Be inspired!

February 2017

This month, we share three very different medical placements and hope that you will be inspired by these students’ experiences.

Sarah Hookham shows how important careful planning is to make the most of an internship. Her internship at the Karapitiya Hospital in Sri Lanka was an enriching experience, which left her with many fond memories. Always remember to send us your feedback after your elective is finished. Not only are we looking forward to hearing all about it, but whether it is positive or negative, it is a very important tool to help other students to find an placement which is perfect for them.

Kerman Kahlon had known since his third year of study what he wanted. His determination finally led him to the endocrinology department at the Waikato Hospital in New Zealand. During his six-week placement he not only had the opportunity to study interesting diseases, but also to explore the surrounding area.

Fiona Robertson talks about her time at the Jikei University Hospital in Tokyo. Her placement in anesthesiology gave her not only important insights into the workings of this department, but also allowed her to experience other specialisations. She was very touched by the stories of some patients and makes comparisons to healthcare back in her home country.

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Better planning means a better placement: Sarah Hookham’s elective in Sri Lanka

Sarah Hookham shows us how a well-planned elective can lead to a fantastic experience. Read her account of a pediatrics placement in Sri Lanka.

My elective experience began 9 months before my departure date! Scrolling around maps online, I started my search for a country to fit my criteria: a country which spoke a reasonable amount of English, could offer an interesting clinical experience, and had plenty to explore during my time off. I also wanted lots of sunshine to escape from the cold weather where I live, in the north of England.

Once I’d narrowed my search down to Sri Lanka, The Electives Network was an invaluable source of information in choosing and contacting hospitals. I’d definitely recommend looking through student reviews of each hospital, as this gave an accurate representation of what an elective at that hospital would be like. I actually ended up emailing around 6 hospitals in Sri Lanka. The hospitals who replied quickly were a good sign as it indicated their organisation was good, which was vital when trying to pull together such a long trip abroad!

I chose Karapitiya Hospital in Galle for the following reasons:

  • It was close to Galle Fort: one of the most popular tourist areas of the country with plenty of shops and restaurants to spend evenings, a little bit more of European feel, and close to the beaches!
  • Karapitiya is a large teaching hospital and I felt this would offer the best learning opportunity, as well as the speciality I wanted to see (Pediatrics).
  • Previous students had rated the hospital well and had commented on the relaxed attitude to choose how to spend your time (be this in the hospital or at the beach), which gave my elective more daily flexibility and independence
  • The city had good transport links to other areas of the country, including the only highway in the country!

I spent 6 weeks at Karapitiya Hospital, mostly in the Pediatrics department. First impressions of the hospital were quite overwhelming – I had never been to a resource poor country before and hadn’t completely prepared myself for the cultural shock. It was commonplace to see animals in the hospital – many stray dogs would wander the corridors and one of the resident cats had kittens on a ward! The hospital had a huge catchment and the corridors are packed with patients overflowing from clinic waiting areas. There were very few sinks on the wards and it was unusual to see a doctor washing their hands in between patients. I think it’s difficult to really prepare yourself for the cultural shock you experience on elective in countries like Sri Lanka, and the life skills and appreciation you gain from electives like mine can only been gained from experience – not reading or watching online! However making yourself aware that you might see surprising things on your elective may ease the initial culture shock when you arrive.

The placement and doctors themselves were really interesting and impressive. Sri Lankan doctors and medical students work very hard and are clinically very good. The medicine is largely the same as in the UK – they even use the same textbooks; the main difficulty for the hospital is lack of resources and lots of patients. In a typical week, we would spend 3 days on the ward and 2 days in clinic. Ward days consisted of a mixture of teaching wards rounds (a consultant, 25 Sri Lankan students and around 5 elective students in June/July), mannequin paediatric emergency teaching, and case studies. Clinic days consisted of observing the 50-100 patients seen in a morning by one doctor, and getting hands-on experience examining for clinical signs during that time, as well as teaching by the cases that came through the door. It was nice to have an organised structure to the day, but whilst the doctors expected you there for teaching they were flexible in the afternoons if you wanted to have some time off.

In my spare time, I did a variety of things – at weekends we hired a driver to travel to local areas like Tangalle (beach time and temples), Udawalawa (amazing elephant safari and orphanage!) and Hikkaduwa (more beaches and a river canoeing trip). We also had a week of travel after placement to explore the highlands and more northern regions like Kandy – this would probably be the minimum amount of time you should leave for travel as it takes a long time to get across the island due to slow public transport, and there’s plenty to see and do! However, most importantly, in afternoons and evenings Galle provided a nice variety of different things to do. Some days we went to the beach to sunbathe or surf (although be warned – the sea is very rough in the monsoon months!), some days we went to the fort to socialise with other elective students, and other days we just stayed at our homestay to relax.

