Work the World in Tanzania

Work the World midwifery placements

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Before you embark on electives most people look at the options and boil it down to the basics. Why book with a company? It’s easy! Why organise it independently? It’s cheap! 

Depending on which matters most to you, emails are sent to companies like Work the World or the research begins on which hospitals to contact.

But it’s not so simple! There are lots of things you should think about before you make the decision whether to book with a company or go independently, and they extend far further into safety, ethics, experience and planning… have a read through the below and then think about which option suits you better.

Getting the right placement

You may have a good idea of what it is you want to do, but how flexible are you ? We had a student intent on oncology in Northern Tanzania, but outside of the capital the focus on cancer is almost non-existent, so was it really an option? Another independent student got in touch with us whilst in Nepal – she thought she’d arranged a midwifery placement but the hospital had no space and wanted her to go into another ward. She wanted us to step in and help find something in her field?

Independent travel

It is wise to put in the hours before you leave ensuring that your host hospital and supervisor know what you want to focus on, but keep in mind that it can be hard to build the strong, trusting relationships before you go and things may well change when you arrive. The hospital may have misread your messages, not understood the importance etc, and it is not until you arrive and speak to them face to face that it can (or sometimes cannot) be resolved. Many students spend the first few days in a tangle of administrative red tape, which can delay and shorten their time in the hospital. This may not happen to you, but the idea is to be ready to compromise!

Booking with Work the World

We have built up great relationships with the partner hospitals, clinics and government authorities that we work with, which means we have more flexibility in planning your placement, tailoring it to your skills and abilities. Once you have discussed what you want with our UK office, our in-country staff actually go into the hospital to plan your elective. Contracts are in place guaranteeing everything, so you do get to go in and start immediately. It was through our contacts that we were able to find the oncology student above a bespoke placement with the only oncologist in the Lake Victoria region. Newly returned from training in Italy he was busy setting up a new department, so our in-country staff met with him and requested the elective. This allowed her to study her chosen field literally from the ground up.

Getting the right supervisor 

A supervisor can make or break your elective. It can be the most amazing learning experience, or you can feel alienated and removed from the team. Be savvy to the fact that some hospitals have also placed the revenue from student fees above both patient care and student experience. You may have a great teacher, but if their time is split between several of you it can be hard to progress or get hands-on work experience.

Independent travel

Getting recommendations from friends is a start, but if you are going to a untested hospital then there is not much you can do before you leave. To avoid finding yourself trailing behind a supervisor in a group of twenty other students, try to find out as much as you can about how your placement will work, who your supervisor will be and if they have asked for a fee (typical of most hospitals) where the monies you are paying will go. You should also find out about whether your role will involve “hands-on” work and how many other medical students will be working with you.

Booking with Work the World

Work the World choose their placement supervisors because they provide excellent teaching. In return students are encouraged to share skills and make it an educational experience for everyone involved. We also make sure that supervisors have no more than 4 students with them at any one time (our busiest placements), and that this number is balanced with in-country students. If hospitals refuse to agree to limit numbers, which was a problem we faced with our old Zanzibar programme in Stone Town, we relocate. Our Dar hospital placements are dramatically better and with Zanzibar on your doorstep, we have the best of both worlds.

Communicating your level of skill

Working in an overseas hospital presents a number of difficulties, the most problematic being the clinical and ethical dilemmas that can arise if supervisors do not adequately understand a student’s skills. Horror stories have cropped up in the BMJ online forums about students that have  arrived to find their supervisor heading off for a holiday because they thought the arrival of a new doctor meant holiday time!

Independent travel

If you arrange to work in an overseas hospital independently, be very clear when you get in touch about your abilities and goals. Many remote hospitals may not understand how global health elective placements work, and that they need to give you supervision.

Booking with Work the World

Again, our relationships with the hospitals means that students don’t need to worry about their supervisor or department understanding. Contracts are in place guaranteeing students safety and supervision. Don’t think you can just sit back and get invited to do things though – you still need to build relationships and prove yourself in the hospital. We’ll get you there and support you, but then it’s over to you.

