One thirteen year-old girl fortunate to receive extensive multi-disciplinary treatment as an inpatient had psychotic symptoms, low self esteem, obsessional traits, self harm, mood disorder and dissociative symptoms, with a long history of sexual abuse and inconsistent parenting. While her home environment was unsafe, she spent her weekends there and often returned with much of her progress undone after two days in the township. Poems she wrote about the abuse she had suffered provided a small insight into some of the trauma experienced at such a young age. The team worked tirelessly with her challenging behaviour, to support her as she went through puberty and tried to cope with her childhood past – though still a child.  Ultimately though, she was to be discharged back into a violent, risky home environment – since there were so many boys and girls just like her, in grave need of one of the few inpatient beds available. The team did amazing work with her, but it really was the tip of the iceberg. The ability of the CAMHS team to work non-judgementally with parents with as many social and psychiatric problems as their children was truly powerful to watch.  

My elective experience was one of contrasting frustration, sadness and regret, with inspiration and even hope. I could leave each day thinking how much more could be done with just a little more – another psychiatrist, another clinic, a little more funding for a few more psychiatric medications or psychological therapies. Or I could leave thinking how much was achieved with so little, how life-changing the treatment in the face of such unimaginable deprivation, suffering and trauma.

Even on a more optimistic day, there was no denying the sheer magnitude of inequality and plain unfairness of life in Cape Town – and the Western Cape is the country’s most prosperous province. How, as a doctor, do you get up each day and go to work in this context? The 19^th century French quotation adopted as Valkenberg Hospital’s motto stays with me, as I approach the start of my medical career, in the magnificently privileged NHS environment. Sometimes to cure, often to relieve, always to comfort.