March 28, 2012
Article by Global Pre-Meds
Hospital doctor shadowing & global health experience programs.
My experiences of medical work experience abroad. I first applied to medical school aged 17. Despite having 3 conditional offers from universities, I had itchy feet. I decided to turn down my offers and take a gap year. I’d always wanted to go to Africa, and this seemed like a great opportunity to gain some medical experience abroad too. Through a family friend I made contact with the lead doctor at a small 75-bed hospital in rural Cameroon. I arranged a two week placement, shadowing the three doctors, looking after the people living and working on a plantation near to Douala.
It was my first time away from home alone, and despite my bravado, I was pretty nervous. The culture shock of leaving Manchester airport one day and the next day being the only white person at a tiny hospital in rural Africa was mighty. I didn’t really know much at all about medicine and I didn’t speak great French. Initially I found it difficult to adjust; the intense heat, the poverty and lack of equipment, the degree of ill-health and the sheer number of people queuing up in the waiting room. I wasn’t really sure what I’d been expecting. Truthfully, I don’t think I’d given it much thought. I must have looked shell-shocked.
I spent my days shadowing the doctors on their medical and surgical ward rounds. I observed in theatre with the surgeon, who allowed me to ‘scrub in’ and assist by holding various pieces of equipment for him. I visited some of the clinics situated in the village ‘camps’ – a bit like very basic GP surgeries staffed by a specialist nurse. I helped the nurse in the mobile immunisation clinics for babies and infants.
On returning from Cameroon, I applied to a large gap year project operator for a four month medical placement in a government district hospital in southern Ghana. There were about six other students out there with me and we were living with host families nearby.
Whilst there, I saw patients with medical problems common to the UK such as ischaemic heart disease, cerebrovascular disease and diabetes. I also saw plenty of tropical conditions including malaria, leishmaniasis and parasitic illness. In many cases, the diseases were at a much more advanced stage than you would expect to see in the UK. Patients typically presented late due to having first consulted a local ‘witch doctor’ or from a lack of funds for medical care.
The obstetrics and gynaecology ward was an incredibly busy place. A lack of beds forced some women to give birth on chairs in the corridor. I assisted the midwives with vaginal deliveries and the doctors with caesarean sections. I also had the chance to sit in with the specialist nurses running the HIV testing and counselling sessions.
In additional to the great hospital experience, I also had an unforgettable time outside of the hospital. At the weekends we made the most of our free time with mini trips around the country. We visited amazing beaches, camped under the stars in the rainforest and went shopping at huge bustling markets. Most of us also had a little time at the end of our placement to travel further afield. The unusual circumstances and the intense shared experiences meant that we made firm friendships very quickly. I met some brilliant people, most of whom I’m still in touch with eight years later.
I started studying medicine at Edinburgh University in 2003. I travelled during my first few long summer holidays, most memorably to Venezuela where a friend and I spent six weeks in rural health clinics in the Gran Sabana region. It took twelve hours by a series of buses to reach the first clinic from Caracas. It was staffed by a recently qualified Venezuelan junior doctor and a couple of nurses. They had a telemedicine link, allowing the junior doctor to get advice from the city hospital via video conferencing. Sometimes, this was still not enough. There were no inpatient beds, so on one occasion when a young child presented very unwell with suspected meningitis we had to speed them by jeep to the nearest hospital on the Colombian border. The fact that this happened during a thunderstorm in the middle of the night made it all the more dramatic.
The second clinic was accessible only by light aircraft. It had to make a special stop to drop us off and I’ve not been anywhere more remote in my life. We took part in an outreach programme, hiking on foot through savannah, jungle and crossing rivers to a small isolated tribal village to set up an immunisation clinic in the church. We also administered anti-parasite medication for people with tapeworm infections and collected stool samples for a parasite prevalence study being conducted by the local doctor.
A highlight of the last year at medical school is the elective placement. I chose to go to the main government hospital in Belize City. I enjoyed attending the twice weekly consultant-led ward rounds on the medical and surgical wards. There was a wide spectrum of pathology, including cardiomyopathy, tuberculosis, snake bites and AIDS-related disease. In the outpatient clinics, I had the opportunity to first see patients on my own before presenting them to the doctors. Once I’d found my feet, I based myself in the A&E department. The department was at its busiest on night shift. I saw many acute trauma cases including gunshot and machete injuries and the doctors kindly took the time to teach me suturing and plastering, even some simple surgical procedures.
What I’m doing now
Now I’ve finished Foundation Training in South East Scotland, I’m off to New Zealand for a year to work in A&E and Obstetrics and Gynaecology. When I come back I hope to study for the Diploma of Tropical Health and Hygiene in Liverpool. I also hope to develop my interest in expedition and wilderness medicine by volunteering as team Medic in the near future.
Why should you consider medical work experience abroad?
Motivations for applying for medical placements abroad are usually mixed. For most, the excitement of travel to exotic destinations is a big draw. You might have a certain country in mind or be seeking a particular cultural experience. You might be keen to see diseases which are rarely, if ever, seen in the UK. You might be looking for an insight into the practice of medicine in a resource-poor setting. Perhaps your aim is to show universities that you’ve sought out opportunities to consolidate and demonstrate your motivation to study medicine? You might even have been thinking about working or volunteering abroad later on in your medical career and want to test yourself in a developing country.
Personally, medical work experience and volunteering abroad appealed to my sense of adventure. I have always enjoyed a challenge and relished the chance to experience countries in a different way to the traditional tourist. It has been a great opportunity to develop my medical skills, while adding some interesting and unique points to my CV.
What did I gain from it?
I cannot emphasise enough how much I’ve gained from my medical work experience abroad, both personally and in terms of my professional development.
I’ve experienced some incredible and little-visited parts of the world. I’ve met some inspiring doctors, working in incredibly tough circumstances. I’ve seen pathologies I’d only previously seen in text books. It’s inspired me to consider exciting work opportunities abroad later on in my career.
That said, witnessing developing world medicine as a westerner can be frustrating and is often distressing. The imbalance between the extraordinary demand for healthcare and the stark lack of resources makes it easy to become demoralised. I have a huge appreciation of how lucky we are in the UK to have a national health service, providing free well-resourced care for all.
How did I use my experiences at applications and interviews?
Medical schools were very keen to discuss my medical work experience abroad at interview. In particular, my reflections on what I had learned from the experiences. They invited me to draw comparisons and contrasts from my time abroad to the healthcare system and burden of disease in the UK. Even in my final exam at medical school, one question was ‘tell me about your elective!’. It was a brilliant opportunity to wax lyrical about my time in Belize.
Why choose Gap Medics, rather than a generic gap year operator?
Gap Medics is unique in that it specialises in organising clinical hospital placements for would-be medics. In particular, placements that structured, supervised and ethical. No student should be in a position where they feel they are being asked to act outwith their capabilities. With Gap Medics, you are allocated a clinical mentor to guide you on the wards and create a safe, enjoyable learning environment. These mentors are paid a fee for their services, which means that Gap Medics is investing in the hospitals and their staff, rather than placing a burden on already strained resources.