Elective is something everyone looks forward to at medical school. Initially however, I was not sure whether to go all out on my elective or for my holidays after my medical assistantship placement (as I was given Elective 1st and Medical assistantship 2nd). Since the news came out that I would be going on my elective before I did my Medical assistantship placement, I knew I would be going with my housemate. Our initial thoughts were very varied, but we decided to look into going to Malta for our elective due to, among other things, the English-speaking natives and the price of the flights. We thought planning this would be straightforward, but it wasn’t. The hospitals in Malta required a fresh DBS form, among other things that I have since forgotten, that made the application slightly longer than we first thought. My mother, when hearing of Malta, was also weary of us using this placement, which is once in a lifetime, to go to Malta, which isn’t very exotic. Due to these reasons, we thought better of Malta and began thinking of places further afield. We also spoke to friends who had gone through agencies to plan their elective, which had made it easier for them, so this came into our fresh planning. We decided on going to Puerto Vallarta, Mexico with Global Medical Projects. We found this by simply google searching elective companies/agencies, and GMP prices and lengths of placement fit nicely.
Initial planning:
Why Mexico:
Personally, I had already been to Mexico, and had really enjoyed it, although I had wanted to experience it more deeply than before. It is also a massive country, and I had only seen the southern east coastal region and Mexico City. This time I wanted to see the west coast, with the famous pacific sunset. My housemate had not been but had always wanted to, as his father had lived there in the past and told him to go, and he had old family friends there that he wanted to see. Other than these reasons, Mexico at the time we would be going would have the exact weather we wanted – 20 degrees at night and 30 in the daytime. We also were excited by the Mexican cuisine and were both happy to immerse ourselves into a Spanish speaking country to try and pick up some passable Spanish.
Looking back post-elective, I believe Puerto Vallarta and the surrounding area really lived up to my expectations. Additionally, Mexico is sometimes branded as unsafe with talk of cartel ruling the streets etc. In Puerto Vallarta the cartel and crime are present, but not the degree that I felt unsafe at any point. I believe that if you don’t get involved in anything dodgy in Mexico, it will rarely come to you de novo. Sticking to lighted areas is wise though.
Why with Global Medical Projects:
The definitive reasons for this are that it was so much easier to have an agency sort out everything for you (except flights), and the cost didn’t work out as too much more. I think if you are going somewhere you know/where everyone speaks your language/you are going to be on placement with family or friends, going through an agency is probably not worth it, but in our case, we felt it was. GMP provided transfers from the airport, organised our accommodation and food during weekdays, set up some beginner Spanish lessons on arrival and organised the hospital placement as well. They have been working for 20 years at this, and it showed, with everything going smoothly from start to finish.
The hospital:
Our shifts were to be 7am-3pm every weekday, although we were allowed to leave at 1pm when the students ate and had teaching. We also took a few days off to travel one weekend and a few days off in exchange for doing night shifts. The hospital we were working in was one of the lowest resourced hospitals in the region. The emergency department was run by 3 medical students who were basically F1’s without all the teaching, one ED consultant, one T+O consultant, and a team of nurses. Paediatrics, Internal Medicine and Surgical teams also came through to see patients and do procedures (and sometimes even hallway surgery). It was possible to join each of these teams if I wanted to, but I enjoyed working in the ED and getting to know the team more and more each day helped my Spanish and allowed me to increase my participation slowly.
We slotted in as medical students who couldn’t speak Spanish. There were only really 2 medical students who spoke good English, so it was quite difficult for us at the beginning. If you plan on doing an elective in a Spanish speaking country it is definitely a good idea to know some basic Spanish before you go. I didn’t know any. Luckily, I had google translate (so make sure your phone is unlocked and you can get a Mexican sim) and am decent at picking up language – if you struggle with this, I would highly recommend some beginner medical Spanish lessons. Saying this, by the end of my placement I was seeing patients by myself and writing notes in Spanish by myself (of course everything was checked by the medical students before being signed off by the doctor). Practically, we got to assist with CPR twice, suturing multiple times, doing ABGs, ECGs, and examining patients is universal. In this demographic of patients (from the street, don’t pay tax or have insurance), many of them couldn’t afford their medications, didn’t believe the advice given by the doctor, or had tried the medications but thought they didn’t help and only hindered. This was frustrating to see. What was more frustrating though was the hospital resources being quite low, which meant known best treatment could not be given. I think the most memorable is that Tb patients only receive levofloxacin for a couple weeks in hospital due to resources, but you or I could buy rifampicin etc. at the pharmacy across the road at any time, however the patients can’t because they can’t afford it for the long course they need.
The surrounding area:
Along the coast there are many beach towns and hidden beaches which for the most part are easily accessible by bus, or even hitch hiking which I did many times. In many of these towns surfing is a major past time. The sea food along the coast is awesome too. I went inland twice, to Guanajuato, which is where the Mexican people began winning independence from the Spanish. It is a wonderful place, and where my housemate’s family friends took us for a good time.
I began my 4-week Global Medical Projects (GMP) student paramedic placement on the 11/1/19 in Guadalajara (Mexico) after an orientation to the hospitals, ambulance services and a few Spanish lessons. The first week I worked in the Green Cross (South) emergency department and conducted health status assessments, practiced IM injections and IV cannulations, administered medications and learnt how to suture under the supervision of the qualified nurses and doctors. There was a vast array of medical and traumatic patient presentations I experienced including: a deep tendon laceration from workplace equipment, a basal skull fractures from a physical assault, respiratory emergencies including acute exacerbation of asthma and more.
My second week I worked on the Green Cross (South) Ambulances alternating between 8-hour day and 12-hour night shifts. During my ambulance placement at Green Cross (South) ambulance service I worked under the supervision of paramedics and firefighters on a patient that had been ejected 30m from his car. The car was completely destroyed, and he was said to have been travelling 100km/h before the crash. I utilised key skills such as C-Spine immobilisation, appropriate extrication and then conducted a thorough head to toe and medical examinations on route to hospital. During a couple of night shifts we also attended gun shot victims that were deceased on the scene and confirmed death. At the Green Cross ED I also assisted the doctors and nurses in intubation and ventilation of a 1YOF with a head injury that began to have seizures and required sedation. I ventilated her from the Resus room to the major hospital under the doctors supervision.
