𝐈𝐧 𝐃𝐞𝐟𝐞𝐧𝐬𝐞 𝐨𝐟 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐈𝐧𝐭𝐞𝐫𝐧𝐬: 𝐓𝐡𝐞 𝐇𝐞𝐚𝐫𝐭𝐛𝐞𝐚𝐭 𝐨𝐟 𝐎𝐮𝐫 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥𝐬

In South Sudan today, it is not uncommon to hear frustration expressed about Juba Teaching Hospital being “run by interns.” The assumption, often said in anger, is that this automatically means substandard care. But this view is both unfair and uninformed. Having walked the wards and lived this reality, I want to offer a different perspective, one grounded in lived experience and the wider truth of how health systems in our region function.

South Sudanese healthcare workers, whether in public hospitals, private facilities, or under NGOs, are among the least paid in the region. Ethiopia, too, struggles with poor pay, which is why so many of its best doctors migrate in search of greener pastures. What this translates to here at home is a survival economy of care. The doctors cannot rely on a public hospital salary alone. They work at Juba Teaching Hospital or any other public health facility to serve the less privileged, but they also rotate through private facilities where middle-class patients can pay, just to fill the gap left by meagre public income. The result is a schedule stretched across three or four workplaces a week. And yes, this means consultants and specialists may not always be physically present at the teaching hospital. Yet absence does not mean abandonment. Senior doctors ensure they are available for remote consultation, showing up when something beyond interns requires their physical presence, and the day-to-day running of wards is entrusted to medical officers and medical interns.

It is important to clarify who medical interns are. They are not random volunteers or students in training. They are already doctors. They are graduates holding a Bachelor of Medicine and Bachelor of Surgery, licensed temporarily by the South Sudan General Medical Council (SSGMC) to practice. By the time they step into internship, they have rotated across wards, performed procedures under supervision, and mastered the foundations of medicine. Internship exists precisely because medicine is a profession of practice as much as knowledge. The system assumes that, with a few days or weeks of close supervision, a medical intern can competently run a ward. And often, they do. Across Africa, interns are the unseen workforce keeping hospitals alive. Many people today owe their lives to an intern who could not skive a shift because their seniors required accountability, and so they stayed to resuscitate, stitch, prescribe, or simply hold the line until help arrived.

I say this not only as an observer but as one who has lived the life of a medical intern. During my internship in Kenya, I once ran an entire department for four weeks almost alone. The consultant and medical officer provided wonderful supervision and guidance, but they were not always present. It meant I was overstretched, which I would never recommend as a healthy norm, yet it proved beyond doubt that an intern can keep a department running. I also vividly recall a 36-hour stretch where I had to perform thirteen caesarean sections, with only the scrub nurse assisting me. As the intern on call, I had no excuses to hide behind. The mothers and babies could not wait, and I had to deliver care competently, decisively, and tirelessly. These experiences are not unique to me, they reflect what medical interns across Africa face daily. And so, when people dismiss interns, I cannot help but remind them that hospitals run because interns show up, endure, and deliver.

To dismiss medical interns as incapable is to erase the very backbone of healthcare in fragile systems. It is also to misunderstand how learning or teaching hospitals operate. Globally, teaching hospitals, from Nairobi to Kampala, Addis Ababa to Johannesburg, run on the shoulders of interns. Consultants guide, medical officers support, but it is the interns who do the daily grind that keeps patients alive. Yes, they are still learning. But learning in medicine is not an excuse for incompetence. Learning is the design of the profession itself and everyone in it learns until their last breath. The Hippocratic tradition expects every doctor to be sharpened in practice.

If there is outrage, let it not be about medical interns. Let it be about why we have forced a generation of doctors to become part-time workers in their own public hospitals. Let it be about the erosion of policies that once recognized internship as a paid, structured, and respected pathway. Let it be about corruption and uncaring leadership that budget less than 2% for health and then turn to blame the very health workers they underpay and overburden.

The real question is not whether medical interns are capable, they are. The question is how to create conditions that allow both interns and their seniors to thrive. That begins with fair pay and retention so that healthcare workers are not forced to scatter across multiple workplaces simply to survive. It also requires structured supervision, with consultants consistently incentivized to spend more time mentoring interns and guiding them in real time. Equally important is restoring value to internship itself, recognizing it as a paid, protected stage of professional growth rather than cheap labour to be exploited. And above all, the public must demand accountability from leadership: national budgets should reflect health as a priority, not as an afterthought.

So yes, Juba Teaching Hospital is run by medical interns. But that is not the scandal. The scandal is that we undervalue them, underpay them, and then scapegoat or shadowbox them when systemic neglect shows itself. If you walked the wards as I have, you would see a different truth. Interns are not a weakness of our health system; they are its heartbeat. And perhaps the wisest thing we can do is not to sneer at them, but to protect, equip, and honor them. For in their hands, quite literally, rests the future of medicine in South Sudan.