By Finian O´Malley.
Motivation: Why I Chose to Go Abroad
I have always been interested in global health. Stories of Médecins Sans Frontières first inspired me to pursue medicine, and I’ve long understood that working in countries with low doctor-to-patient ratios allows you to make a more meaningful difference.#My ophthalmology elective to Eswatini in 2021 was cancelled during COVID, but the idea stayed with me. Although I had not worked in Australia at that point (I have since), I already had a strong desire to experience medicine outside the cultural boundaries of the UK. With the British National Health Service (NHS) morale low post-COVID and during industrial action, I wanted perspective, challenge, and the chance to understand how other health systems function.
My goals were to learn more about ophthalmology, help where I could, and explore whether this could be the specialty for me.
Application and Registration
I already had an email relationship with the consultant from my originally planned elective. When I reached out again two years after graduating from medical school, he was incredibly supportive and even helped arranged my accommodation on his beautiful farm, which was peaceful, welcoming, and wonderfully close to the clinic.
Because I attended as an observer, I did not require medical registration or indemnity insurance. Doctors practising in the region register with the Eswatini Medical and Dental Council or the HPCSA in South Africa, but this was not necessary for my supervised role. I had standard travel insurance with medical cover in case of illness.
To find the placement initially, I used my university’s list of previous elective destinations. Other excellent methods include contacting NGO hospitals, global ophthalmology groups, mission hospitals, or consultants who regularly supervise electives. Word of mouth is invaluable.
Tasks and Working Conditions
I volunteered at the ophthalmology department for one month, plus an additional week with a visiting corneal transplant outreach team from the United States*. In addition, I spent time with the general surgical team at the local public hospital, who were extremely accommodating and taught me a lot about rural surgery.
As my role was always supervised I was not incorporated into the regular doctor roster, but was always with another, more senior doctor. My clinical interactions gave me opportunities to learn, however were more hands off than my day job back in England. I was there as an observer, not a fully registered doctor. In future I intend to return with enough clinical experience to be more independent, full medical registration and for a longer time, all of which will mean I could make a greater contribution to the team.
Across the placement, I attended busy ophthalmology clinics and theatre lists at both private and public institutions. My work included:
- observing and practising in slit-lamp examinations
- attending cataract theatre lists 10–15 cases daily
- helping with logistics, equipment, and patient flow
- joining a cataract outreach in the Kalahari, flying there in a tiny twin-propeller plane with the outreach team
The consultant taught throughout clinics, explaining findings as he examined each patient. The registrar, highly skilled after only two years, was an excellent teacher and guided me through the foundations of ophthalmology.
Theatre photos from the ophthalmology outreach. The surgeon would operate on
one patient while the next patient was prepped and draped on the table next to
them. This would maximise the surgeons actual operating time and minimise down time between operations. © Finian O´Malle
Working hours:
Generally, Monday–Friday, with long days during outreach.
Language:
Most patients spoke English; Mozambican patients who spoke Portuguese often brought family translators.
Team integration:
The team welcomed me completely. I saw firsthand how ophthalmologists there take on vast responsibilities outside clinical care; logistics, staffing, public health and financial management were all within the remit. Also, the importance of having a good team of optometrists, ophthalmic assistants, scrub nurses and administrators.
Workplace Description
Despite being remote, the ophthalmology service was well equipped thanks to sustained investment and the huge effort of the staff. The clinics had:
- slit lamps
- retinal imaging and optical coherence tomography
- ocular ultrasound
- YAG and other therapeutic lasers
- well-maintained, fully functional theatres and trained theatre staff
- Trained optometrists
Often challenges were logistical: medications, supply chains, patient travel distance, and unpredictable clinic volumes with no retinal surgeons easily available.
Patients came from all backgrounds. Many had advanced pathology such as cataracts, and a significant number travelled from Mozambique seeking high-quality, affordable care.