During my third and fourth week on placement I worked between the Red Cross (North) Ambulance service and in a small rural Red Cross emergency department in Toluqilla (located outside Guadalajara, Mexico). During my time at Red Cross Toluqilla we had an imminent birth and I assisted in delivery of the baby, placenta and neonatal resuscitation. I also treated two factory workers that suffered facial burns in a confined space when a machine exploded while on shift. I assisted monitoring these patients and conducted the burns appropriate treatment before they were transported to a major hospital. On my final shift at Toluquila I also had a 30YOM with 18 stab wounds present while I was working. Part of his stab wounds included protruding abdominal contents and a sucking chest wound. Under the supervision in the resus team I assisted taking vital signs, the head to toe examination and interventions keeping him stable until he was transported to a major hospital.
I had an incredible experience during my 4-week paramedic student placement with GMP in Guadalajara, Mexico. Between the Red Cross, Green Cross ED and ambulance services as well as the Toluqilla ED I practised a lot of key skills and competencies from my own personal skillset in medical and traumatic emergencies. The hands on experience I received was invaluable and I feel has accelerated my understanding of critically injured and unwell patients.
My name is Jack and I’m a 2nd year BSc biomedical science student preparing for postgraduate entry into medicine. Of the many choices that Global Medical Projects offer – I chose to take the 2-week volunteer project away in the small village of Meru, Tanzania.
The arrival
After the longest flight I’ve ever taken, I was thankful that the time difference in Tanzania isn’t too different to that in the UK! (2 hours ahead). Kilimanjaro airport is a small airport but nonetheless – landing in a country halfway across the world can be daunting! Thankfully, due to the planning of GMP, it was organized for us (I was with my friend Luke) to meet GMP’s Tanzanian contact -Elias and our host who we would be staying with – Zablon.
The trip to Zablon’s house in Usa river (pronounced oosa – we were calling it the USA river!) took some time but it passed quickly as Zablon was cheerfully explaining the names of all the mountains and why they were named that way. Zablon then went on to explain how he had just got married and was excited for us to meet his new wife Pretty!
Upon arriving at Zablon’s (and Pretty’s) house on the Friday, Elias took our passports and photos to go and get our work visas sorted for the following week – leaving the weekend for us to settle in.
Settling in
Zablon and Pretty were fantastic hosts and cooked us meals every night. I wont ruin the experience for you by telling you what they made us, but I will say that we tried some of the traditional Tanzanian dishes and they were delicious!
It wasn’t long before I was given the title of Mr. Bean as I couldn’t stop making our hosts laugh – part of this was because my Swahili was pretty awful and I often mispronounced words so that they started meaning very different things to what I was trying to say!
Zablon and Pretty are two of the most happy and kind people I have ever met. Zablon is an examiner for trainee teachers and pretty is a teacher at the local school in Usa near the house. Zablon and Pretty met when Pretty was training to be a teacher and Zablon was assessing her – before long they fell in love and got married. Luke and I had the privilege of watching their wedding video (which they were very proud of).
First weekend
During the first weekend, Luke and I decided to rest for half of it to get over our lack of sleep on the flight, and then visit the market in Usa River. Zablon came with us to show us around and find our feet. He also showed us where we would be taking the Dala Dala (the public transport) to the Meru district hospital on the Monday. From this point onwards we could find our way round Usa relatively well.
Luke and I discovered that Mango juice is relatively cheap and tastes delicious but the chocolate was really expensive!
The Hospital Experience
Luke and I were given the choice of whatever department we wanted to work in. We aimed to cover most of the hospital’s departments (there weren’t many) within the 2 weeks we were there.
To begin with, Luke was placed in the Male ward and I was placed in the female ward. My first impression was that compared to the hospitals in the UK, the facilities (as expected) were very limited. Privacy was a luxury and had to be paid for, ward rounds and scheduled times were rarely stuck to and everyone there had a serious problem (you generally wouldn’t find a local going into hospital unless it was of great importance).
Here are some of the things I saw in the female ward:
• Anaemia due to immunocompromisation – given antiretrovirals
• Secondary criminal abortion attempt – resulting in infection – Amoxicillin given
• Cervical cancer – X-ray confirmed metastasis of cancer – referred to palliative care
• Possible ectopic pregnancy – patient was 37 and had 6 children – refused pregnancy test
• Child with a broken femur – plaster casts are not available so the leg was immobilized and suspended
• PVB – with denial of being pregnant despite urine test proving +ve
• Diabetic patient with very high blood sugar
• 91 year old patient with hypertension
• A woman with a diabetic foot which was amputated – unfortunately this lead to impaired lymphatic drainage and she got generalized bodily swelling – she also had liver cirrhosis
• Psychiatric patient who had to be sedated several times but still wouldn’t stop shouting – referred to psychiatric nurse
• Patient with dysentery
Interesting note – many women get pregnant in Tanzania due to incorrect use of the contraceptive pill. They take it just before or during the act – hence they often get pregnant.
After the female ward, I made my way into major surgery and was shocked to see that they were performing surgery with the window open!
Some of the things I saw in Major surgery:
• C-section – patient given a similar injection to an epidural – the uterus was pulled out of the body to be sutured! The baby had to be removed by C-section as it was obliquely oriented and was pressing on the aorta causing hypertensive crisis
• Total Hysterectomy – this had to be done as the patient had over 7+ uterine myomas! The uterus weighed 2.5kg and was 22cm wide!
