To express your interest in participating in our student program, please e-mail Dr Petros.

Below you will find a range of information on various aspects of your visit. We want you to enjoy yourselves at GSH. Let us know if there is anything that we can do to try and help.

This will largely depend on which subject you are working in, but there are some areas of common ground.

Monday, Wednesday, Friday
8am Business meeting - boardroom

Daily ward round
8am (or after the morning business meeting)

Outpatient's clinic
Daily after completion of ward rounds

Surgery operating days
Tuesday and Thursday - all day

Obs/Gynae operating days
Tuesday and Wednesday - all day

Tea break
Approximately 15minutes around 10am daily

Lunch break
1pm - 2pm daily (Absolutely everything in Swaziland stops for lunch at 1pm)

End of working day
4pm daily, 1pm on Friday. Only the on-call doctor is present after this time.

SPECIAL MEETINGS

Every Wednesday morning, the business meeting is run as an educational forum. This is aimed at the medical staff, but is usually pitched at a level where all students and staff will learn something. Elective students are required to present at least once during their stay at Good Shepherd.

The first Wednesday of the month, the morning business/educational meeting is supplanted by a multi-disciplinary meeting for the heads of all departments. Students have the option to attend.

Also on the first Wednesday of the month, the afternoon is dedicated to the regional doctors educational meeting. This rotates around the local private clinics and GSH in an attempt to involve all the regions medical staff in continuing medical education. Literature reviews, topic presentations, and patient case studies are all part of this forum. Debates often get quite lively. Students are encouraged to attend.

Wrap up rounds occur irregularly at 4pm throughout the week meeting in OPD. If you have an interesting patient to show off, gather the team together and show us what you have. This is informal teaching and discussion at the bedside.

STUDENT RESPONSIBILITIES

There is a huge variation on what a student is asked to do. It depends on many factors such as your experience and confidence, and staffing levels. We have had students who want to take minimal responsibility only working alongside the medical staff. We also have had students running wards nearly autonomously, requiring almost no extra input from the medical officers.

You are welcome to take as much or as little responsibility as you wish. If you feel you are capable of doing a minor surgical list, tell us. We endeavour to tailor the elective to your needs, within the bounds of skills and staffing available.

TREATMENT REGIMES

Many of you will be initiating and following through patient management with only a little input from the medical staff. You will often find that how we treat a patient here in Swaziland differs from what you would be used to at home. If you really want an idea of how to treat patients, before you arrive.

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For most students, the elective primarily takes place at the Good Shepherd. However, we encourage all students to spend at least 1-2 days with the Home-Based Care program. This is an outstanding opportunity to see how people live in Swaziland. This is probably one of the favourite activities of many students, allowing you to witness the true lifestyle of Swazis. Out in the countryside, people of Swaziland live within a Homestead. Homesteads are made up of an extended family. Depending on the income of the homestead the houses can range from nice brick or concrete homes (well off homestead) to thatched huts. Many of these homesteads do not have either electricity or running water and must cook over an open fire. The home-based care program was set up initially to look after terminal HIV/AIDS patients, but the scope of the project has extended greatly since its inception.

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The Board Room doubles as a small library. Many of medical books that kept by the hospital are fairly old, but still useful. If anyone would like to donate any books, some that would be beneficial to this collection include Williams Obstetrics, Harrison's Medicine textbook, Nelson's paediatric textbook, the Red Book, and a procedures book.

The Board Room also houses the open access computer (see below) and so is kept locked. The key is freely available to students.

THE COMPUTER

There is one computer with open access to all. It runs Windows XP and is Pen4 - 512MHz. It should run whatever statistics package you wish to use, but currently only has Microsoft Excel loaded. You would have to bring the discs for anything other than this I am afraid.

In reality the computer is extremely busy...Several doctors have only this computer to use, and visitors also need to utilise it. Computer time is therefore very precious as it is the main form of communication to the outside world. Dr Philip and Dr David have their own machines but they are out of bounds to the general public - sorry.

The other main problem with computers is the hospital power. We have electricity 99% of the time but it comes from 2 sources. When we have full mains power, all the electricity in the compound works fine. However when we switch over to generators, only lights and cooking power is available - so no computers.

Whilst you are at GSH, you are welcome to use the open access computer for e-mail. The address is doctors@realnet.co.sz. Please ask your friends and family to put your name in the subject line so that everyone knows whom it is for.

The internet is extremely slow in Siteki, so it is recommended that you use the hospital e-mail address and Outlook Express rather than your personal hotmail or similar account. All internet time must be paid for by students.

TELEPHONES

The student / residents house has a phone. In the past a phone line was installed, but due to abuse this facility was removed. It has just been reconnected as an incoming line, and local outgoing calls - NO INTERNATIONAL CALLS.

The hospital has a payphone, which runs from locally available phone cards (E100.00 for around 16 minutes at international rate)

There is a reasonable cell phone network in Swaziland (MTN network). Starter packs can be bought for most common brands of phone, so you can bring you phone with you and connect up when you get here. Many global networks do NOT cover Swaziland.