The homestay or accommodation you pick is probably one of the biggest decisions to decide for your elective. TAKE NOTE! Do not just accept the first email offer that you will inevitably receive from a stranger who offers you a room! Most students did this and ended up staying in what was called a ‘homestay’ but was really a hostel, with one stove between 25 students and rats in the kitchen! It really pays to do your research and the hospital send you a list of different accommodations as soon as you’re accepted. If you spend an hour going through this list, you really won’t regret it and it will make a huge difference to your elective experience. The homestay I chose was very cheap, the family were extremely welcoming and friendly and always helped us out when we needed it (such as taking me to hospital after a surfing injury!), and the setting was ideal – a little haven set in the jungle where we could relax with other students in our own space away from the hustle and bustle of town.

A real highlight for me would have to be getting to know other elective students from around the world – from Germany to New Zealand! Everyone was really friendly and keen to meet up for weekend trips and after placement. Being in such a large hospital meant you met lots of like-minded people and never felt alone on your elective. I still miss relaxed sunny evenings of card games and Lion Beer (the only beer they seemed to have in Sri Lanka) in the Hammock Bar in Galle Fort!!

I feel very humbled by my experience in Sri Lanka and hugely appreciate the opportunities I’ve been lucky enough to be born with at home in the UK. I gained a huge amount of confidence and independence by travelling away from my family and I would strongly recommend that anyone thinking of stepping out of their comfort zone for an elective does so – you will come back a changed person!

This version of Sarah’s article has been abridged and edited by The Electives Network for the purposes of this newsletter. To view the original article, please click here or contact info@electives.net.

An Invaluable Experience: Kerman Kahlon’s elective placement in New Zealand

Kerman Kahlon writes about using his elective as a chance to gain experience in his field of interest – endocrinology, on a placement at Waikato Hospital, in New Zealand.

Planning
I undertook my elective placement in the endocrinology unit at Waikato Hospital in New Zealand. New Zealand was a country that I always wanted to visit as it is very known for its beautiful scenery and it is a place where I would seriously consider working after my junior doctor years. As for the country’s healthcare system, I was coming into the placement very much blindly, as I didn’t know anything about healthcare within New Zealand. Some doctors I spoke to who had worked in New Zealand told me it was fairly similar to the UK, which appealed to me as I am a big advocate of the NHS.

At my university, the elective period starts at the beginning of the 5th year so into the second semester of my 3rd year of studies I already knew New Zealand was the place where I wanted to do my elective. As I was planning to apply to hospitals quite early, many other students hadn’t really given much thought into their electives so I knew that I was going to be doing my elective on my own. It would be the first time I would be travelling on my own but this didn’t faze me at any point even though at times it may be challenging it would allow me to do my own thing and maximise the opportunity of the elective.

I used The Electives Network website to look at the hospitals within New Zealand. I was looking at hospitals preferably in the North Island as this would allow me to travel to different areas of the country on weekends and afternoons off. Many hospitals did stand out to me including Auckland, Wellington and Waikato so I did send a number of emails asking about undertaking an elective in my interest of Endocrinology, and Waikato was the only one who could accommodate me in that speciality. Before accepting the position, I looked into Waikato hospital and was very impressed, as it was a very large hospital that provided healthcare for over 350,000 people living in Waikato and the surrounding areas. Waikato hospital was located within Hamilton, a city within the district of Waikato. This city had a very central location on the North Island so it would give me the opportunity to travel around.

I knew by taking the position I was likely to be exposed to lots of interesting cases within Endocrinology. Endocrinology has always been an interest of mine, but due to a disappointing previous placement I still hadn’t managed to see many of the interesting conditions I’d learnt about in class and from my textbook. The endocrinology unit within Waikato hospital was highly regarded from information I found on the internet and the supervisor from Waikato hospital who I was in contact with. This elective would also give me the opportunity to see patients and become slicker in taking endocrine histories and performing the relevant examination and investigations.

My placement
During the first week of my placement I was mostly observing clinics to get a feel how the clinics run and how each consultation works. I found that in Waikato hospital each doctor had a lot more time for each patient consultation compared to the UK; a new referral would typically last 45 minutes whereas in the UK it would be around 20 minutes.
During the second week, I was seeing patients on my own. During thyroid clinic with Dr Paul I was always given the new referrals to see and take a full endocrine history, perform a full examination, and document these in the patient’s notes. I would then explain my findings to the doctor who would confirm them quickly and I would come up with a management plan too.

I also counselled patients starting new thyroid medication such as Carbimazole and told them about how to take the medication, any side effects and what to do in case of any signs of agranulocytosis. Again, this was invaluable experience. I got to take histories and examine patients with various conditions (including a condition I’d never seen before – MEN type 2b in a patient with bilateral pheochromocytomas).

Every Thursday, I got to help the consultant teach the 4th year students, which I found very rewarding. I got to teach clinical skills such as cardiovascular and cranial nerve examinations. I learned new techniques from the consultant, but at the same time I also got to show the students and the doctor how I had been taught to examine different systems. I thoroughly enjoyed this aspect of the placement as teaching is something that I have always been interested in.

During my six weeks in New Zealand, I was in a homestay with a married couple. The elective supervisor put me in contact with a couple who also worked at the hospital. I thoroughly enjoyed staying with them for 6 weeks and spent lots of evenings chatting away – they made me feel at home. During the weekends, I would meet up with other students from my university who were in different hospitals in New Zealand and travelled to places such as Auckland and Rotorua, which I thoroughly enjoyed.

