Electives in resource-poor environments: what can you do to help?

March 2017

This month, we are focusing on placements in resource-poor settings. Many students use The Electives Network to plan placements in developing countries, and want to know beforehand what they can do to make a positive contribution to the local community. In this month’s newsletter, we feature an article from International Health Partners, who have developed the Doctors’ Travel Pack, a supply kit you can take on your elective which “gives health care professionals the ability to go to a resource-poor environment already equipped”. We also bring you two case studies written by students whose placements took them into resource-poor settings, whose experiences may inspire you to go on an elective where you can really make a difference.

Featured hospital

Featured hospital

Gizo Hospital is a main referral hospital serving a population of 60,000 in the Solomon Islands. It is a relatively remote hospital and is therefore a good choice for students interested in remote, island care, who also want to see a range of cases. » read more

Featured country

Featured country

The Maldives is made up of a chain of nearly 1,200 islands, most of them uninhabited, which lie off the Indian sub-continent. There are many beautiful lagoons and amazing coral reefs with exceptional underwater wildlife such as butterfly fish and bluestr » read more

Access to medicine and the Doctor's Travel Pack program

Patrick Keys from International Health Partners talks about access to medicines and good donations practice.

For many of us across the globe, it is easy to take for granted that when we write a prescription we know that the pharmacist will be able to provide the medicine and not only that, but the medicine will be what it says it is. But there are many parts of the world where stock-outs, drug shortages and counterfeit medicines all make it harder for a patient to get the drugs that they need.

As Europe’s largest coordinator of donated medical product, International Health Partners (IHP) is a UK-based Non-Governmental Organisation (NGO) working to help improve access to medicines and healthcare for those who would otherwise find it near impossible to receive.

“We respond quickly to humanitarian disasters, support long-term healthcare development projects and equip doctors, nurses, midwives and health care professionals with supplies for short-term missions through our Doctors’ Travel Packs,” explains Patrick Keys, IHP’s Health Programme Manager. Keys also manages IHP’s Doctors’ Travel Packs (DTP) programme. Packs can be carried by elective students on the proviso that the medicines are given to a suitably qualified health care professional at the host facility.

“The Doctors’ Travel Pack gives health care professionals the ability to go to a resource-poor environment already equipped,” says Keys.

A DTP is a mixture of over-the-counter and prescription medicines packed in two boxes, and serves as a mobile primary care pharmacy. Once an application for a DTP is received and IHP has confirmed the applicant is who they say they are, that they are going where they say they are going and that they will use and store the medicines properly, IHP ships the DTP directly to a hospital, clinic, surgery or pharmacy. The applicant then carries the DTP to wherever they are planning to deliver it once they arrive in-country.

The pack contents have been chosen in consultation with the World Health Organisation (WHO), the British Medical Association (BMA) and with the guidance and advice of medics that have spent time working abroad in resource-poor settings. Whilst packs are not designed to supplant the usual ways medical supplies are sourced in a country, they provide a welcome boost to medical facilities with tight budgets and intermittent supply of essentials.

If you would like to know more about IHP and how you can take part in the Doctors’ Travel Pack programme go to www.ihpuk.org or contact Patrick Keys – p.keys@ihpuk.org You can also follow @IHP_UK on Twitter.

An elective in Kenya

A case study of Dr. Bryanne Robson’s experience with Elective Africa in 2011 at the Coast Provincial General Hospital in Mombasa, Kenya

When I decided to go to Mombasa, Kenya with Elective Africa, I had three years of medical training under my belt – one of which was clinical work. I was excited by the possibility of experiencing a culture much different from my own, and being able to provide care to patients in a limited resource environment. Culture shock is something you cannot prepare for, but must simply embrace and enjoy the experience.

I don’t specifically remember why I chose Mombasa, but I can tell you it was a good choice. Mombasa is a busy, friendly, exciting and beautiful city. There are beautiful beaches to explore. There are a number of restaurants and shops to see. The people of Mombasa are hardworking and welcoming.