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Firstly, we are not responsible for getting you here, you must make you own travel plans, but we can help with information on flights etc.

There is a direct linking flight from Johannesburg International Airport to Manzini (Matsapha Airport). Flights are booked via South African Airways; check out their website for flight details (http://www.flysaa.com/saa_home.jhtml).

Many travel agents will give you a blank look when you ask them about this so tell them:
Matsapa Airport code = MTS Flight numbers are SA7996 - SA7999, and SA8981

When booking your tickets do take the time of arrival here part seriously. Honestly you don't want to be travelling on the Swazi Roads after dark (driver error is huge here, RTA very common) I will not drive after dark unless essential. If your flight times are inconvenient, it may be worth staying in the airport overnight (Holiday Inn - Garden Court very reasonable prices check out their website http://www.sixcontinentshotels.com/h/d/hi/hd/JNBAT )

For the adventurous there is a 5-hour bus ride from Jo'burg to Manzini, everyone I have met however flies!

When you get to the airport (or bus station!) you will be met by a GSH driver and brought to the hospital. Tell the driver if you want to do any grocery shopping on the way here, as he will stop off at the large SPAR complex in Manzini centre.

TRANSPORT WHILE YOU'RE HERE

Some students / residents rent a car for their time in Swaziland. Rented from AVIS, it costs around E3000.00 for a month. Insurance is the same amount again, unless you can put the car hire on a VISA card that has rental car protection. Remember that AVIS and Hertz have age requirements, often over and above that required to hold a licence. Both AVIS and Hertz are based at Matsapa Airport, but you may be able to book in advance from home.

The roads in Swaziland are generally very good; all routes between major towns are tarmac. Speed limit is 80kph on most roads, 60kph in urban areas and 100+kph on selected roads.
You will not need a 4WD vehicle out here unless you are extremely adventurous and plan to go far off the beaten track (even the Home-based care truck is only a 2WD)

Buses come in 2 varieties, the big buses (50+ passengers) that run the major routes according to (Swazi-Time) timetables, and combis. The combi is a cross between a bus and a taxi. They run set routes, but will pick-up drop off as required. They are modified minibuses that carry 15 people and go extremely fast. The driver gets paid by the number of runs he can do in a day, so the faster he goes, the more he gets paid!

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SiSwati and English are the official languages of the country. In the shops and businesses of the main towns, English is freely spoken. English is the language of commerce and, fortunately, of medicine. However, expect a huge language barrier, very few patients at GSH speak English (although some patients understand, but will not speak it). Relying on a translator can be difficult and frustrating. Many times you will treat a patient for an illness aware that you did not get the whole story.

Make an effort with SiSwati though; the nurses will love (or laugh at) a few well-practised SiSwati phrases. If you are seen to be making an effort, so will they.

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Malaria is a seasonal problem in Swaziland, starting in October/November finishing in June/July. All of the lowveld (the majority of the country) is affected. However Siteki is Malaria free, at an altitude of 650m it is never the right environment for the parasite to live (although we still get the mosquito, no malaria). If you plan to travel anywhere outside the Lubombo foothills then prophylaxis is a must. The parasite is almost exclusively Plasmodium falciparum (the nasty one) and Chloroquine resistance runs at 40%. Choroquine/Paludrin is not sufficient; you should be on Mefloquine (or analogues) or Doxycycline.

If you drink river water then expect cholera, dysentery, amoebiasis etc. and any standing fresh water has bilharzia. The hospital water is an isolated / treated supply and is safe. Most major eating establishments/game parks/hotels the water is also safe. (Simunye and Big Bend country club swimming pools are schistosome free!)

Tick bite fever is endemic; wear long trousers whilst hiking and tell someone if you get an unusual rash/fever.

If you plan to do any adventure sports, check your medical insurance. Rare that there is an injury with a well-organized business, but if you are injured, you DO NOT want to be treated for a serious head injury in Swaziland. Make sure you medical insurance will evacuate you to Johannesburg.

HIV- 60% of outpatients, and in excess of 90% of inpatient load are HIV positive. You will be at risk of HIV exposure if you do any procedure involving sharps. The hospital has an active post exposure prophylaxis policy (available on request), using AZT and 3TC in combination (CombivirTM). You may want to bring your own supply (28days recommended) if you are doing a surgical elective. The hospital has prophylaxis starter kits, but bringing your own will not hurt. I suggest that you check with your medical school, they may supply this for you, or they may have their own policy regarding this. For more information, you might want to look up the following site: http://bmj.com/cgi/reprint/325/7371/1010.pdf

Remember you are staying in a hospital; we have many drugs if you do fall ill. We do recommend having all of your immunizations up-to-date (including BCG), take malaria prophylaxis, bring HIV prophylaxis and use mosquito repellents, but don't worry too much about the other stuff - just be sensible.

