Navigating the gap between skills acquired in university and the misalignment with expectations of being in health care.
“Find your heart and follow it.”
These are words said to me in my 5th year of medical school by one of my professors, Prof Nonhlanhla Khumalo (head of the dermatology division at Groote Schuur Hospital and UCT). The phrase is permanently ingrained in my mind and my spirit. The assumption I made about being called for something is that it would be a relatively smooth ride, that it would be easy to cope even in the face of some challenges and that those challenges could always be easily overcome with a bit of will and motivation.
I was disillusioned when it dawned on me that the preparation we undergo at medical school does not adequately equip us for the stark realities of being a junior doctor in South Africa and all the expectations that befall us.
Navigating the saviour complex
You see many patients; many human beings with their individual histories and narratives. They bring their whole world with them into that consultation room and give you all their problems to solve, looking at you with a hope and desperation in their eyes that says, “You will help me, won’t you?”
There are many varied determinants of health outside of what is in the textbooks: access to clean water and adequate sanitation services, access to housing, substance abuse, safety and security, unemployment, interpersonal relationships and dynamics, just to name a few, all which impact people’s physical and mental health and wellness. The burden to solve all the problems of the populations we serve, be it medical, political or socio-economic, is real and it is heavy.
Whether you focus on the medical problem or approach your patient as a whole human being with other issues that need to be addressed, there is no winning. You fail the patient by focussing only on their immediate medical needs and throwing tablets and bandage solutions at them. On the flip side, you will inevitably fail them by carrying (and being crushed by) the weight of responsibilities that are not yours to be burdened with. It is impossible to solve all their problems, even those that may be directly related to their medical concerns. Patients look at us like we are the answer to everything. Those of us who ardently care about their work and their patients, who carry the words of the Hippocratic Oath in their hearts, almost believe it too. But, we have limitations. We can only do so much. We can only carry so much. The balancing act called for by this “between a rock and a hard place” scenario is a skill not taught to us at university and one I battle to develop every day.
Navigating a broken health system and lack of public knowledge of the system
Because doctors and nurses are the face of and point of entry into the health system, people take out their frustrations with the system on us.
There are many factors at play which ultimately pit patients – who are rightly seeking medical attention – and health care providers – who are understaffed, under-resourced and simply doing their best to do the most good for the most patients – against one another, an issue for which university did not prepare me.
In addition, the provider to patient ratio is so off that we often fail at this very thing of doing the most good for the most people. In my experience, it seems patients need to be very sick to finally get suitable care. On top of this, public health education is so lacking that patients are lost to follow-up or don’t enter the health system until severely ill. The uneven distribution of resources across the levels does not remedy the situation. The preventative care model becomes lost to us as there aren’t enough resources at the primary and secondary levels to execute it.
As though we have not enough gaps to navigate, there is now the looming threat of unemployment. One of the perks of going into health care was the guarantee of employment. How things have changed. We are learning to adapt to a reality in which being a doctor no longer means guaranteed job security.
Navigating the health care service as a wounded healer
I spent my entire childhood being an overachiever. It has left me with debilitating anxiety and depression, perfectionism and a fear of failure.
My twenties have been about 2 things: becoming a doctor and navigating my mental health. I was 17 when my anxiety disorder began to rear its head after years of brewing in the shadows. I had my first panic attack in the middle of the night in my parents’ house. I had no idea what has happening. I just knew to avoid making noise and waking up the house. I remember feeling like I was choking, like the more air I tried to sequester into my lungs the thicker it got and the more stenosed my throat became. I don’t know if I really went blind in those few minutes or if my tears were that heavy and thick. My mind felt dense and dark, and my head throbbed and throbbed along with deep palpitations in my chest.
Years 20 to 22 are when I was formally diagnosed, had my first course of psychotropics and started psychotherapy. It was a lifechanging event in my life. Through therapy, I began to understand my own wiring. There have been ebbs and flow to this journey. For the most part, I have been coping relatively well under the care of great doctors and my loving family and close friends.
My current challenge is navigating the health care space as wounded healer. My mind ponders, is a wounded healer a professional hazard? Is there space in health care for self-care?
Living a life in service of others is exhausting and, sometimes, all consuming. There is no glamour in being a doctor in South Africa. Called by a higher power to do the work or not, you are faced with unrealistic expectations as a health care provider. You inevitably collect all sorts of wounds of your own: fatigue and burnout, trauma, guilt, jadedness, thick skin and mental illness (if, unlike me, you don’t already have that under your belt).
We are constantly pouring out. What is the solution? My psychological first aid consists of: seeking help, community, debriefing and self-care in the form of exercise and a vibrant life outside of medicine.
What I am missing more of is community, in and outside of medicine. While I have great family support and some close friends, they are scattered elsewhere in the country and I am frequently alone and lonely, having no one to pour back into me.
I see community as a way to refill your cup, a way to return to your humanity.
There is power in debriefing. Having a safe space to retell traumatic events heals wounds. It fosters community and connection. Whether correct steps were taken or mistakes made, debriefing provides a safe space to feel things, to reflect, to learn and grow.
I recall a failed resuscitation of a new-born baby. We had done everything right. It was simply a battle we were not going to win. None of this would have mattered to me had our consultant not come in to debrief with us. We retold the steps we took and in return we received comfort, validation and reassurance. This is vastly different from the case of failed resuscitation on a 19-year old. I carried this death with me for weeks until we had a ‘morbidity and mortality’ meeting where the death was finally discussed. In the first case, we were given a space to acknowledge our defeat and powerlessness. We were provided room to accept that not every fight is a winning battle, thus avoiding adorning the wound of failure.
I think things are looking up. Our generation is more introspective and tapped into their mental health than those that came before us. Self-awareness precedes any change. We are better at looking at and after ourselves. We want to prioritise ourselves. We reject the status quo of working oneself to the bone. We are more open about the traumas we carry. We are keener on therapy, allowing more individuals to grow skills to heal their wounds and navigate life from a healthier point of view.
I strongly support having a therapist especially if you are a health professional. It doesn’t make you weak; it makes you smart and non-hazardous. It enables you to be better equipped to deal with things that the average human being will never see. We are feeling beings and we should never rebut that. Our humanity connects us to our people. It enables us to tap into an inner strength to which we otherwise would not have access.
Conclusion
The question begs to be asked: Why medicine? I have a passion for problem-solving and it has led me down the path of health sciences. I cannot imagine doing anything else. I have been called to do the work and every day there is an event that validates that I am right where I am supposed to be, even on the difficult days – especially on the difficult days. Be it delivering someone’s child or figuring out a long-awaited diagnosis, something always happens that fuels a spark in me that I am hooked on. I find validation in the moments that I feel that heat and excitement in my chest when we win a battle, when the amniotic sac is nicked during a c-section to bring out a brand new life; I find it in the vulnerability shared between patient and carer. It doesn’t matter who the patient is, be it a child, the elderly or a prisoner. There is something pure about the interaction one has with patients, something special about seeing someone in the most vulnerable time in their life and having the power to make a difference. I find faith when a patient says, “Thank you, doctor.” I have found my heart and I am following it.Written by: Ofentse Monnaruri
Edited by: Emma Reinecke
About the author Ofentse Monnaruri : My name is Ofentse Monnaruri, I am 26 going on 27 years old. I was born and raised in Bloemfontein, Free State where I spent my entirely life up until my university days. I attended medical school at the University of Cape Town where I earned by MBChB. I am currently living in Cape Town and working in the public health sector as an intern medical officer.
Navigating the Twenties Ms Zinhle Novazi
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