Overall, I really loved my elective in Waikato and highly recommend anyone to come here, particularly to the endocrinology unit, which made me feel part of the team from the very beginning. There are plenty of hospitals to undertake an elective within New Zealand and if it’s a place that appeals to you, it is definitely worth going for. If you do have an interest in endocrinology I highly recommend picking Waikato hospital as the doctors are very welcoming, they give you responsibility of seeing patients and make you very much part of the team. I did speak to the doctor once I got signed off after the six weeks about working in the department after my years of working as a foundation doctor and it’s something I will discuss with them closer to the time. It was a six-week experience that I’ll never forget.

This version of Kerman’s article has been abridged and edited by The Electives Network for the purposes of this newsletter. To view the original article, please click here or contact info@electives.net.

An elective in Tokyo: Fiona Robertson writes about her experience in Japan

Read Fiona Robertson’s report on her elective experience, including a survival guide for electives in Tokyo!

My placement

I spent 6 weeks on an elective in Tokyo, Japan, with the Jikei University School of Medicine. Here I underwent a clinical observership with the Anaesthesiology department at the Jikei University Hospital. I witnessed several surgical procedures and had the opportunity to attend the Pain Clinic, Intensive Care Unit and Acute Pain Ward Rounds. I was able to carry out some procedures under supervision such as bag and mask ventilation, intubation and drawing up anaesthetic drugs and running fluids. Other opportunities during my elective included attending Jikei student seminars and opportunities to help teach students medical English. I was even able to act as a simulated patient for their exams.

One particularly notable case I learned from was a liver transplant between two sisters. One sister had primary biliary cirrhosis and received a partial transplant from her healthy younger sister. Despite my being within a different culture and country, this procedure still struck a chord with me as I have an elder sister with a similar age difference. It made me really realise the importance of family looking after each other in Japan.

I was able to shadow both patients from preoperative assessment, surgery to their progress afterwards in ICU. I was surprised by how humble they both were despite undergoing such a major operation. Looking after their personal and family’s health felt like a duty. These sisters had very little fear about undergoing the operation despite its risks, as they were willing to take the risk if it offered any chance of getting rid of disease.

The donor (i.e. healthy) sister deteriorated for a short while in ICU postoperatively. Despite this, both sisters felt very well-supported during their hospital stay and were very thankful for all the effort put into their care by healthcare professionals. There was a strong no-blame culture in Japan as patients feel fully responsible for their own healthcare and the risks associated with any procedures. This was quite surprising to me, especially as I was used to seeing more patients in the UK at times putting blame on their care providers when their condition does not improve. A balance must be struck for doctors to ensure that patients receive the optimal care in a safe environment, yet not feel penalised if they make mistakes.

Tokyo Survival Guide

The staff at Jikei were all very welcoming towards international students. The accommodation provided by the University was very affordable and comfortable – I had my own private apartment right beside the hospital and in the middle of Tokyo (I could see Tokyo Tower from my window).

For anyone considering this elective I would offer the following advice beforehand:

  • Knowing Japanese is not essential but it really helps. I had very simple Japanese which got me by, but was not enough to carry out full patient consultations. The level of English spoken by the staff and patients was extremely variable from fluent to virtually none.
  • Anaesthesia was a great specialty to be involved in as a foreign student. If you have an interest in seeing a wide range of hospital specialties this is a good choice of elective as all surgical specialties could be observed from paediatrics, ENT, O&G to neurosurgery. I even saw a liver transplant during my placement.
  • Be clear what you want to get out of your elective to the staff as if you don’t ask often they don’t realise that you would like to see or do things (e.g. I found out after 3 weeks that there were mannequins I could practice intubation on). Also, if I wanted to spend a day at another department such as ICU they were very happy to arrange that for me.
  • There are a lot of opportunities to learn due to the wide variety of surgeries and anaesthetic techniques being carried out. The anaesthetists and surgeons are very willing to try and teach foreign students without compromising on the local students teaching.
  • If you are looking for an elective with a strong component of practical patient responsibility (i.e. individual consultations) Japan may not be the first choice of country for your elective as these opportunities are reserved for those fluent in Japanese. However, there were still many opportunities as discussed for learning, teaching and patient exposure.
  • There is a big social culture at work – many workers in the department would meet together after for drinks and food at izakaya. Definitely recommend! Japanese doctors definitely like to party!
  • Karaoke is a must do!
  • Tokyo is initially a very hectic and overwhelming city to be in and navigate. However making some Japanese friends helps as they can guide you around for the first couple of days. The metro system is fantastic once you get the hang of it.
  • Menus are very difficult to read. When ordering at a restaurant that doesn’t have an English menu, it’s also useful to have a Japanese friend help you translate or you could end up ordering an interesting delicacy such as fish testicles or natto (slimy fermented soy beans)!
  • WiFi is surprisingly difficult to access. Neither the hospital nor its accommodation provided WiFi so I rented a portable ‘pocket WiFi’ device.

This version of Fiona’s article has been abridged and edited by The Electives Network for the purposes of this newsletter. To view the original article, please click here or contact info@electives.net.