Me holding a snake during a venomous-species relocation. The man to my right and another volunteer helped catch a poisonous snake which was in someone’s house and relocate it to an unpopulated bit of land. All the credit must go to them, I just observed. © Finian O´Malley
Reflections and Lessons Learned
The placement taught me clinically, personally, and professionally. I learned the basics of ophthalmic examination, theatre flow, and rural outreach work. I tried to contribute where possible to the team with logistics, transport, and daily organisation, which helped me appreciate the hidden infrastructure behind patient care.
It also reinforced that returning in the future as a more experienced doctor, able to be more independent clinically would allow me to contribute in a deeper and more sustained way.
Working in Eswatini gave me a renewed appreciation for the NHS. Seeing clinicians manage heavy workloads and complex logistics with such dedication; highlighted strengths in our own system often taken for granted. Such as the ready availability of prescription medicines or specialists to refer to.
Beyond the medicine, I had an amazing time. I met inspiring patients, worked alongside dedicated doctors, and made friendships with local clinicians that I hope will last throughout my career. I had the chance to explore Southern Africa’s beautiful landscapes, go on numerous safaris, the world’s highest bungee jump, meet local people, and experience a culture that was warm, welcoming, and deeply memorable.
Me pretending to fly the small propeller plane used for the Kalahari outreach. The photo was taken mid-flight, however the pilot to my left was doing all the flying. © Finian O´Malley
Safari images- Pilanesberg National Park (elephants, rhinos). © Finian O´Malley
Cost table for 5 weeks
| Description | Price in £ |
|---|---|
| Accommodation per night (backpacking & private room) | 17 |
| Food and living costs | 5-10 per day |
| Sum 5 weeks | 750 |
| Return flight London – Johannesburg | 600-900 |
| Internal regional flights | 100 |
| Total | 1600 |
Local transport: very little public transport available, access to a car is very useful. I would highly recommend having a driving licence or being with someone who does, in order to get the most out of the trip.
Useful Links/ recommended reading
Two books I would recommend before any trip to South Africa would be:
An absolute classic, his story is central to modern South Africa, completely inspiring, well written and extremely moving. I am sad I never read it sooner, one of the best books I have ever read.
A South African comedian reflects on his childhood in South Africa. He was born to a black mother and a white father, an illegal inter-racial child born during apartheid. It is a poignant, well written introduction to the horrific racism common during this period. And Trevor Noah is an excellent storyteller. I would recommend this to anyone travelling to South Africa.
- “After an unrelenting year, stressed-out NHS staff deserve more than a clap”, By Rhiannon Lucy Cosslett. The Guardian
- Very useful website with lots of information on all things ophthalmology
- The world’s highest commercial bungy jump in the Cape of South Africa
- Kruger national Park– one of South Africa’s many amazing safari parks, it is roughly the same size as Belgium
* The mentioned U.S. institution comprises several organizational levels: the Global Ophthalmology Fellowship Program, a specialized postgraduate training program focusing on global eye care, is based at the Dean McGee Eye Institute in Oklahoma City. The institute is a nationally recognized center for ophthalmic research, education, and patient care and forms part of the University of Oklahoma Health Sciences Center, the medical campus of the University of Oklahoma, which brings together clinical practice, academic teaching, and biomedical research.
Contact
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Published in GI-Mail 01/26 (English edition), ISSN: 2312-0827, Going International, Vienna 2026
Author
Dr Finian O’Malley MBBS Currently working as a general surgery unaccredited registrar in Sydney, Australia Hoping to start Ophthalmology training back in the UK in August 2026
Citation
O’Malley, Finian: “Cataracts, Clinics and the Kalahari: A Clinical Observer Placement in Southern African Ophthalmology”
(In: Polak, G. [ed.]: GI-Mail 01/26, ISSN: 2312-0827, Going International, Vienna 2026)
This publication is available for download here.
Will be published in GI-Mail (Egnlish edition).
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