Same, same, but different

So, I find myself in a cold house, with a snoring guard dog at my feet, surrounded by a kind of intense darkness that we only see in the winter in Sweden. Of course it is winter here in Botswana, which just adds to my already confused mind.

I arrived yesterday. Ngaire, an Australian emergency physician, picked me up at the airport. Today she and Amit, an American emergency physician, took me out to lunch to introduce me to my work at the Princess Marina Hospital accident and emergency, A&E, department. I thought I had come here for a four-month clinical rotation in emergency medicine. The think I have come here as a specialist to help them train and supervise EM residents and medical students. The present tense signifies that I didn’t manage to convince them otherwise.

Botswana has a small population of only two million people. Thanks to the unfortunately so rare combination of democracy and natural resources, mainly diamonds, it is the richest country in Africa. Earlier they have had to rely on foreign doctors or send their students abroad for undergraduate and specialist training, but three years ago the University of Botswana, UB, started a medical school and residency programs in six specialties, among them emergency medicine. Amit, Ngaire and the head of the A&E, Andrew, who is also an American emergency physician, are here to train these residents. That is different from Sweden where every hospital can train specialists, even if there aren’t any specialists there to supervise them, which is the case for many smaller hospitals that are now starting to train emergency physicians.

Amit and Ngaire explain to me how things work here. The A&E is currently staffed with medical officers, i.e doctors who lack specialist training but may have several years of experience. Some of them have even done clinical rotations in other departments, but that hasn’t been well organized. They have just hung out there for a couple of months and it has been up to their own motivation how much they have actually learned.

But doesn’t that qualify as specialist training? Because that is exactly how we train specialists in Sweden. I did a six month rotation in cardiology. Nobody told me what I was supposed to learn during this time. I wasn’t assessed in any way after completing the rotation. As long as I did all the paperwork everybody seemed pleased with my work.