• Surviving Ophthalmology Residency in South Africa

    By Anesu Madikane, MBChB, FCSA, DipSA, MMed

    My home is often described as being the gateway into Africa. It is renowned for its picturesque landscapes, pristine beaches and incredible wildlife. But it is also a country of stark socioeconomic imbalances between the wealthy and poor, a country with a rich, yet troubled history.

    A Long and Arduous Road to Residency

    Residents are called registrars in South Africa. Most subspecialty training programs span four to five years. Becoming an ophthalmology resident is especially challenging because of limited trainee posts and the highly competitive nature of the field. 

    To qualify for residency, you must complete a six-year basic undergraduate medical degree. After that there is a mandatory requirement to work in a government hospital within the country for a minimum of three years. During the three years, newly qualified doctors work as general practitioners while rotating through all the major specialty disciplines for two years. 

    The final year is called community service, when junior doctors are often placed in a rural hospital. After this final year applicants can apply for a position as a trainee ophthalmologist at a training hospital affiliated with one of our major universities that offer postgraduate medical training. Sometimes junior doctors may not get a residency spot  immediately after completing their compulsory general practitioner years, so most of us then go on to work for a few more years before beginning residency. If you are lucky, you might secure a nontraining position in an ophthalmology department to begin getting some exposure to ophthalmology while waiting to get a training post.

    I began my residency at the end of 2016, 13 years after completing high school. I remember the day I got the confirmation of my residency position like it was yesterday. A literal dream come true!

    Collage of a few highlights of my residency.

    Ophthalmology Residency

    I arrived for my first day of residency training bright-eyed and bushy-tailed, ready to mesmerize my seniors with my vast amounts of knowledge (or so I thought), work super hard, and become a surgical prodigy in no time. Alas, these lofty aspirations were soon replaced with a large dose of reality. 

    Ophthalmology residency in South Africa involves long days in clinics that are overflowing with case after case of advanced diseases. Government hospital bureaucratic systems are overwhelmed with red tape, making an already challenging environment even more difficult for both doctor and patient. 

    However, it’s not all doom and gloom. There is a silver lining and rainbow of opportunity in our South African health care system. The socioeconomic inequalities in South Africa provide medical trainees with a unique combination of factors that make South Africa a wonderful place to be exposed to some of the most complex cases and an opportunity to provide care to some of South Africa's sickest patients. 

    We have access to some of the world’s best technologies. Most of our training hospitals are fully equipped with microscopes, phacoemulsification machines, and diagnostic tools that are equivalent to those that are available in the richest nations of the world.

    Our clinics see hundreds of patients daily depending on the size of the hospital and the city one might be training in. Surgical time is abundant since we have large numbers of people on waiting lists. The wait can span years with numbers running well into the hundreds awaiting surgery for cataract, retinal detachment repair, glaucoma and squint (strabismus) surgery. 

    Apart from day-to-day surgical and clinical work, residency also includes regular academic discussions and presentations. There are also three major exams that must be successfully completed during the course of the four- to five-year training and the completion of a research project in the form of a thesis dissertation and publication.

    After Residency

    After completing my academic requirements within four years, I am now a qualified ophthalmologist. I am two years post final fellowship exams and am navigating the wide world of ophthalmology practice in South Africa. I work part time in a government hospital two days a week and the other three days I am at a private practice, which I started four months ago with two other young ophthalmologists. I aspire to pursue a cornea and refractive surgery fellowship.

    Would I do it all over again? Yes, in a blink of an eye! Ophthalmology is the most rewarding career. The joy of restoring eyesight to someone who might not have otherwise been able to see is unparalleled. The long road to this point has proven to be worthwhile in more ways than I can describe.

    As I stand on the threshold of the rest of my life, I am grateful for the gift of education, and the skills I have acquired over the years. I look forward to many years of continued learning and pouring back into not just South Africa, but to the continent at large. I look forward to many trips abroad to learn from and connect with ophthalmologists around the world. But most importantly, I look forward to a lifetime of restoring sight.

    Anesu Madikane, MBChB, FCSA, DipSA, MMed About the author: Anesu Madikane, MBChB, FCSA, DipSA, MMed, is an ophthalmologist with an interest in outreach cataract surgery and cornea refractive surgery. She is the current and inaugural president of the African Ophthalmology Council’s Young Ophthalmologists. She previously served as vice president of the Ophthalmological Society of South Africa’s Young Ophthalmologists for 2021 and 2022. She is also a wife and mother of two energetic and entertaining girls, aged 6 and 4.