Pediatrics clinical experience in South Africa

Emma McCrady, a pediatric resident at UBC, spent three months completing a general pediatrics elective at Paarl Hospital in South Africa’s Western Cape.

"From April to June 2025, I had the privilege of completing a three-month global health elective at Paarl Hospital, a community pediatric hospital in the Western Cape of South Africa. This experience was transformative for both my clinical skills and broader understanding of healthcare delivery in a resource-limited  setting.

My clinical responsibilities primarily involved caring for general pediatric inpatients and neonates in a level 2 NICU. From day one, I was immersed in a high-acuity, hands-on environment that pushed me to grow rapidly in my procedural skills. I gained extensive experience in IV insertions, lumbar punctures, neonatal and pediatric intubations, fine needle aspirations, pleural

taps, chest tube insertions, and phlebotomy. What stood out was the creativity required to adapt to clinical resources available: whether that meant using adult-size equipment modified for small children, conserving supplies through reuse and sterilization, or learning to complete a diagnostic workup without extensive imaging or lab testing.

My clinical responsibilities primarily involved caring for general pediatric inpatients and neonates in a level 2 NICU. From day one, I was immersed in a high-acuity, hands-on environment that pushed me to grow rapidly in my procedural skills. I gained extensive experience in IV insertions, lumbar punctures, neonatal and pediatric intubations, fine needle aspirations, pleural taps, chest tube insertions, and phlebotomy. What stood out was the creativity required to adapt to clinical resources available: whether that meant using adult-size equipment modified for small children, conserving supplies through reuse and sterilization, or learning to complete a diagnostic workup without extensive imaging or lab testing.

The emphasis on clinical reasoning and physical exam skills was also impactful. In the absence of ready access to advanced diagnostics or in house subspecialists, I learned to lean heavily on history, physical findings, and clinical gestalt. I became more confident in interpreting X-rays, blood gases, ECGs, and EEGs — often in real-time and with limited access to formal reads. I also learned how to titrate and trouble shoot respiratory support independently in both the NICU and pediatric wards – equipment which is typically managed by our RTs at BCCH.

The realities of working in a health system under strain is something that I will carry with me from this elective, and my respect for the Paarl team is immense.  During critical moments like pediatric resuscitations, equipment like the hospital’s pediatric ventilator had to be physically transported between departments. At one point, the NICU’s cooling machine for infants with hypoxic-ischemic encephalopathy was out of service, requiring us to outsource those cases to the tertiary center under significant time pressure. Even when functioning, the cooling capacity was limited to one infant at a time — requiring ethical, clinical decision-making around resource allocation. Lab sheets were marked with the cost of each test to remind providers to be judicious with testing. These challenges underscored the importance of resilience, resourcefulness, and team-based problem solving.

This elective also provided the opportunity to manage pathologies that have been less prevalent in my training thus far, including pediatric HIV, tuberculosis, severe acute malnutrition, and severe cases of acute gastroenteritis. These cases challenged my differential diagnoses, broadened my clinical exposure, and strengthened my confidence in treating conditions I had minimal exposure to. In an increasingly globalized health care system, I feel fortunate to have been able to learn from local experts and will carry this knowledge forward to future cases at home.

Despite the differences, I found striking parallels to my work back here in British Columbia. The hospital in Paarl serves a large catchment area with diverse geography, echoing the realities of rural pediatric care in Canada. We navigated the same clinical decisions around when to refer, when to manage locally, and how and when to involve subspecialists who are not physically present. The burden of transport logistics, patient follow-up, and resource allocation were also familiar — reminding me that health system challenges transcend borders.

I wouldn’t have had the same experience without the amazing team at Paarl Hospital. The doctors, nurses, and allied health staff were kind, welcoming, and truly supported my learning. They patiently guided me through unfamiliar protocols and systems, celebrated my clinical progress, and created space for me to shape my experience around my personal goals. I felt embraced as a valued member of the team, encouraged to push myself, and supported when I struggled. Managing procedures, interpreting investigations, and making complex decisions under stress made me feel more like a doctor than I ever had. The collegiality and mentorship I experienced in Paarl will stay with me for the rest of my career.

This elective affirmed my passion for global child health and commitment to working with underserved populations — whether at home or abroad. The skills I gained in acute care, resourceful decision-making, and culturally responsive communication will serve as a strong foundation for my future career in Pediatric Emergency Medicine. I am grateful to the Institute for Global Health for the support in making this elective possible, and I look forward to working together in years to come so that more pediatric residents can benefit from this formative experience."