Paediatrics was next after major surgery:
• Severe pneumonia – fluid in lungs – unable to feed – antibiotics given
• Bronchiolitis – viral infection
• Trauma above ear and Vitamin K deficiency
• Immunocompromised child – exposed to mother with HIV (placental HIV) – given antiretrovirals
• Severe burns – 50% of torso! Given ketamine to relieve pain and rehydrated – also antibiotics as a preventative measure
• Child that had drunk kerosene due to it being put in a soft drink bottle (apparently a common thing to happen in Tanzania!) – caused pneumonia
After Paediatrics I decided to spend the afternoon in Minor surgery – having said this – some of what was thought as minor surgery there could be deemed as major surgery in the UK! (I have only put in what I think are the minor ones):
• Circumcision under no anaethetic – baby was starved before surgery and then breast fed to stop crying
• Plaster removal
After Minor surgery it was the male ward:
• Spinal TB with bed sores – Anti TB drugs and dressing/rotation for bed sores (Potts disease)
• Distal 1/3 of clavicle fracture – head of humerus dislocated – caused by car accident
• Hepatic Encephalopathy – suspected Hepatitis B
• Lacerated head and swollen right eye – head x-ray taken – from car accident
• Chronic asthmatic
• Swollen leg – Elephantitis – lymphatic obstruction
• Stroke with hemiplegia
I then went on to spend a few days at the C.T.C (Care Treatment Centre) for those with HIV with Luke. We learned that the C.T.C mostly consisted of treatment counseling and that villagers were recruited and trained in special HIV treatment schools to care for their own at home. The HIV clinic/CTC was there to ensure that HIV wasn’t spread between patients. We were told that anaemia was a common side effect of antiretrovirals. We also learnt that all HIV +ve patients were given a form confirming their condition and all the drugs they are taking
I also managed to visit radiotherapy, the maternity wards and the outpatient’s clinic, but I don’t want to ruin all the experience for you so I will only say that you need to visit them yourself! The one area of the hospital that Luke and I didn’t manage to visit was the TB clinic – this was due to the risk of us catching TB!
Donations (coats, books etc.)
By the end of our hospital visit, Luke and I thought we would donate our white lab coats, a few of our medical books and some antibacterial hand wash (all of which is hard to come by in the hospital!)
The school (Pretty)
Before we left Zablon and Pretty, Pretty gave us the opportunity to sit in on a friend of hers class. Somewhat fittingly, they were learning about first aid! Luke and I explained some of what we had learned about treating burns to the class as the teacher translated – the class then asked us questions.
Conclusion
Tanzania is an amazing place and the sheer quantity of things you can do there is practically limitless! Luke and I thought we would take advantage of the fact we were so close to the Serengeti and after our final week working at the hospital we went on a safari.
Why this project was good and why I recommend it
This project will open your eyes to what all those charity programs are trying to raise money for! You will experience what its like to be a Doctor in Tanzania and see what its like to be a patient there too. You will see what limited resources the hospital has and what they do the try and get round their limitations. You will have hands on experiences with patients and apply some of the things you’ve learnt in the past. You can’t get a purer project than this when it comes to the basics of medicine!
On top of this you have the opportunity to get to know the community at Usa River and perhaps even go on a safari like Luke and I did.
I’d like to thank all those who helped me pay for this life changing trip, those who helped me organize it (Kevin Dynan in the UK and Elias in Tanzania) and of course the wonderful Zablon and Pretty, whom without them – I would have not left the country feeling nearly as cultured and satisfied as I did.
With a sweaty hand, I nervously clutched my backpack and stepped foot out of the plane. I took a deep breath as I admired the warm, yet quiet evening in Mexico. There were no other planes at the airport and the sun had just set. In the distance, I could see the soft-glow of the airport lights surround me as I patiently waited for the shuttle to bring me to the nearby terminal. Who would be picking me up? I know someone is coming, but I don’t speak that good of Spanish. I hope they can speak a little bit of English. I was nervous and so many questions flooded my mind, but it was now. Now, was the time for me to step out my comfort zone. I had just flown out of the United States for the first time in my life and my volunteer journey with Global Medical Projects was about to begin.
For the past two years, I have worked as a paramedic in the United States. Although I love my job as a paramedic, I had always had a desire to provide care in an underserved area outside of the United States. By volunteering abroad, I was hoping I would gain invaluable knowledge by experiencing another culture, learning about other health care systems, and by being exposed to different medical differentials and techniques. Little did I know that as I nervously stepped out of the plane that evening, I would be fulfilling all of those desires by the end of my trip.
After being picked up that evening by Alberto, one of the volunteer coordinators for Global Medical Projects (and yes, he spoke English very well), I was taken to my “families” house. Prior to arrival, I knew I was going to be assigned to live with a family in Guadalajara and that the family would be providing me with 3 meals a day as well as a clean, safe living quarters. The coordination with getting to Mexico was effortless. Kevin, the program director based out of the United Kingdom, was very quick at responding to calls/emails and kept me informed with any changes in living arrangements, assignments, and with answering any questions/concerns that I had.
When I first arrived at the house, I immediately felt at ease. Since I had a late arrival that evening, the family had just finished eating and had been expecting my arrival. They were overjoyed to meet me and welcomed me right away to eat some of the meal they had just finished. The father of the family spoke a little bit of English, but he encouraged me to use some of my Spanish since the mother did not speak any English and she was quite excited to talk to me. After gaining some confidence from the father’s encouragement, I felt comfortable attempting to use my basic Spanish (with, of course, a little help from Google Translator). Not only was the family waiting to greet me, there were two guys sitting at the kitchen table. The two guys were student paramedics/ volunteers from the United Kingdom who had already been volunteering for a week longer than myself. The two volunteers were wonderful and they shuffled me up the stairs to show me my bedroom.
Although my room had two beds in it, I had my own room and shared a bathroom with the other two volunteers (who also had their own rooms). Mary, the house mom, kept the space very clean and was constantly concerned if we were getting enough to eat or if we needed anything. This fantastic hospitality remained the whole trip and the house really felt like my home away from home. There were many nights of delicious family dinners followed with great conversation, games, and laughter in the upstairs living room.
