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Have you ever been away on a medical placement and felt completely out of your depth? Rebecca Hope did and helped to devise and write an advisory elective pack for medical students
Every
year thousands of medical students leave the cosy berth of their
medical school to go on elective. Many of them travel to developing
countries, for various reasons - the chance to experience another
culture, to gain clinical knowledge of unfamiliar conditions, to try
out a career overseas, or simply to experience a change of scenery.
Some of you will be planning your elective right now or will have just
returned to medical school with a fetching suntan and a sackful of
memories. And perhaps with some questions about what you have
experienced.
SIPA/REX Not being able to help really got Rebecca's goat
How well prepared are we when we set
off on electives? Some of us will have already travelled or worked
abroad on gap years or long vacations. For others, it may be their
first venture overseas. I embarked on such a trip to Nepal after my
second year of medicine with a smattering of clinical skills and plenty
of confidence that I would be able to do some good by volunteering in a
rural health post. I was woefully unprepared for what I would face. I
spent my first day in a state of bewilderment, bombarded by strange
smells and sights in monsoon time Nepal and more than a little
linguistically challenged. The staff laughed at me for my fear of
leeches. Any upset I might have felt was overshadowed by my dismay at
the overstretched facilities and outdated equipment. Queues of poor and
usually illiterate people stretched out of the health centre, and the
limited drugs available in the medicine shop were priced out of reach
of many of them. I felt hopelessly out of my depth. But worse was yet
to come.
The next evening I was
drinking tea outside the medicine shop when a man arrived with his wife
who was semiconscious on the back of his bicycle. She was sweating,
confused, and acutely unwell. The shop owner asked me to help him. The
health post was closed. I would like to say I knew exactly what to do.
In fact I admitted that I was not able to help this woman and
recommended that they contact a doctor. The only doctor available was
private, at a price, as the town had no government doctor. Her husband
set off on his bicycle; I do not know if he was able to afford to pay
for effective treatment for his wife or if she recovered. The next day
I contacted the voluntary organisation for which I was working. The
health post's expectations of my skills, I said, exceeded what I
was capable of, and I was worried that I would end up doing more harm
than good. They transferred me to a local school, and I spent the
remaining months teaching there.
I
had learnt many lessons in this short time. I hoped that when my
elective came around I would have more skills and supervision in a
placement where the staff were aware of my capabilities. Perhaps I
would know how, in some small way, to help the woman on the bicycle.
The presence of a medical student should not, and need not, be
a burden on already overstretched
services.
Yet, when I go
on my elective, the same dismal conditions will exist in the Nepali
health post, one of many in the developing world. Next door, the same
understocked pharmacy, the same grinding poverty preventing those
patients from buying the drugs they need. How could I prepare myself
for this? I wanted to know
more.
This was one of the reasons
the International Health and Medical Education Centre (IHMEC) at
University College London in 2000 first opened its doors to medical
students by offering a BSc in international health. The course tutors
felt that all students should be better prepared before they set off on
elective. The director of the IHMEC, John Yudkin, said, "Most
students in most medical schools are provided with pre-elective
advice regarding immunisations, HIV prophylaxis, and antimalarials and
are told what to do in case of needlestick injury. But it is less
frequently the case that there is any decent preparation for
the broader experience of a medical
elective."
Not all students
can benefit from formal teaching before their elective or would be
willing to devote a year to the BSc, however. So in 2004, the IHMEC
devised The Elective Pack: a Medical Student's Guide to
Essential International Health and Development, which aims to equip
students with a better knowledge of international health on key global
issues.1
It has sections on infectious diseases, poverty, trade and aid,
nutrition and clean water, access to medicines, maternal and child
health, conflict and refugee health, and ethical
electives.
It includes comments from
elective reports and snapshot reports from those living and working in
developing countries. It is available free on studentbmj.com
in the International Experience section and on the IHMEC's
website:
http://www.ihmec.ucl.ac.uk/IntHealthElective/Resource_Pack/ElectivePack.pdf
as an electronic version; it is also available not for profit as a hard
copy. The guide aims to be easily accessible and understood by medical
students, not only for those departing on elective this year, but also
for those who share an interest in international
health.
Rebecca Hope, fourth year medical student, Leeds University Medical School
Email: rebecca.hope@almamata.net
"The shop owner asked me to help him. The health post was closed. I would like to say I knew exactly what to do. In fact I admitted that I was not able to help this woman and recommended that they contact a doctor." The line touched me a lot.
Well, most of the Nepalese are illiterate as we all know. Above all they have a belief that people with white skin have got some kind of special power. So everybody wants to be touched by them. When people see some white skin individual with a white coat in front they tend to rush after him/her without caring whether he/she is just a medical student. This kind of problem we face in our hospital which is placed in the capital of Nepal. Anbody can imagine how much worse the scenario can be in a remote area.
Rebecca has given the perfect picture of a health post in remote areas of Nepal. Yes; it is like that: a small hut without a doctor and some well experienced medical shopkeepers presribing their high priced medicine by just watching a patient from distant. It is a pity. But it is the harsh reality.
So, anyone who is planning to do electives in remote areas of Nepal, come prepared to at least give them some hope and not to disappoint their belief. Be brave enough to admit that "I can't help you. I am just a medical student.";Rebecca did.
