Two months in the emergency room of Africa’s largest hospital

Clinical elective in an emergency zone

What fascinates me about medicine is how precisely and complexly the human body functions – and how quickly this balance can be disrupted. I’m particularly interested in surgery. It combines medical knowledge with manual skills, offering the opportunity to make a direct impact with your own hands. Often, you can see the immediate effects of what you’ve done – that’s what makes this field so special for me.

It was actually quite a coincidence. I was attending an informational lecture at TUM about clinical electives and the practical year (PJ) abroad. When the topic of South Africa came up, the name Chris Hani Baragwanath Hospital in Johannesburg quickly followed – or simply “Bara”, as people there call it. The speaker went into detail about the wide range of trauma cases one encounters and learns to manage. I was immediately captivated.

Bara is the largest hospital in Africa and serves many townships – vast settlements of tin shacks where poverty and violence are part of everyday life. Government structures are often weak, and violence is frequently used as a form of vigilante justice. As a result, the number of patients and the patterns of injuries resemble those seen in conflict zones – and this happens every day. At that moment, I knew: I wanted to experience the reality of this completely different medical environment. To help, learn, and take on responsibility in ways that are hardly possible as a student in Germany. 

I mostly worked night shifts, from 7 PM to 7 AM, often followed by a morning round. The nights were intense: fewer staff, but just as many – often even more – critically injured patients. From the very first moment, I was right in the middle of it: gunshot and stab wounds, severe burns, patients who had been run over, or victims of violent vigilante justice by groups of locals, known as “Mob Assaults”. I was usually in the “Resus” area, the section for the most critical cases, where I got to do a lot myself: arterial blood draws, more complex wound care, and inserting central venous catheters – these are accesses into major body veins, usually in the neck or groin. I even performed some thoracostomies, where a drainage tube is inserted into the chest cavity to re-expand a collapsed lung.

When it was quieter, I helped in the “Pit”, the part of the emergency room that’s more like a “normal” emergency room, similar to what you’d find in Germany. Here, I admitted patients, examined them, provided care, and documented everything by hand – no digital systems whatsoever.

The professional challenges were huge, but the greatest challenge was dealing with the overall situation. You’re constantly confronted with extreme cases, seeing suffering, death, and chaos. There’s a lack of supplies, structure, and sometimes even light. Many patients are under the influence of drugs, aggressive, or perpetrators of serious violent crimes.

In such an environment, it’s surprisingly easy to become cynical – whether out of stress, overwhelm, or as a form of self-protection. Still, one always must remind oneself that behind every injury is a person who deserves dignified treatment with respect and compassion. Not becoming desensitized to “smaller” cases wasn’t always easy – when you’ve just treated someone with multiple gunshot wounds, a simple cut might seem almost trivial. But for the person lying there, it might be the worst thing that’s ever happened to them.

There were many moments that have deeply stuck with me. Children with severe injuries. People who were doused with gasoline and set on fire. A father who threw himself over his children to protect them and was shot multiple times himself. But the biggest change in my perspective on medicine didn’t come from a single case, but from the overall picture. It became clear to me just how much “luxury medicine” we practice in Germany – and we should appreciate that. We have strict standards, highly specialized doctors for every field of medicine, meticulous controls, and the ability to optimize even the smallest details. It’s only in direct comparison that you realize how privileged that is.

In South Africa, due to the large number of critically ill patients, it wasn’t about achieving absolute perfection, but about survival. You had to work with whatever you had – in terms of materials, staff, and time. Long discussions or extensive diagnostics were often not possible because decisions had to be made quickly and implemented immediately. Globally speaking, complaining about the state of the healthcare system in Germany still seems like “complaining from a position of privilege.”

Professionally, it was by far the most educational time I’ve had. I was able to acquire an immense amount of practical skills in a short period of time – to a degree that would be nearly impossible as a student in Germany. I was pushed, had to take on responsibility, think critically, and work collaboratively – all while feeling genuinely needed.

On a personal level, this experience has sparked a desire in me to continue doing similar work in such regions in the future. These situations offer the chance to focus entirely on the direct care of people in need, often with simple means but with noticeable impact.