Alastair McAlpine is a fellow in paediatric infectious diseases at BC Children's Hospital in Vancouver
People sometimes ask me, "What’s the difference between medicine in Vancouver and medicine in Cape Town?" The answer is, quite simply, Everything.
But let’s rewind a bit. In July of this year, I flew the 20 or so hours it takes to get from South Africa to Vancouver. I arrived in the city by myself with 2 suitcases, knowing hardly a soul, and feeling completely overwhelmed. A few months earlier, I had been accepted into a 2 year paediatric (even the spelling is different) infectious diseases program at BC Children’s Hospital. Before coming I had filled out endless paperwork, done a million online courses - including learning what to do in the event of an earthquake ("I didn’t know those were a thing in Canada", I remember telling my friends) - and completed an interactive module which told me earnestly that in the event of a fire, patients on the 5th floor of the hospital should not be evacuated through the windows.
On arrival in Vancouver I immediately noticed that the general language Canadians employ is quite different from South African English. I nearly lost my apartment when I casually remarked to my landlord that a sunny spot in one room would be a good spot for a ‘pot plant’.
‘No no no!’ he exclaimed, ‘I cannot permit that sort of illicit behaviour in this building! This is a reputable area!’ When asked what, exactly, was so problematic about an hydrangea in an apartment, he paused and then said, ‘You don’t mean marijuana?’ First lesson learnt: there’s a BIG difference between a potted plant and a pot plant in Canada.
Bathrooms are ‘washrooms’, whether they contain a shower or not. Beanies are ‘toques’. Dustbins are ‘trash cans’. Cubby holes are ‘glove compartments’. Electricity is ‘hydro’. ‘Ice hockey’ is ‘hockey’, and I get laughed at when I ask if the Canucks are in with a chance of winning the Stanley Cup.
Eventually, I arrived at BC Children’s, which emerged from the skyline like a benevolent mother-hen. Its name is perhaps the only anodyne thing about it: inside are gleaming corridors, talking lifts (sorry, ‘elevators’), tranquility gardens, individual rooms for every patient, wards named after animals, and a maze-like structure that would have confounded Houdini.
The medical hierarchies here are also so different. In South Africa, undergraduate medical training is usually a run-through 6 years, followed by a 2 year internship program, then 1 year of rural community service, then any number of years as a ‘medical officer’ or ‘senior house officer’, before you’re accepted into a speciality program, at which point you become a ‘registrar’ (the equivalent of a resident here). Registrar training takes 4 years, after which you become a ‘consultant’ (‘attending’ here). If you wish to super-specialise, you will become a ‘senior registrar’ (‘fellow’ here).
Practically, what this means is that, in South Africa, someone who wishes to specialize has usually been a practicing doctor for at least 4 years, and often has at least 18 months’ experience in a particular field before starting as a registrar. It was therefore interesting to me to see that first and second-year residents in Canada are the equivalent of interns back home, except that instead of rotating through all the different disciplines, they just do their chosen one. I have wondered if this is a good idea or not, but that is a topic for another day.
The Canadian system results in 2 things: residents who are often fairly inexperienced, which puts a lot of responsibility on the shoulders of attendings. And a system that is attending-driven. This is in contrast to home, where attendings (consultants) provide a supporting role to a system overseen largely by fairly experienced residents.
Because South Africa is relatively poor and has a shortage of doctors, the local system aims to produce ‘all-rounders’ – doctors who can manage just about anything that comes their way (because it is not inconceivable that you could be the only doctor covering the entire emergency area of a rural hospital). Canada has enough professionals that it can afford to train them all to be heavily specialized. Consequently, when I told my Canadian paediatrician colleagues that I was quite comfortable performing my own Caesarean Sections, as I had had to do 34 on my own during my internship, they nearly fell over. I told them I could also do appendicectomies (‘What’s that? Oh! You mean an appendectomy, or appy!’), general and spinal anaesthesia, and was extremely comfortable with chest drains and central line insertions. This provoked low whistles and shaken heads.
Another unique sight met my eyes as I looked around BC Children's: empty beds! Back home, beds are incredibly prized possessions. Desperate registrars spend hours phoning the wards in the hospital begging, pleading and cajoling for somewhere to send a seriously ill child. ICU is constantly overflowing, and as a result, it is quite commonplace to see patients in the general wards on CPAP and inotropes. Here, general wards are often filled with relatively well-looking kids. Not only is the burden of disease lower, but the severity is, too.
So I’m here for a while longer, and I haven’t even begun to scratch the surface of how (you guessed it) different everything in Canada is. But one thing is for sure: although it’s not perfect (no hospital is), the kids of Vancouver are extremely lucky to have such an excellent hospital as BC Children’s, filled with caring, knowledgeable and competent staff. I’m really looking forward to working here.
Now, where did I leave my toque?