My first day in the city was relaxed. I was able to sleep in before Alberto returned the next day to take me around the city. We wandered the city and soaked in the culture. Alberto made sure to take me to some of the best food and drink spots. Although the city was hustling and bustling, it was so much fun because we were able to take the city bus around to see so much of the city including: the old churches, family owned coffee and food shops, shopping centers, the heart of downtown Guadalajara, and the other main hospital. Alberto took me to Cruz Verde, the hospital I would be volunteering at, and introduced me to the staff. The staff hardly spoke English, but that didn’t stop them from trying to talk to me- they were incredibly friendly and inviting! They wanted to know who I was, what I wanted to help with, and what I already knew.
I spent a bulk of my three weeks in the hospital.The hospital experience was perfect. As volunteers, we took the bus and train to the hospital every morning around 7 am. We were “on-duty” from 8 am to 2pm. I was able to assist and perform many procedures (under the guidance of one of the physicians) that are not normally in the scope of practice for a paramedic in the states. Some of the most memorable things that I was able to do included removing and doing stitches, directly assisting in the operating room, helping put casts on patients, assisting with cleaning and wrapping wounds, starting IV’s/setting up drips of medications, assisting during cardiac arrest, and etc. The list could go on. Some interesting cases that I saw included: multiple cardiac arrests, a scorpion sting on a little girl, a traumatic femur fracture, a man stung by hundreds of bees, and a man who went into anaphylaxis due to eating a duck egg.
In the emergency room, as a volunteer if you simply asked, you could learn and assist with almost anything under the guidance of the doctors. They truly wanted us to learn and help as much as possible. Not only was I able to pick their brains about medical procedures, but I was able to understand how their health care system worked. By the end of our trip, the doctors and nurses became close friends to us. We often went out in the evenings together and they truly made us feel like we were part of the hospital family.
Following my experience in the hospital, I decided that I wanted to branch out and volunteer for the night shift on the ambulance. The ambulance night shifts were 12 hours long. I was paired up with another volunteer for the evening shifts so I was not riding the bus and train to the hospital by myself. We were on separate ambulances, but we stayed in the paramedic quarters in the hospital when we weren’t on calls.
The only way to describe the paramedics is with one word: passionate! They were incredibly passionate about their job and were extremely proud to be able to provide people care in a pre-hospital setting.. Although their trucks are not equipped with cardiac monitors and cardiac drugs like the US and UK, they otherwise had similar pre-hospital drugs and interventions. Since the city and hospital does not have a lot of money to put into the ambulance service, the paramedics were very careful not to be wasteful and they often “created” there own splints as necessary. Some calls that we worked included: many motor vehicle and bike accidents, dog bites, very sick elders, and traumatic injuries on work sites.
As a volunteer, I rode third person in the back of the ambulance’s captain chair. (Let’s just put it this way: you definitely had to buckle in and hold on when they were driving emergency traffic or you risked flying out of your chair!). The director of EMS made sure that we stayed with the same paramedics during our time volunteering. My two paramedics were no different than the hospital staff in the respect that they wanted me to be at home. Between calls, they would often sneak me away to see something “cool” or to eat a traditional meal that I was “required to eat” before leaving Mexico. They made sure I got the true Mexican experience. In the field, similar to the hospital, the paramedics let me function as a paramedic. I noticed in the homes that the residents of the city were extremely respectful and thankful for the paramedics. It was a wonderful experience to see and the respectfulness truly reflected the “Mexican way of life” (as they would often tell me about).
When we weren’t working in the hospital and on the ambulances, we were able to venture around the city of Guadalajara and surrounding cities. The evenings were often full of fun adventures to shop, eat, drink, and enjoy the Latin culture. The weekends were especially exciting because we elected not to work on the weekends (although you could if you wanted or needed to). As a group, we picked places we wanted to go see and would travel to them via Uber or the bus. One weekend, we took a bus to Puerto Vallarta. Puerto Vallarta was a neighboring beach city about 4 hours away. We were able to book an “Air B n B” hotel room for extremely cheap to stay right on the beach. Another weekend, we got rained into a “fiesta” in a nearby city and enjoyed some local drinks and festivities- not so bad to be rained in with good food and company!
After my three weeks were up, I found it difficult to leave. The culture was incredibly inviting, I felt part of the hospital and EMS staff, and I had made wonderful friends. I’m already looking forward to the next opportunity I get to go back. Thank you Global Medical Projects for providing a safe, fun, and invaluable learning experience that was, and is, an experience of a lifetime!”
My Medical Elective Placement in India – Alvin Katumba
In July I travelled to India to carry out my month long medical elective in Trivandrum, Kerala. During my stay, I was based in the Global Medical Projects house and worked in various hospitals around the district.
Our House in India
The house was nice and comfortable and accommodated up to 12 other students. It was located away from the busy main roads which provided the house with a relaxed, quiet atmosphere to return home to after a long day of placement. In the house there were two main housekeepers that cooked and cleaned for us every day and the elective director, Babu, who was always around to help with any queries or questions I would have. They were all really friendly and helped the house feel like a home very quickly. The front courtyard was secured by a large gate which made the house feel extra safe. Each bedroom was spacious and most importantly had a fan which helped us keep cool in the sweltering Indian heat. The house also had wifi which helped us keep in contact with friends and family.
Sree Gokulam Hospital
During the weekdays I spent most of my time in one of three medical institutions; St Joseph’s Hospital, Sree Gokulam Medical College and Shneha hospital and during the weekends I would have free time to travel and experience other parts of India.
During my elective I rotated through a number of specialities as the staff were very flexible and accommodating. I spent time in many specialities including orthopaedics, cardiology, haematology, gastroenterology, neurology, ophthalmology, obstetrics and gynaecology, paediatrics, geriatrics and palliative care. This gave me the opportunity to experience as many specialties as possible and therefore work with, speak to and learn from as many doctors and nurses as possible. There were also many Indian medical students around who were friendly and easy to talk to.