The Coast Provincial General Hospital is the second largest hospital in Kenya. They provide all services and see a large number of patients. This allowed my peers and me to have a vast and rewarding experience. We were able to participate in the OB/GYN Department, assist with vaginal deliveries, cesarean sections and miscarriage management. We were also involved in the Emergency Department and Minor Theatre Surgical Department. Here is where we could triage and treat a variety of pathology. We were involved in a number of minor surgical procedures and many post-traumatic suturing. The staff at CPGH welcomed us and readily involved us in the care of the patients.

For a developing country healthcare system, it’s beneficial if you can bring a lot of supplies to the clinical setting where you will be rotating. We collected donations of gloves, sutures, surgical masks, tools, etc. We also had a fundraiser before we left, to raise money for donations while in Kenya. We donated some to the orphanage we visited, some to the hospital, and purchased an air conditioner for the Minor Theatre operating suite. The hospital is very different from most westernized facilities. There is no hand sanitizer outside every patient’s room. There are no patient rooms but wards with beds aligned against the wall. The windows and doors are open to the outside. There is no endless supply of equipment. Most things are reusable and not disposable.

While preparing for travel you’ll need: a checkup – you’ll need certain shots and prophylactic medications; approval from your school; a passport and a visa; a mosquito net for your bed, bug spray, sun block; all other general travel stuff.

Most importantly, be prepared to feel unprepared. You’ll frequently find yourself in situations you haven’t experienced before, and it is essential to remain calm, apply all of the years of training, collaborate with others and work your way through. This is a unique experience that will forever change your life, your perspective of medicine and the way you practice medicine in the future.

Bryanne Robson studied at Drexel University College of Medicine in Philadelphia, USA

Memories of our elective in Nepal

Amy Gasper and Rachel Clark share some of their experiences from a placement in the Himalayas.

Our medical elective took place at Tansen Mission Hospital, in Nepal. We felt incredibly welcomed by the team and fully embraced the opportunities offered to us. The following extracts from our blog summarise some of our experiences.

A pause for reflection
Water is in short supply here in Tansen. Rain water is saved and utilised to flush the toilets and there is a bucket to collect our shower water which is also recycled.
Many of the people we see in clinic are desperately poor. Their clothes reek and hang from their emaciated bodies. In the UK we calculate medications and fluids using an average weight of 70kg, which is probably a vast under estimation of the size of the average UK person. Here the average weight is 40kg.
In Tansen, locals drink ‘Roxy’ – a potent home brew which is also a source of income for families. Alcohol related problems account for around a third of admissions. Unemployment is estimated at 46%.
The cost of food and drink here is absurdly cheap for us. A cup of tea (chiya) is 10 rupees, the equivalent of 6p, our delicious lunches in the hospital canteen cost less than 100 rupees (75p), our accommodation is about £2.50 per night. It’s hard not to feel guilty about the wealth we have. This experience is making me realise how little we need to live on, a lesson in frugality, which is very humbling.
Life is hard here, but within the hospital there is such a spirit of compassion, love and respect for humanity that is makes you forget about wants and focus on needs.

A Woman’s World
Admittedly, I felt apprehensive about the conservative dress code before coming to Nepal. But what I didn’t anticipate was the plight of the Nepalese woman. Women are incredibly strong here. Their physical strength is commendable; women in their seventies pass you on steep mountain trails with a load of wood or bamboo twice their size strapped to their backs.
Marriage and childbirth are important here, from as young as 14. Once married, the local men now work and live away in India, beyond returning to the village once or twice a year to visit their wife and family. This is so common that in maternity we often date a pregnancy by asking “when was your husband last home”, giving an accurate window of days in which conception was likely.
Coping with young marriage, poverty and illness it’s clear to see why we see such a high rate of depression here. Many women complain of the somatic symptoms of depression, commonly tingling all over their limbs, difficulty sleeping and general aches and pains.
Even now that I have returned home, I think of these women. I know the hospital’s pastoral care system and doctors provide great support and hopefully new fresh outlooks for a more positive future.

Conclusion
The elective was a life changing experience. We gained insight and self-confidence and enjoyed the chance to fully engage in the hospital community. Consequently, we feel ready and prepared to undertake the challenges of future training and opportunities to work overseas as our careers progress. We give thanks for the wonderful people we have met in this fascinating country and hope to visit again in the future.