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The currency is the Emalengani (E); current exchange rates can be found at Xe.com

The Emalengeni is fixed to the South Africa Rand (E1.00 = R0.995). For all day-to-day transactions, the Emalengeni and the Rand are used interchangeably in Swaziland (but not in South Africa). The Rand is in a high state of flux at the moment, so we have fixed some prices in dollars, although will accept any form of cash equivalent (not travellers' or personal cheques)

Accommodation - Please enquire
Education fee - Please enquire via email

We suggest that you bring some Rand as ready cash, but any other money as travellers' cheques. Travellers' cheques are a little bit of a problem; sometimes it can be difficult to get them changed in the Siteki banks. However, the bank in nearby Simunye, and all the banks in Manzini/Mbabane will change them for you (if you can get to a bank, they close at 1pm weekdays, and 11am Saturday). Credit card is widely accepted outside Siteki.

Payments are made via the Hospital Accountant; please ask for a receipt. Alternatively, you can pay directly into the hospital account. If you want to pay by direct transfer please contact the hospital for details.

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Q - What are electives really all about?
A - Having a good time. It is great to be in a rural hospital and do stuff, but an elective is about FUN.

Skip Kruger completely. Yes I know it is a big, famous game park.... etc.…etc…. yawn. It is however relatively expensive, organised for the tourist++ and even has real tarmac roads. For the full game/bush experience stick to Swaziland, you're only here for a short time, so use that time to see the country properly.

Do not get too hung up on seeing the 'Big Five'. There are plenty of other animal experiences so don't become a box ticker (oh look...Leopard - tick on sheet - what's next). If you spend all your time rushing around trying to see rare stuff you will miss out. I have yet to complete the big five (Leopard is a really elusive creature) but have had plenty of animal experiences. Swaziland does have the big five however; it is just that you will have to travel around a bit.

Lion - Hlane, Nisela
Leopard - Hlane
Black Rhino - Mkhaya
Elephant - Hlane
Buffalo - Mkhaya

Hlane is on our doorstep, Mkhaya 45minutes away, and Nisela 1hour. Also Mlawula, Milwane, Mantenga, Mbulozi, Shawula all worth a visit - no big game, but great walks etc. For more information check out http://www.biggame.co.sz

The Ezulwini Valley near Mbabane is worth a visit. This is the real tourist strip, full on "cultural" experiences. It is all a little bit tacky, but very definitely Africa. The Swazi Cultural Village you will receive a personalized tour of a homestead and learn a bit about the Swazi culture, you even get to see a Sangoma (witch doctor, even if a slightly watered down version)

Please note: this is a Catholic Mission Hospital. We will not arrange for you to see a traditional healer (Sangoma or Inyanga) as a lot of what they preach is in direct conflict with the Catholic Faith. If you want to see a real Sangoma you will have to arrange it for yourselves by talking to the local people.

If you ring the Swaziland High Commission / Embassy and tell them you are coming to Swaziland, they will inundate you with tourist information. If you're really enthusiastic they may send you a copy of the Jumbo Guide to Swaziland for free. This is the only guidebook worth having. (180 pages compared to only a 20page mention in the Southern Africa Rough Guide). Also can be ordered on from jumpub@iafrica.com.

Kwazulu Natal is easy access from Siteki, in a little over 2 hours you can get to St. Lucia wetlands, Cape Vidal, Hluhluwi / Umfolozi game park. Maputo is also worth a visit, but you will need an extra visa to get into Mozambique (this can be bought easily at the border).

Book flights etc before you come, but for holiday plans, leave a lot of the booking until you get here. It is easy to book things from Swaziland and you do want to be flexible...this is Africa.... stuff happens that you don't expect. You don't want to end up paying for a hotel that you never use.

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PROJECTS

The section on elective project is consigned to its rightful place, the bottom of this section. It should also be consigned to end of your list of priorities. Elective should be about the experience, not the work. Does your Med School insist on a project? Most project work is just an exercise, unnecessary, and in the future is not going to be read by anyone. (Oh I know that all projects are designed to make a DIFFERENCE, but take it from me - in the end they don't, so why bother) If you have to do a project keep it short and sweet, minimum input for optimum output... I used to grade projects when I was in the first world, believe me the important things are how well it is written up, not the content (I gave some great marks for projects with no definite results, but a great intro/conclusion/discussion)

I am sorry if this sounds a little negative, but this is real life. In the long run your project will not matter much. Don't get too hung up on it.

On the plus side, we will do all we can (with limited resources) to help out. Before you come out have a general idea of want you want to look into. Do not set all your project aims before you arrive. It is very difficult to work out the fine details by e-mail. You need to be here to see what info can be gathered. For most elective students we suggest that you collect data whilst on site, but leave analysis and report writing for your return. Enjoy your time here, don't bog yourself down with work, honestly the social life here will not leave you a lot of time to work in the evenings.

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