In addition to the common conditions seen worldwide, I saw many interesting cases that I would not normally have had the opportunity of seeing in England. I saw patients with leprosy, tuberculosis and HIV and learned how these patients are diagnosed, investigated and managed in India. When seeing these patients, I also gained a better understanding of the stigma and social factors surrounding HIV and leprosy in India which was interesting to compare with what I had seen and experienced during my previous four years as a medical student in the UK.
Inside the hospital
My time on placement was a once in a lifetime experience as I saw and learnt a lot. Each of the hospitals I worked in offered a different unique learning experience. The Sneha hospital was a primary health care clinic so dealt with patients with minor illnesses and injuries. Here the most common things I saw were patients who had been in road traffic accidents or had non-specific coughs, aches or pains, similar to what is seen in a normal GP practice in England. Sometimes these patients would need to be referred to a bigger, more equipped hospital for more specific investigations and treatment options. Gokulam Medical College and St Joseph’s Hospital were larger hospitals that took care of these patients and it was in these hospitals where I spent most of my time in surgery, inpatients departments or outpatient’s clinics.
During the weekends, I travelled with the other students and volunteers to various cities and towns around southern India. The weekend trips were a chance to relax and enjoy as much of India as possible with my new friends. These trips involved sightseeing, guided tours, boat rides, elephant riding, relaxing on the beaches, watching the sun set, exploring the market stalls and eating the amazing traditional dishes from around the area.
Watching the sunset
Overall, I gained everything I hoped to achieve by going to India. I gained hands on clinical experience in a developing country that I had never been to before, I saw conditions that would not normally see in the UK and learnt a lot by living in a different culture for a month and meeting so many new people. The doctors, nurses and other healthcare professionals, as well as all the organisers, housekeepers and other students made it an enjoyable experience that I would recommend to anyone hoping to do their elective in India.
In April I travelled to Cape Coast, Ghana where I spent one month working in Central Regional Hospital for my medical elective. I was based in the Global Medical Projects house with other volunteers, approximately a twenty minute journey away from the hospital. The large house was very clean and comfortable, and quickly became my home. The house is set away from the hustle and bustle of the local market and feels entirely safe with its walled courtyard, locked gate and security guard. In a building next to our house lived Eric Essuah and his wife Mary, the house “mum and dad”. Night and day, they were always around and really helped in every aspect of the trip. They helped show us around, ensured we had everything we needed, organised the placement at the hospital, advised us on prices so we were never overcharged, put us in touch with a very cheap and trustworthy taxi driver (who became our private chauffeur when we explored the area), arranged for a local seamstress to make Ghanaian outfits for us and even took us out for meals and to a local bar. Mary took us to her gospel church one Sunday morning and to an Easter celebration beach party, which are experiences I will definitely never forget! They were both always so cheerful and had huge smile on their faces; they made me feel completely at home and safe. Having a housekeeper six days a week, who prepared three meals a day, cleaned our rooms and arranged for our clothes to be washed really was a luxury. It really took away the pressure of having to cook and prepare meals in a foreign country with ingredients I had never even heard of. It was also a fantastic experience to try some of the delicious, local cuisine on a daily basis.
The Obstetrics department of Central Regional Hospital
Central Regional Hospital is a large and busy hospital. Not only does it receive patients from the Cape Coast area, people are referred here from all of the smaller district hospitals in the Central Region. It therefore has a number of experienced speciality doctors and the patients have unusual and complex medical conditions as well as the diseases that are typical of an African hospital, such as HIV and malaria. The hospital is also a teaching hospital so there are always a number of very friendly medical students on the wards receiving teaching from the consultants, which was great to join in with. The placement was well organised and I was assigned to a doctor on my first day who helped me find my feet and plan my time there. I spent my four weeks working in the obstetrics and gynaecology department, as this is what I had planned to do for my elective, but I could have worked anywhere I wanted in the hospital as staff were very accommodating and flexible. Before travelling to Ghana I had decided that I wished to undertake some research in the hospital, and with the help of Eric, this was approved before I arrived. This was easy to arrange with Global Medical Projects as having somebody in Cape Coast who was in regular direct contact with the hospital allowed my project to be arranged quickly and efficiently. I successfully completed my research by interviewing doctors and patients, and using healthcare records and registers.
During my placement I divided my time between the ward, delivery suite, theatres and outpatient clinic. All of the nurses, midwives and doctors were very approachable and helpful. I became good friends with a few of the house officers and they spent a lot of time sharing their knowledge with me and teaching me new skills. The delivery suite consists of one room containing twelve beds for all the women in the first stage of labour (if there are more than twelve women, they have to lie on the floor) and three special delivery rooms down a corridor where the babies are delivered. After completing four years at medical school, the doctors regularly allowed me to assist them in their work and encouraged me to get involved in caring for the patients, but they were very keen for all volunteers to have a hands on approach. I was able to monitor the women in the first stage of labour, perform vaginal examinations and keep a check of the fetal heart rates with a foetoscope (the only piece of equipment available to monitor the baby in the suite). I was able to assist the midwives in the deliveries, and I was taught how to suture any tears that had occurred. Following the deliveries, I monitored the women and babies, and helped to check the women over before they were discharged. Also on the suite I assisted the doctors in treating women who had suffered miscarriages and incomplete abortions. Abortion is illegal in Ghana, but there were many women who took herbal remedies to initiate the process. There were therefore a number of women on a daily basis who presented requiring the treatment.
Rachel in surgery during her elective in Ghana
The delivery suite has two theatres attached where caesarean sections are performed. Due to the lack of equipment in the suite, the doctors admitted to being overly cautious and would decide a woman required a caesarean with little definitive evidence of there being a problem. There were therefore a lot of procedures carried out, with 71 caesareans undertaken over the month, the majority emergency surgery. Nearly all were carried out by the house officers and I was able to assist in a number of cases, gaining experience in suturing during the procedure. A common occurrence was power cuts. With no backup power in the delivery theatre, you either had to wait and hope it came back on soon or carry on in the dark. During one caesarean that I assisted in, there were two power cuts: the first whilst the placenta was being removed from the womb and the second whilst the wound was being sutured. During the first we had to pack the uterus with swabs and “pray she does not bleed to death”. Luckily the power came back on after 5 minutes and the woman survived. During the second, after waiting for fifteen minutes, we had to stitch the woman up in pitch darkness using only the light from a mobile phone to guide us. It was definitely one of the most exciting, if not anxious, moments in theatre. In the main theatres, other procedures were carried out and I was able to assist in myomectomy and salpingectomy cases and observe cervical cerclages being performed.
