A healthcare elective is a 6 – 8 week period of work experience organised by each individual student. It is taken as part of a degree course and, depending on each University, will be scheduled into the fourth or fifth year of study.Although you can stay at home, many students choose to travel overseas so that they can combine their work experience with the opportunity to see more of the world before they settle into a new career. It has become increasingly popular to arrange placements in developing countries, with students enjoying the opportunity to learn more about global healthcare whilst learning and practicing new skills in resource-poor countries.
Electives in resource-poor countries - the benefits
Although it can be a huge learning curve, an elective in a developing country could give you the opportunity to practice and develop new and existing skills.
Hospitals in developing countries are short staffed and have a high patient load, so students often find themselves involved in treatment and care very quickly. Ill-equipped wards can also mean a return to the basics of healthcare education, diagnosing and treating without the best laboratory or medical equipment. Rachel, a medical student in Ghana found “relying more on clinical judgement and medical knowledge was a challenge, but I felt my clinical skills and acumen really improved”.There is also a great opportunity to see cases that are seldom, if ever, found in the UK. Whether you are interested in tropical diseases such as malaria, leprosy or dengue fever, or wish to focus on specific areas like Charlotte, who worked alongside an Oncologist in Tanzania specifically to focus on “haematological malignancies such as African Burkitts Lymphoma, which is rife in Eastern Africa”, this is a great chance to expand your medical knowledge.
Unfortunately cost, distance and a lack of education in resource poor countries mean patients regularly present themselves with diseases or pathologies that have advanced to a critical stage. Jonathan worked in India in a Government hospital - “I saw lesions greater than anything I had ever imagined, and symptoms that were so far progressed the patient was exhibiting signs I had only ever read about in text books. The chance to witness and treat such problems taught me an incredible amount”.
Working as an undergraduate overseas - the clinical and ethical issues
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 or procedures are at odds with UK teaching.
BMA guidelines are very clear that it is illegal and unethical to work as a qualified doctor if you have not yet graduated, but it can be difficult to communicate this to a hospital or supervisor that does not understand how UK electives work. Matt “heard horror stories about doctors that went on holiday when a student arrived, thinking they were volunteering to take over their workload.” There have also been a stream of reports about students who took advantage of their position in the hospital to practice procedures they had not been adequately trained in. “…It was a relief when I discovered a specialist agency that could arrange the whole placement for me. I knew this was the safest way of ensuring I got as much out of my elective as possible, with minimal hassle on my part and no risk to me or my patients”.
It’s important to understand the effect cultural differences play on healthcare in many developing countries too. Many students witness unusual symptoms such as burns or side effects that do not match the primary illness and these are often attributed to traditional healing methods. Fundamental patient rights like privacy and cleanliness can also be compromised. Matt worked in the Obstetrics and Gynaecology ward in a Government hospital in Nepal and found “there was no concern for patient privacy - no curtains around the beds. Latex gloves were used for internal examinations but these are recycled and washed at the end of the ward round for re-use”. It is important to respond to these issues with sensitivity – you are in their country, they are not in yours.
How to arrange your elective overseas
The first thing to decide is whether you want to book an elective through an established company or independently. Either way, the best advice is to start planning it as early as you can. Aside from the logistics of your actual placement, you need time to arrange visas, insurance, injections and anti-malarials (if relevant).
If you arrange a placement independently, be very clear when you get in touch with the hospital about your abilities and goals, whether you are choosing a remote destination or not. As electives overseas become more common, some hospitals have placed the revenue from student fees above both patient care and student experience. 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, where the monies you are paying will go, whether your role will involve “hands-on” work and how many other medical students will be working with you.
The same applies if you choose to book through a company - make sure they are specialists that can answer all of the questions above. One of the big additional benefits they should also provide is a person “on the ground” that can support you if things go wrong – whether that is during your placement or your time in another country. This can be the most amazing experience of your life if you take the time to organise it properly.
Ruth Chapman, Work the World (www.worktheworld.co.uk)
Received July 2010
All of the students quoted in this article travelled with Work the World, the UK’s leading provider of healthcare electives in Africa, Asia and South America for UK and international students. Programme fees include a placement tailored to your interests, a guaranteed supervisor, pre-departure support and advice, accommodation and meals in a Work the World student house, 24-7 support staff, airport pick up and a local orientation around the town. All images used with permission, courtsey of Work the World.
Contact Work the World on 01273 573 863 or email info@worktheworld.co.uk
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