Author: Dr Victor Kong, MD, PhD, ChM, MSc, DRCPSC, MRCS, FRACS, Trauma surgeon

Pursuing a passion
This is what dreams are made of—the relentless pursuit of a passion, transforming desires into action, and continuing on that journey no matter what. I discovered my passion many years ago. I had always wanted to be a trauma surgeon, but did not discover the exact trajectory of my dream until I arrived in South Africa, when I decided to specialise in trauma surgery.

Entrance of the hospital

A life-changing experience
My time spent in South Africa during the formative years of my career continue to influence my clinical practice. After completing my specialist surgical training, I returned to South Africa, working at the Chris Hani Baragwanath Hospital in Johannesburg (affectionately known as Bara). While there, I began to diarise my personal experiences and reflections, and from my diaries I penned a series of articles, which are collected together here—Letters from Johannesburg. However, no amount of ‘letters’ I wrote could ever do justice to the richness of the professional and personal encounters I experienced living and working in this part of the world.

Chris Hani Baragwanath Academic Hospital
The Chris Hani Baragwanath Academic Hospital (CHBAH) is located in Soweto and is the third largest hospital in the world, spanning 173 acres, and has approximately 3200 beds. It is a major teaching hospital, affiliated to the University of the Witwatersrand, and is responsible for training healthcare professionals. The name ‘Baragwanath’ originated from John Albert Baragwanath, a Cornish immigrant, who set up a refreshment post in the area now known as Soweto. The word ‘Baragwanath’ derives from the Welsh word ‘Bara’ (meaning bread), and ‘gwanath’ (meaning wheat). The land on which the hospital stands was initially purchased by the British government in the 1940s, and the first hospital built there was called The Imperial Military Hospital.

Successive changes in the political landscape of South Africa resulted in the establishment of a civilian hospital, now known colloquially as Bara.

The Pit

The trauma centre at Bara
The trauma centre at the hospital is one of the busiest in the world, and, over the years, has become an urban legend in itself. Annually, more than 5000 priority one (severely injured) patients are treated in the resuscitation room. It manages massive volumes of penetrating injuries, with an equal split (50 per cent) between penetrating and blunt mechanisms. Gunshot wounds (GSWs) alone account for more than one-third of all penetrating injuries treated in the trauma centre at Bara. So, it is no surprise that generations of doctors from almost every corner of the world who wish to specialise in trauma surgery come to train there.

The receiving area of the trauma centre is known as the ‘the pit’, where patients are assessed and triaged. This area comprises 11 examination cubicles. The triage area is located between the resuscitation room and the examination cubicles and can accommodate up to 40 patients. Those who require immediate treatment are brought into the resuscitation room, which comprises 16 resuscitation bays. CT scanners are located 50 meters from the resuscitation room. Three dedicated operating theatres are available 24/7 and are located 30 meters away from the resuscitation area. There are 56 beds in the trauma ward, including four high dependency beds, and eight ICU beds.

On-call trauma surgeons are on site, and doctors of various training grades (including medical students) are assigned to specific areas. At Bara, I worked with doctors from all over the world, from diverse backgrounds and specialties, including general surgery, emergency medicine, anaesthesia, critical care, etc.
No two days are the same in the trauma centre at Bara, because anything and everything trauma related can and does happen. However, one constant is the feeling of being in a massive casualty situation, where injured patients pour through the doors.

A day in my life working at Bara
It is my first day walking past the ‘the pit’ and it conjures up an idea of what it must have been like at the Battle of the Somme. It is surreal. Patients arrive with stab wounds, gunshot wounds, and who have been assaulted or involved in car crashes—are all there. In the resuscitation room, the bay always seems to be full. It feels as if another patient is being brought into the next bay even before I have the chance to blink. The first patient I operate on is unstable with thoracic stab wounds and requires a thoracotomy for major lung injury. Operations, that follow involve performing laparotomies for stab wounds and gunshot wounds (including on patients with a history of previous laparotomy—also for GSWs). The last operation on my first day at the hospital is the exploration of peripheral vascular injury from a stab wound. All this happens within 24 hours.

The resuscitation room

The Pit
I begin to see that everyone in the unit—medical students, house officers, registrars and consultants alike—work extremely hard round the clock, providing exceptional patient care, with incredibly good outcomes. The level of dedication to patient care, the resilience and the tenacity shown in managing such a massive volume of trauma on a daily basis, is truly exemplary. The trauma surgeons are extremely experienced, and are generous in sharing their knowledge, as well as operative decision-making processes, and technical tips and tricks. They draw on years of experience. What a real privilege to be working with such an amazing team at Bara.  

Dr Victor Kong in the OT with Dr Yuma Takeuchi from Japan (visiting surgeon) and Dr Hevashan Moodley (senior registrar)

My special place
South Africa is a special place for me. It always has been, and it will always have a special place in my heart. ‘Bara’ is phenomenal place to work, and I recall my time there as exciting, stimulating, challenging, and frustrating—all at the same time. At Bara, I was exactly where I wanted to be. This was not my first time working in South Africa, and the learning never ceased. Indeed, the more I learned about trauma, the more I felt I needed to learn, and the more I wanted to learn. Being there truly felt as if I was on a journey in the pursuit of a dream, one which I have always held dear.