The outpatient clinic consists of one small room, one examination couch and one desk with three doctors crowded around, each seeing a different patient at the same time. With no booking system or prioritising of patients, if a person wants to see a doctor they arrive at the hospital early in the morning (the majority at 4am) and queue for many hours. During the clinics I clerked the patients and then either examined wounds, performed vaginal examinations, helped collect vaginal specimens for the pathology lab, scanned pregnant women or scanned women with suspected fibroids and cysts. I also practiced cleaning and dressing wounds. I was taught how to give guidance to couples who are having difficulty conceiving (which included telling the couple to pray hard and sing loudly in church!) and I was encouraged to discuss a number of gynaecological conditions with patients.
The obstetric and gynaecology ward consisted of 40 beds and two examination rooms. Here I clerked patients, performed vaginal examinations, checked wounds and changed dressings, assisted in induction of labour and monitored pregnant women. Catheterising and cannulating a number of women helped improve my clinical skills and I was able to assist in treating one lady who required chest and abdominal drains inserting before resuscitation was needed due to metastatic ovarian cancer.
Rachel on the outreach project in Ghana
I think the most fulfilling and enjoyable experience of my trip was working on the outreach programme. We travelled out of Cape Coast to the rural villages where we went into the schools and treated children who required healthcare, but could not afford health insurance or the money to see a doctor. We taught the children how to treat cuts and bites, stressing that they must try to keep them clean and hygienic to avoid infection. We then cleaned any dirty wounds that the children had and put on sterile dressings. The children were so joyful to see us and receive treatment, they were pretending that they had more wounds that needed treating and clung to us as we tried to leave the village. This was very touching and made me really feel that I had helped children that are so greatly in need and hopefully made a difference to their lives.
Rachel drumming during her elective
During the weekends I thoroughly enjoyed travelling around the area and really experienced the Ghanaian lifestyle and culture. I made the most of my free time outside the hospital by visiting nearby towns and villages, browsing through the markets, eating from the road side stalls and cafes, taking guided tours through the rainforest, relaxing on the glorious beaches, learning how to play the Ghanaian drums and visiting the many historic sites and tourist attractions in the area. I never sat still during my time in Ghana, each day was filled with new and tremendously fun activities and the time seemed to fly much too quickly.
I thoroughly enjoyed working in Central Regional Hospital, I learnt a number of new skills that will help me in my work in the UK, saw interesting medical conditions that I have never seen before UK hospitals and observed and assisted in surgery that was also completely new to me. It was exceptionally eye opening to work in an African hospital and I learnt a great deal about the way healthcare is given in Ghana, and how medical conditions and treatments differ to those found in British hospitals. At times I found it very difficult, especially working in such difficult conditions with the unhygienic and unsanitary wards and the lack of medical and surgical equipment. I will certainly always appreciate the healthcare and facilities available to us here in the UK. However, I found the challenge extremely rewarding and a very exciting experience. It is definitely one I will never forget. The main image that will stay with me is the friendliness, happiness and optimism of the staff and patients who were always extremely pleasant, had a smile on their faces and made my elective such an enjoyable and fulfilling experience. I am confident that I will return Ghana in the futures and will hopefully be able to work at Central Regional Hospital again.
I could not have wished for a more exciting and successful trip to Ghana. Everything, from what I experienced in the hospital, to meeting some truly inspirational people, exploring the country and making some great friends along the way, it was second to none. I would recommend Global Medical Projects to anyone planning their medical elective. They organised and planned my placement quickly and extremely well, eliminated any stress that I had about spending a month in a foreign country on my own and took care of all the other things that I hadn’t really thought about, for example, providing my meals, taking me to and from the airport and ensuring that I was safe and well every day and night. I would like to thank Global Medical Projects, and everybody who helped me during my trip, for making my adventure in this fascinating country possible and enabling me to get the most out of my elective.
I completed a medical placement with Global Medical Projects in Ghana from June-Aug 2015. As a final year medical student from the UK, the placement was my medical elective. I spent 7 weeks on the medical placement and then 2 extra weeks in Ghana for my own travelling. I thoroughly enjoyed my time and would highly recommend it – the experience was eye-opening and challenging, but also fun, exciting, inspiring and memorable.
Preparing
I chose to travel with an organisation as I found it can sometimes be difficult to make direct contacts in developing countries and to get as many opportunities organising things yourself. I was also travelling alone, and going with an organisation meant I felt I’d have more support and security, and be able to meet other volunteers when I was out there. Global Medical Projects was a great choice of organisation to go with and I’m very pleased that I chose them! They gave me lots of information and support before I went, which was great. I spoke to Kevin on the phone before booking and he was very helpful in answering all my questions and giving me more details. As soon as I booked with Global Medical Projects I got my own webpage with all the info I needed before I left – this was really useful for things such as advice about currency. I didn’t have a great deal of time to organise my trip overall, so it was brilliant that it was so straightforward and quick as soon as I got in touch with the organisation.
The Medical Placement
I spent my time working in the Cape Coast Regional Teaching Hospital, Ghana. Although this is the largest hospital in the region and receives referrals from other medical facilities, it was actually smaller than I expected (in comparison with UK hospitals!) However, there were many departments and it was busy – there was plenty to do!
