Week one

The days leading up to my departure are stressful and emotional. Stress is being created by the rhetoric I'm hearing about Johannesburg and the emotion is because this will be a very long time away from my family.

Even though there is an element of fear, I am also incredibly keen to gain what knowledge I can about how a hospital dealing with a large number of gunshot victims trains staff to provide the best possible care. But despite my apprehension, my objective is to return to Homerton Hospital with some good ideas about how to teach junior doctors to cope with an increase in gunshot and stabbing victims in London. Hackney is not Soweto by any stretch of the imagination, but going to Soweto will give me the chance to see how people are trained in treating similar injuries.

Chris Hani Baragwanath Hospital ("Bara" as they call it) is everything I had expected. Its size is daunting. At 3,200 beds it is much larger than any hospital I have seen before, and it covers an area into which you could fit a small English village. The catchment area is a conservative two and a half million, serving a population suffering from high poverty and unemployment and all the diseases associated with such conditions.

The medical workload is mind-blowing, not because of the disease processes at work, but because of the sheer number of them. I am used to a UK workload, but here it is 10 times greater. I have obviously chosen the right place to achieve the aims of my trip.

Week two

Traditional training here is designed to produce "general surgeons" who can deal with any part of the body in an emergency. In the UK, specialisa tion is a major requirement in coping with the workload. New style training in the UK creates a specialist at a much earlier stage in the learning curve, but may leave young consultants feeling vulnerable when dealing with trauma patients.

Penetrating injuries often affect the chest and/or abdomen. At Homerton, as in nearly all hospitals in the UK, such patients are "resuscitated" along the lines of a system called the advanced trauma life support. ATLS is a multi-disciplinary and systemic approach to saving life; once stabilised, the patient is then passed over to the surgeons for definitive treatment. In the majority of cases, time can be gained by application of the ATLS principles, but in about 10%, urgent surgery is required if the patient's life is to be saved.

Bara sees 350 trauma patients each month. Half of these are from traffic accidents, the others usually sustained because of gunshot wounds. As in the UK, the majority of penetrating injuries occur at the weekends.

Week three

I have been assigned to the professorial trauma unit at Bara. "Take" days (when the team is on call) usually start quietly enough, as the outgoing team tries to clear up from the night before. Most often, we are in theatre helping out during the morning, while other members of the team run the surgical "pit". At Homerton this is equivalent to our A&E department, but here the surgical patients in attendance are seen directly by the surgical team on call, and not the A&E staff.

After theatre, lunch and sleep are the priorities, as the main trauma workload comes in at night. At Homerton two major trauma cases a night will keep you busy, but at Bara two arrive before 10pm. By the time you leave the operating theatres with the first two, there are 10 more waiting for surgery. There are just not enough doctors, nurses or other health professionals to cope with this workload, but the few who are here manage to keep their sense of humour. Each night is like a major incident procedure at Homerton.

After my first few takes, I attend the definitive trauma surgery course at Witswatersrand University Hospital. This is aimed at training surgeons in how to cope with penetrating trauma, as well as a massive workload. It has been designed along the lines of ATLS in that priority setting and life-saving procedures come first, with more advanced surgical techniques taking place during a second-look operation.

This is an approach not commonly practised at Homerton, but the concept of saving life first, stabilising the patient in the intensive care unit and reoperating 12 hours later is very sound. Army surgeons are trained on the same lines. Without applying these principles surgeons can be operating on one patient for far too long, while others are waiting for their skills.

Week four

Equipped with my new approach to the management of trauma patients I can, at last, be of some benefit to Bara in dealing with the vast trauma workload. This will prove to be beneficial to both myself and Bara as April is school holiday time in South Africa, so all surgical teams will find themselves short-handed during this time.

The lessons learned, including not over-operating in the first instance, make handling the workload easier.

Bara is undergoing a period of refurbishment which results in ward closures. This further increases the bed occupancy rate to well over 100%. It also means that "routine" surgery has been minimised. This is a blessing as it gives us time for a small recovery period before the next "take". How the permanent staff cope with this never-ending workload is a mystery to me, as I'm physically and emotionally exhausted at the end of one month.

Week five

The more I am able to relax into the workload, the more I am able to cope with it. The team has now accepted me and will seek out my advice, as well as laugh at me when things go wrong. With the easing of time, I am able to reflect on what I am seeing.

South Africa is a beautiful country with a great diversity, but working at Bara could never be considered a hol iday. It is nice to get away at weekends to see this wonderful land, but relaxation is hard when there is no one to share it with. I realise that, despite all the kindness and friendship given to me, I am homesick. I am also unable to detach myself from some of the patients we have treated and I am making the mistake of becoming emotionally involved.

My original task was clear: would I be able to transport the lessons I had been taught in Bara back to Homerton? Despite the massive differences between Soweto and Hackney, where are the similarities that could be explored in the world of trauma medicine? I know that in my remaining time here I must talk with the professor of trauma, who has worked in London, to ask his advice as to the best way to pass on to my colleagues at Homerton a sound, workable approach.

Week six

This is my last week at Bara. My last "take" night is quiet until 1am, when what has become the "usual" occurs. A man has just been admitted with a gunshot wound to his foot. Just as I am examining him, three other men arrive in the resuscitation area having been shot in the chest and abdomen. At Homerton we have a trauma team made up of surgeons, consultants and anaesthetists. This team resuscitates and stabilises a patient along a given set of guidelines. This is not the case in Bara. All resuscitation is performed by the surgical team itself, including attaching breathing tubes. In the UK this is a skill perfected by anaesthetists who do this safely and who are also very good at it. Putting breathing tubes into a conscious patient is difficult even in the most skilled hands, but in Bara it is performed by the surgeons. In two of these patients, putting the tubes in was only possible by anaesthetising the patients: a decision I had to make.

Once resuscitated, the patients are taken to theatre for surgery. On returning to the surgical pit, there are two more abdominal shootings waiting. By the time the night ends, our exhausted team has worked 24 hours without sleep. The man with the gunshot foot is still sitting there when I leave. His was only a minor wound. It seems to me now that in becoming acclimatised to the sheer volume of work, I have simultaneously become depersonalised.

Yes, I have learned a great deal about the management of trauma patients, but Homerton does not have this volume of work and it is still able to provide a personalised approach to the treatment of all patients.

An integrated, multidisciplinary team approach is how trauma is dealt with at Homerton, but here at Bara, the workload is so high and the staffing so low that the same practice cannot possibly apply.

There are many lessons I have learned here, but the colossal amount of work undoubtedly forced me to depersonalise. It is time to go home.

· All NHS trusts have charitable fund accounts, which means that you can make a donation towards improving facilities and buying equipment. If you would like to offer your support to Homerton University Hospital, please contact Shahzaman Uddin on 020 8510 5106.