Ethical issues

There is a common misconception that people in poverty will benefit from any level of medical care, and there has been some scary stories of students “trying out” new procedures that they are not familiar with. It is also common for students to “forget” this is a working hospital that is undoubtedly severely understaffed. Students need to respect guidelines laid out by their university, or by regulating bodies such as the BMA or the Medical Journal of Australia (MJA).

Independent travel

To ensure that you do not demand too much of your supervisors time and taken them away from their patients, you need to put the work in before hand. Swot up on the likely diseases and problems, as well as the local language – all of this will help you fit right in. Then it’s just up to you to follow the guidelines and  treat these patients the same as you would at home. If you don’t feel comfortable doing something, you need to make sure you are heard.

Booking with Work the World

We work closely with the regulatory bodies to make sure that the impact on our host hospitals and clinics, students and most importantly the patients is not negative. Placements are planned so that students understand their role and supervisors are fully briefed on skill sets. The result is a mentorship programme that does not impact on patient care, but provides a learning experience through the delivery of the best level of medical treatment available. In short we do the preparation work for you and brief you with all the information you need to know.

Bilateral benefit 

The focus for electives is almost always on the benefits to the student. What about the host community?

Independent travel

Any fees you pay to the hospital will be made directly. The decision about who should receive them is in your hands. Likewise, any further donations are up to you. The contribution you make to the community you are living in is up to you.

Booking with Work the World

Work the World have a unilateral exchange programme that uses the fees paid by students to reward individual mentors, wards and departments at the hospital, as well as to train local staff to manage sustainable projects. Because we have the numbers, we are able to employ local staff to run our Work the World houses, buying in local produce for meals and supporting the local community. We also encourage students to get involved with local orphanages and community projects.

Safety and security

Travelling abroad does bring risks, and working in a developing country hospital increases those potential problems. What happens if something goes wrong? Will you be all alone out there?

Independent travel

You will need to make sure you take all the relevant contact numbers so that you are able to get in touch with the embassy or a hospital should you need it. You should also look at reviews before booking accommodation and make sure that you follow guidelines about staying safe in your host country.

Booking with Work the World

One of the big additional benefits of our placements is the Work the World houses. They provide safe, secure and social housing for all of our students. We often get feedback to say they are one of the highlights – the fact that after a day on placement there was a comfortable home to relax in, amazing staff and delicious meals, as well as friends to discuss the day with and plan trips to the bar or weekend travels. Our staff are always on hand if things go wrong, whether that is during your placement or whilst living in their country.

In summary.....

So, a few more things to think about! What is interesting though is that the choice still boils down to ease and cost, but it’s whether you feel the ease is worth the cost of booking with a company like Work the World, not which is more important. Doubtless everyone wants to save money (and although we don’t make that much money from each student, the cost of admin and staff etc does add up and so we are always going to cost a bit more), but it really isn’t an option to go alone and not put in the hours – not if you want your elective period to be a success.

For me it seems that if you have the time to put in before you leave, the challenge of independent travel can teach you valuable lessons in making introductions, building the potential for bilateral exchanges and develop your research skills.  Once on placement you may need to compromise on time and specialism, but if you’ve put in the work and understand your role then it could be an amazing experience.  On the other hand, Work the World take away all the hassle of finding somewhere and give you a more concrete elective. Signing up with them gives you a safe, structured placement tailored to your interests. It will start when you want it to start, you don’t need to worry about where to stay, who your supervisor is or where the money is going. You still need to put in the work when you are on placement, so it’s not an entirely easy option, but it gets rid of alot of the hassle.

Compare it to a sandwich. If you are starving hungry and there is a sandwich shop next door to a supermarket, you can either pop in and buy yourself a quick tuna melt, or buy bread, tuna and cheese and then make it all at home. You save yourself money, but you have to invest a whole lot more time and effort before you can eat the sandwich…… If I could scrape the  money together I know what I would do!