Lessons in South Africa as a Patient and Provider

Pictured here is Farhan Ladhani, PGY-2 resident, viewing the “skyscrapers” on his recent trip to South Africa, where he completed and international elective in Durban, South Africa at the Nelson R Mandela School of Medicine. Here is a piece he wrote about an enlightening experience as a patient on the trip.

It was midnight on a Friday in Empangeni, South Africa, and a piece of mystery meat had been lodged in my esophagus for two hours. I was working at Ngwelezane Hospital as a visiting psychiatry resident for the past three weeks and was staying at the only hotel nearby (which also happened to double as a casino). That evening, I decided to try the casino grill’s “curry of the day” unaware that the meat in the curry would trigger my eosinophilic esophagitis and put my gastrointestinal tract on lockdown.

Over the course of the next few hours, I tried numerous home remedies to somehow force the food bolus down. Nothing worked. By midnight, I had the choice between going to the ED or possibly aspirating in my sleep. My South African colleague was incredibly kind when I frantically texted her at midnight. She suggested I present to the private clinic in the nearby town, to avoid the long wait lines and limited resources at the public hospital. Heeding her advice, I rushed to the hotel lobby where the clerk, grumpy that I had woken him up, called me a cab at a glacial pace.

As I waited outside, I was frantically trying to do the mental math of how much cash I had in my pocket, what my travel insurance would cover, and what the cost of hospitalization was in that area. As the cab pulled up, the loudest thought in my head was “Can you afford this?” So began a long journey involving two EDs, a half dozen cash and card payments, multiple IVs, a two day hospitalization, a long wait for an endoscopic procedure, and the operating room. Overall, I received excellent care, especially when the staff learned that I was a visiting doctor working in the nearby, under-served hospital. Yet, I didn’t speak the same language as some of the hospital staff or other patients, didn’t know what the total cost would be of this ballooning stay, and was more than a little terrified as they wheeled me into the operating room with no one by my side.

Thankfully the procedure was a success and I was back in my hotel room by Sunday night, with a sore throat, a few bruises from IVs, and a couple thousand dollars in hospital bills. That experience provided me with first-hand perspective into what it is like on the other side of the stethoscope. As much as I previously understood the stress that our patients experience while dealing with their own acute medical conditions, the significant costs (both time and money) involved, and the culture shock of being treated by strangers, I didn’t truly understand the nuances until I was a patient myself.

To address some of these challenges faced by patients, multiple healthcare organizations in South Africa have been pushing for a national healthcare system to improve coverage, reduce costs, and increase access to treatment. There is a large movement in the US with similar goals in mind. In both countries, I have come across skeptical providers who don’t believe that these systems can be enacted due to various barriers and large legislative changes involved.

However, the reality is that these national healthcare systems have been proven to be successful in a number of developed countries where the health outcomes and annual costs per patient are generally superior to ours. When socioeconomic factors result in huge discrepancies in access to healthcare, we cannot ignore the role that money plays. I am still waiting on my travel insurance to reimburse me six months later. I can afford to wait, but not everyone can. The takeaway from this experience was one of the many lessons I learned in South Africa, and this helped me to better relate to, and advocate for my BMC patients even more.