

From a non-medical point of view, too, it’s been incredible. South Africa is a truly amazing country to explore, with lots to do. We get in a 4×4 and go away almost every weekend – to the beach; to the Drakensberg [mountains]; we go scuba diving; I’ve been to Cape Town a few times; I’ve been to Johannesburg. Here you have almost a perfect balance of being at work Monday to Friday – and having a very fulfilling work week – and then feeling like you’re on holiday, travelling, Saturday and Sunday.

On top of that, another thing I didn’t realise before I got out here is that the pay is quite good. This was not something I was expecting. South African doctors are paid quite well. Consequently, it’s affordable to do a range of things on the weekends. Even to fly to Cape Town or Joburg, for example. This is a real added bonus, not something I thought of before coming.

Which is not to say that there aren’t a lot of frustrating things about the experience.

To start with there are just the general frustrations that come with working in a resource-poor setting, like not having access to certain equipment, and wondering sometimes if the resources that do exist could perhaps be channeled more effectively or appropriately.

Then sometimes you can feel as if you may be doing stuff that is a little bit out of your depth. The example I’d use is anaesthetics. South African interns, people at my level, are trained to do spinal anaesthesia for caesarian sections. That’s something that in the UK you’d do only when you’re very high up – even at consultant level. But when I arrived here they were asking me to do it and it was something that was expected of me by my hospital. It was quite unnerving at the start, but the hospital did a good job teaching me to do the spinals and then sent us for some anaesthetics training to a regional hospital where I got a lot of really good experience.

I am here because I want to develop and grow as a doctor, and because I want this experience to have some impact on my career. It is difficult at this stage to think about what specifically that impact might be. The impact might be simply going back to the UK and being a slightly more clinically in-tune doctor – because I’ve been to South Africa and had this challenging, hands-on experience – and that would be fine.

However, I think it will probably have an impact in terms of career choice. It lends itself to doing work with infectious diseases. I’m doing a lot of work with TB here, which is something I’d never done before, or considered doing. I work in the MDR TB unit at Estcourt, which is the referral centre for the district. We have about 300 patients enrolled in our programme and we have both inpatient and outpatient services.

It’s been a brilliant experience – not only learning about the management of a complicated disease, but also being involved in some of the managerial aspects of the unit. I have attended a lot of provincial TB meetings and been involved in a lot of discussions about MDR-TB policy in KZN. Obviously, my role at this level is extremely small, but just being able to be present at these things has been fascinating.

So it is hard to imagine that this won’t have some effect on my future career. It will make me, probably, always have one eye on travelling and going abroad with my work. Whether or not that will mean working for an organisation like MSF, or whether or not it will make me look for an alternative post abroad, is hard to say. But I can quite easily imagine something along those lines.

It is just really good training in terms of forcing you to adapt to a new environment, new health systems, new cultures. That ability to adapt, I think, will be relevant throughout my career, wherever I go and whatever I choose to do.