SAFFA in Irish EM – a retrospective

If you are reading this, you are likely a South African doctor newly on the emerald isle embarking on your maiden voyage into the HSE and Irish health system, or perhaps looking into the option.

Generally, we SAFFAs (South African Far From Africa) tend to be resilient and adaptable. And the prospect of moving for a post, is also well trodden ground. Nonetheless, moving internationally to start over in a new health system, with new people, new culture and new weather conditions, can be especially daunting.

I remember being nervous about taking on an EM post, despite the general proficiency most South African Docs have in basic EM by the end of their ComServe. I considered that most of my knowledge and experience in the South African ED’s tended to involve HIV, TB or the various related comorbidities. I was also doubtful whether my level of comfort with trauma cases (especially those related to interpersonal violence) would come into play very often, considering that Ireland is hailed as the 3rd safest country in the world as of 2023.

Regardless of your reasons for moving to Ireland, be it a temporary workaway or more permanent emigration, I believe some parts of the Irish experience to be universal. I have found the Irish people to be some of the friendliest and most welcoming folk I have ever encountered. There is an inherent kindness and joviality to be found in most circles, which makes the initial transition less jarring. Even when the weather reminds you how far you have travelled from the African sun, there is always craic to be had in the many pubs, restaurants and social gatherings – which bring a warmth to life here, contrary to what the weather is doing outside.

The Irish are even more enthusiastic about sporting events than South Africans (hard to believe, I know), and it is a joy to get into new sports with the locals, specifically the Gaelic games. Be sure to join the various SAFFA groups – you’ll find a large community of SAFFAs where-ever you may find yourself in Ireland. I was lucky enough to have a large part of my EM team be South African, which certainly softened the transition.

For the nature lovers – don’t fret; Ireland has a beautifully rich outdoors, and as the Irish saying goes; “there is no bad weather, only bad gear”. You have an abundance of safe, lush landscapes to explore, whether it be via hiking and mountaineering outings, rock climbing, kayaking/canoeing, cycling along the greenways or mountain biking trails, surfing or just exploring the many neolithic tombs scattered along the island; there is plenty to explore and do, as long as you have the right gear and prepare accordingly.

Back to the topic at hand. What is it like being a doctor in Ireland? How does the system differ? Is it easy to adjust? Career options?

The first few days (weeks even) might feel overwhelming as you adjust to the system and relearn things you might consider as basic. Outside of getting registered and comfortable using the various electronic systems (PACS, Maxims, blood results, blood gas machines etc.), you’ll find that basic procedures such as IV cannulation

and venepunture have extra steps (PDA labelling) and that the equipment itself differs slightly. I found that the best way to deal with this is by putting on your intern hat and asking about everything until you are comfortable.

One of the most obvious differences in the patient demographics is the ever-aging population that brings with it a host of geriatric presentations that you may not be as familiar with – I have had multiple patient’s who passed the 100 y/o mark, being brought in by their children no less. Most people have at least completed secondary school and you will often find patients (especially with minor complaints) having done research on their symptoms prior to presentation. Consultations are more person centred and less patriarchal than the practice which still prevails in some parts of SA.

There are some aspects of the health system that feels all too familiar; overcrowding, understaffing and bad press among the most prevalent, although I’ve found it to be to a lesser extent than the challenges faced in SA. Resources are abundant, and my South African heart still shudders every time I see things like “single use suture packs” etc.

Ask questions about everything and discuss as many of your patients as possible. It is the best way to learn the pathways and get to know what can and can’t be done at different levels of care. Emphasis is placed on evidence-based practice and protocols tend to be available readily. I have found less toxic hierarchy than was present in SA and that the SpR’s and Consultants are overall approachable and willing to assist, especially if you are keen to learn and show the necessary regard for the patient’s safety, first and foremost. Academics is encouraged and there is ample support available to help you get ready, should you wish to apply to training schemes or write RCEM exams. There is, of course, slight variation in this for facility to facility, but the overall rule rings true.

If EM is not the career path you envisage, or don’t envisage yet; you should be able to interview for other departments within the HSE once your contract concludes and transfer seamlessly.

I hope this was helpful and could ease some of the anxiety associated with the unknown. Welcome to beautiful Ireland. Hope you have a lekker time.

Written by Illona Roux
EM Registrar at University Hospital Limerick