Author: Associate Professor Victor Kong, MD, PhD, ChM, MSc, DRCPSC, MRCS, FRACS, Trauma surgeon, Auckland City Hospital

The Chris Hani Baragwanath Academic Hospital (CHBAH or Bara) in Johannesburg is located in Soweto—a home for nearly 1.8 million South Africans. It is an urban settlement or township, just southwest of Johannesburg. Soweto is in fact, an acronym for ‘South West Townships’ and, historically, was the place where many came from out-of-town to work in Johannesburg. 

Working at Bara provides an intense snapshot of the social problems that come with living in Soweto. However, in many ways, focusing only on social problems offers an unfair representation of everything ordinary citizens living in Soweto experience from day-to-day.  

Massive surges of trauma volume are regularly seen at Bara on what is known as ‘payday weekend’. Injuries sustained by violence are often fuelled by the purchase of alcohol, and ‘payday weekend’ creates a bomb of violence, which explodes over and over again, until all its energy dissipates. The trauma unit must deal with the aftermath of this. Often, it felt as if we are dealing with a mass casualty event on a regular basis. Victims of stabbings and shootings frequently present at Bara, andassaults are perpetrated using an almost endless variety of weapons, including rocks, sticks, metal pipes, sjambok (a type of whip), and panga (a machete)—just to name a few. 

I have seen patients beaten beyond all recognition, and those who have been left for dead in the middle of the night out in the cold. I remember one young woman who had been attacked with a panga, which had been used to hack her across the middle of the face. She had blood and tears streaming down her face under the bandages. I will never forget the sound of her uncontrollable wailing, which faded into the background among the sounds of the cries of other equally traumatised patients in the ‘pit’ (the triage area). I also remember one man in his 30s who had been stabbed multiple times when he refused to hand over his wallet—he had only 20 Rand with him (less than a pound), which could not even buy a cup of tea. 

Another patient I remember was a young man who had been stabbed in his chest. He had sustained a sizable haemothorax that required a chest tube. He was stoic and appeared to have accepted the fact that this was the most appropriate treatment. When the registrar explained the indications and risks of the procedure, the patient half-jokingly commented that he knew all about ‘chest drains’, before taking off this T-shirt to show us two scars on the left side of his chest. The patient told me that one was from a previous stab wound he had sustained several months ago, and the other scar had been made by a chest drain during the same admission. All the while he was nonchalant about the whole affair and simply wanted it to be over and done with. Basically, he just wanted to go home. 

Into the night, variations of the same stories shared by the patients begin to slowly merge into one. Nevertheless, my duty remains the same. As a surgeon, I endeavour to provide the best possible care irrespective of what stories are being told, and how unbelievable they may seem. What I am certain of is that none of these people want to be in hospital out of choice. 

Operating through the night

Returning to work in South Africa, and especially working at Bara, re-opened my eyes, and offered perspectives I never realised I had. It took the meaning of ‘resilience’ to a whole new level. It inspired me beyond what I could imagine. I would always keep in mind my aspiration to continue working as a trauma surgeon—this was and still is my passion. Whenever I caught a glimpse of the beautiful sunrise of Soweto through the cracked windows of the hospital, I would recall a quote from Great Expectations by Charles Dickens I had memorised from childhood, ‘Have a heart that never hardens, a temper that never tries, and a touch that never hurts.'

Assessing a patient