Wednesday, August 11, 2010


different places deliver different opportunities for experience. it is just a fact. a surgeon working in hollywood is going to see a different spectrum of patients than what one in, say, delhi would. it doesn't mean one is better than the other but it does mean one would feel more at home treating certain conditions than the other. therefore when the belgians rotated with us it stood to reason that they would feel a little unsure on their feet in our environment, initially at least.

when i started in surgery there was already a belgian there. our department had an arrangement with a university in belgium which meant there was at least one belgian registrar with us for one whole year at a time. each year the belgian would go back and another would come to our shores to replace him. so i got to know quite a few belgians in my time. chatting to them i realised the vast difference between the approach to training in their country and in our humble department.

when i first joined the department, in an effort to make small talk i engaged the belgian. i didn't really know what to talk about so i decided to ask him about the differences in the sorts of things they saw there and the sorts of things we saw in south africa. i started with things that were common to us.

"so have you ever seen a gunshot wound in belgium?" i asked.

"of course! i saw one that went in the thigh anterior midline and exited on the lateral aspect just before i came out to south africa." i decided to rather ask him about the weather. it would bore me less.

a year later when the new belgian had joined us i decided to strike up a conversation so that he at least felt there was someone he could speak to in this new strange country. at that stage we were so consumed by surgery there was little else we were capable of talking about.

"so have you ever seen a gunshot wound in belgium?"

"of course! about a year ago there was one that went in the thigh anterior midline and exited on the lateral aspect."

"and what's the weather like there?"

my third year there when the third belgian came out i decided to test what was becoming a theory of mine.

"have you ever seen a gunshot wound in belgium?"

"of course!"

"let me guess. it went in the thigh anterior midline and exited on the lateral aspect?" he assured me the weather in belgium could be quite pleasant in the summer.

so the first three belgians had seen the exact same gunshot case. gunshots were so rare in their hospital that when one came in the entire surgery department was called to casualties to see it. i was amazed. they also didn't quite have the same sink or swim way of training that we had. they pretty much didn't operate at all without a consultant being present. in our way of thinking it was madness, but in reality it was just a different road to the same destination.

so imagine the culture shock when one particular belgian registrar started in our department. he was shuffled off to kalafong and put on call alone his very first night. now as i have mentioned before, getting a consultant out to kalafong at night was only fractionally easier than turning lead into gold. the senior south african registrars informed him of this fact and availed themselves to be called if he needed advice. they quickly added that they would help him telephonically but they would not actually come in. he would have to sort everything out on his lonesome.

the next day he was a wreak. he was talking about packing it all up and going back to belgium (where the weather was pleasant in the summer). to his credit he stayed.

you see, that night, not only did he see his first gunshot abdomen, but he was required to operate it. after that he did his second one and after that his third. on his very first night on call in this glorious country of ours this poor first worlder really got a taste of what it can be like. i really felt for him. but then again at least we no longer had to discuss the weather.


Ciara said...

It works both ways you know.
C Ireland

anne said...

Sounds about right to me. Judging just from the newspapers, there are only handful of gunshots here a year per million people, and many are immediately fatal. Off the top of my head, I don't know anyone in this part of Europe who has seen an abdominal gunshot, but I'll ask around and report back. We do have trauma--mostly traffic accidents, occasional stabbings, family disputes (for whatever reason I've seen a sickening amount of violence against children), and various other alcohol and cocaine-fueled injuries. Gunshots are (thankfully) rarely on that list.