On my first day I met the Medical Director, who asked me about my interests and allowed me to decide what my timetable would be whilst I was there. There were opportunities to work in various areas such as A+E, Male/Female medicine, Male/Female surgery, Obs and Gynae, Dialysis, Paediatrics and NICU, Outpatients, Radiology, and Pathology Labs. The flexibility was great – I was able to choose which areas I wanted to work in, so could tailor the experience around my own interests and skills. As an elective student (so with lots of clinical experience) I was able to get very involved and have hands-on access to all the things that local Ghanaian medical students do, including theatre. Volunteers without medical training were slightly more restricted but still had a huge amount of hands-on experience, for example many of them learnt how to perform malaria tests, take bloods and got involved in resuscitation in A+E. Really it depends how much you are willing to put in – if you are enthusiastic and willing to join in with the medical team then you will find that they give you more opportunities!
I personally spent most of my time in Paediatrics and NICU, with some time in Obs and Gynae, outpatients and A+E. The staff were welcoming, especially the junior doctors, and I was made to feel a part of the team. I did many of the things that I would in the UK, such as attending ward rounds, assisting in outpatient clinics, clerking patients and performing examinations and investigations. However, I was also allowed to participate in some things that I haven’t had the opportunity to in England, such as independently putting in neonatal lines and assisting with lumbar punctures in NICU. Sadly with the higher rate of childhood mortality there were many paediatric and neonatal resuscitations every week which I was often involved in – this was a very useful experience however and an important part of medical training. I also found on-call and night shifts really interesting, as although they are long and tiring they can present you with a variety of different cases and challenges and there are generally fewer staff meaning that I could be even more involved.
Overall, the hospital experience was very different to the UK and a good opportunity to get a different perspective on medicine and healthcare. There is a significant lack of resources compared to developed countries and often equipment and investigations that we take for granted were simply not available. Patients also have to pay for medical care and many cannot afford all of the things that they need. However, seeing how the staff and patients coped in these situations was inspiring and taught me new approaches to medicine that I will remember in the future.
Accommodation, food and basic living
In addition to the medical placement, Global Medical Projects also organised accommodation and some meals and transport.
On the first day in Cape Coast, Eric showed me around the main areas in town, got me a local sim card for my phone and helped me to get local currency. This was really helpful, as these things can be stressful to organise by yourself, but are much easier done by a local who knows where to go! It was very easy to get to town from the accommodation and to get around to places. Everyone travels by taxi for short distances, which are exceptionally cheap and pretty convenient!
The accommodation was amazing! All the volunteers in Cape Coast from Global Medical Projects stayed in a volunteer house together, with Eric and Mary (the Ghanaian ‘host’ parents!) on the upper floor of the building. There were simple dormitories for boys and girls, with en-suite bathrooms (with Western toilets and running showers!) as well as shared areas – a living room with sofas and a TV, a dining room and a kitchen. Wifi was set up whilst I was there which was a great bonus, and fans and mosquito nets were provided. Although it may not meet with all Western standards (for example, there is no hot running water and power cuts are frequent!) the house was clean and comfortable, and a great place to hang out with volunteers in the evening.
Three meals were provided per day Mon-Sat, prepared by Favour, our local housemaid. Favour was brilliant – incredibly friendly and approachable and was happy to adapt meals if needed. She also taught me many local traditions and showed my where to buy certain things and get my hair braided. I had great fun spending time with her and learning more about the Ghanaian cultures. The kitchen was also available to use at any time by volunteers, so we could prepare our own food. The nearby markets sold plenty of food and there were some Western brands available to buy from shops in town, although these are expensive!
Support
Since I was travelling alone, having support whilst I was out in Ghana was important to me. I found that it was very easy to meet other volunteers whilst I was there, both within the house that I was staying in and also working at the hospital (with other organisations). We often went for meals or travelled together in the evenings and weekends. I never felt lonely and really enjoyed meeting new people, both from Ghana and other volunteers from around the world.
Having a local Ghanaian contact (Eric) who you could contact at any time was also exceptionally useful and gave great peace of mind. Eric and his wife Mary were very approachable and were always willing to give help and advice. They kept an eye on all the volunteers and made sure that we were safe and well, telling us to call if we had any problems, even when we were travelling out of Cape Coast! Certainly I enjoyed being very independent but it was good to know that they were there for support if needed. They even took all the volunteers out for a meal, invited us to go to church with them and helped to book taxis at good rates for us when we travelled to local areas at the weekends.
Travel and things to do
Cape Coast itself is a great place to be located and has loads on offer beyond the medical placement that I went for. In the local town there are historic sites to visit, such as the Castle which was used during the Slave Trade and busy Ghanaian markets. There are local music nights at restaurants (look at those next to petrol stations!) and bars such as Oasis, which seemed like a gathering ground for foreign tourists and volunteers! The beaches in the area are beautiful and in nearby sites you can go swimming, learn to surf or take trips on traditional fishing boats.
Myself and other volunteers had plenty of free time in evenings and weekends and often went travelling together. We went on jungle treks, canoed down rivers and visited the stilted village in the far West, Nzulezo. During my extra 2 weeks I also planned a big trip on my own travelling North through Ghana, including Mole National Park and Larabanga Mosque. If you’d like to travel then I recommend taking a travel guide with you but not planning too much in advance – it is easy (perhaps easier!) to plan things spontaneously in Ghana and fun to organise things as you go, along with others who you meet out there.
Great report Charlotte! Thank you for coming with us. To follow in Charlotte’s footsteps on the medical elective programme in Ghana click on the link below:
I began my 4-week Global Medical Projects (GMP) student paramedic placement on the 11/1/19 in Guadalajara (Mexico) after an orientation to the hospitals, ambulance services and a few Spanish lessons. The first week I worked in the Green Cross (South) emergency department and conducted health status assessments, practiced IM injections and IV cannulations, administered medications and learnt how to suture under the supervision of the qualified nurses and doctors. There was a vast array of medical and traumatic patient presentations I experienced including: a deep tendon laceration from workplace equipment, a basal skull fractures from a physical assault, respiratory emergencies including acute exacerbation of asthma and more.
During my third and fourth week on placement I worked between the Red Cross (North) Ambulance service and in a small rural Red Cross emergency department in Toluqilla (located outside Guadalajara, Mexico). During my time at Red Cross Toluqilla we had an imminent birth and I assisted in delivery of the baby, placenta and neonatal resuscitation. I also treated two factory workers that suffered facial burns in a confined space when a machine exploded while on shift. I assisted monitoring these patients and conducted the burns appropriate treatment before they were transported to a major hospital. On my final shift at Toluquila I also had a 30YOM with 18 stab wounds present while I was working. Part of his stab wounds included protruding abdominal contents and a sucking chest wound. Under the supervision in the resus team I assisted taking vital signs, the head to toe examination and interventions keeping him stable until he was transported to a major hospital.
My name is Jack and I’m a 2nd year BSc biomedical science student preparing for postgraduate entry into medicine. Of the many choices that Global Medical Projects offer – I chose to take the 2-week volunteer project away in the small village of Meru, Tanzania.
Zablon and Pretty were fantastic hosts and cooked us meals every night. I wont ruin the experience for you by telling you what they made us, but I will say that we tried some of the traditional Tanzanian dishes and they were delicious!
During the first weekend, Luke and I decided to rest for half of it to get over our lack of sleep on the flight, and then visit the market in Usa River. Zablon came with us to show us around and find our feet. He also showed us where we would be taking the Dala Dala (the public transport) to the Meru district hospital on the Monday. From this point onwards we could find our way round Usa relatively well.
To begin with, Luke was placed in the Male ward and I was placed in the female ward. My first impression was that compared to the hospitals in the UK, the facilities (as expected) were very limited. Privacy was a luxury and had to be paid for, ward rounds and scheduled times were rarely stuck to and everyone there had a serious problem (you generally wouldn’t find a local going into hospital unless it was of great importance).
Interesting note – many women get pregnant in Tanzania due to incorrect use of the contraceptive pill. They take it just before or during the act – hence they often get pregnant.
After Paediatrics I decided to spend the afternoon in Minor surgery – having said this – some of what was thought as minor surgery there could be deemed as major surgery in the UK! (I have only put in what I think are the minor ones):
Tanzania is an amazing place and the sheer quantity of things you can do there is practically limitless! Luke and I thought we would take advantage of the fact we were so close to the Serengeti and after our final week working at the hospital we went on a safari.
This project will open your eyes to what all those charity programs are trying to raise money for! You will experience what its like to be a Doctor in Tanzania and see what its like to be a patient there too. You will see what limited resources the hospital has and what they do the try and get round their limitations. You will have hands on experiences with patients and apply some of the things you’ve learnt in the past. You can’t get a purer project than this when it comes to the basics of medicine!
After being picked up that evening by Alberto, one of the volunteer coordinators for Global Medical Projects (and yes, he spoke English very well), I was taken to my “families” house. Prior to arrival, I knew I was going to be assigned to live with a family in Guadalajara and that the family would be providing me with 3 meals a day as well as a clean, safe living quarters. The coordination with getting to Mexico was effortless. Kevin, the program director based out of the United Kingdom, was very quick at responding to calls/emails and kept me informed with any changes in living arrangements, assignments, and with answering any questions/concerns that I had.
I spent a bulk of my three weeks in the hospital.The hospital experience was perfect. As volunteers, we took the bus and train to the hospital every morning around 7 am. We were “on-duty” from 8 am to 2pm. I was able to assist and perform many procedures (under the guidance of one of the physicians) that are not normally in the scope of practice for a paramedic in the states. Some of the most memorable things that I was able to do included removing and doing stitches, directly assisting in the operating room, helping put casts on patients, assisting with cleaning and wrapping wounds, starting IV’s/setting up drips of medications, assisting during cardiac arrest, and etc. The list could go on. Some interesting cases that I saw included: multiple cardiac arrests, a scorpion sting on a little girl, a traumatic femur fracture, a man stung by hundreds of bees, and a man who went into anaphylaxis due to eating a duck egg.
In the emergency room, as a volunteer if you simply asked, you could learn and assist with almost anything under the guidance of the doctors. They truly wanted us to learn and help as much as possible. Not only was I able to pick their brains about medical procedures, but I was able to understand how their health care system worked. By the end of our trip, the doctors and nurses became close friends to us. We often went out in the evenings together and they truly made us feel like we were part of the hospital family.
As a volunteer, I rode third person in the back of the ambulance’s captain chair. (Let’s just put it this way: you definitely had to buckle in and hold on when they were driving emergency traffic or you risked flying out of your chair!). The director of EMS made sure that we stayed with the same paramedics during our time volunteering. My two paramedics were no different than the hospital staff in the respect that they wanted me to be at home. Between calls, they would often sneak me away to see something “cool” or to eat a traditional meal that I was “required to eat” before leaving Mexico. They made sure I got the true Mexican experience. In the field, similar to the hospital, the paramedics let me function as a paramedic. I noticed in the homes that the residents of the city were extremely respectful and thankful for the paramedics. It was a wonderful experience to see and the respectfulness truly reflected the “Mexican way of life” (as they would often tell me about).
When we weren’t working in the hospital and on the ambulances, we were able to venture around the city of Guadalajara and surrounding cities. The evenings were often full of fun adventures to shop, eat, drink, and enjoy the Latin culture. The weekends were especially exciting because we elected not to work on the weekends (although you could if you wanted or needed to). As a group, we picked places we wanted to go see and would travel to them via Uber or the bus. One weekend, we took a bus to Puerto Vallarta. Puerto Vallarta was a neighboring beach city about 4 hours away. We were able to book an “Air B n B” hotel room for extremely cheap to stay right on the beach. Another weekend, we got rained into a “fiesta” in a nearby city and enjoyed some local drinks and festivities- not so bad to be rained in with good food and company!
After my three weeks were up, I found it difficult to leave. The culture was incredibly inviting, I felt part of the hospital and EMS staff, and I had made wonderful friends. I’m already looking forward to the next opportunity I get to go back. Thank you Global Medical Projects for providing a safe, fun, and invaluable learning experience that was, and is, an experience of a lifetime!”
