Dr Imara Gluning/ Emergency Department SHO/ University Hospitals Sussex NHS Trust
In this article, Dr Imara Gluning reviews her experience of the Global Health and Emergency Medicine Fellowship at the Bristol Royal Infirmary. She takes us through the goals of the fellowship, its highlights, challenges and how to get involved!
Clinical Fellow title, speciality and grade
Global Health and Emergency Medicine Fellowship, SHO or Specialty Registrar
Fellowship duration and split
12-month contract, 80:20 split (Emergency Medicine: Global Health)
Any prerequisites (e.g. qualifications or experience)
The applicant must have completed Foundation Training, otherwise there are no specific prerequisites. If you have some prior experience in either Global Health or Emergency Medicine then that’s a bonus, but not essential.
Location (e.g. main workplace, trips, research labs etc)
For 80% of the fellowship, fellows will be working in the Emergency Department at the Bristol Royal Infirmary. The remaining 20% is grouped to form UK-based Global Emergency Medicine training and an 8-week overseas deployment.
A brief description of the job role
The global health element of the fellowship is commonly an 8-week deployment to the ED at the Nanyuki Referral Hospital in Nanyuki, Kenya, conducting quality improvement projects and teaching. The topic of projects is led by the Nanyuki team to best meet their needs. Some examples are ECGs, observations, triage, basic life support, and antibiotic stewardship.
Most deployments will consist of two fellows for 8-weeks, and then a formal handover to the next two fellows for the following 8-weeks and so on. In this way, projects can be carried over, improving the sustainability of any changes implemented and the overall partnership.
Does the fellowship provide an option for academic credits from a recognised higher education institute? If so, how many and who is the accreditor? What is the qualification received upon completion?
There is the opportunity to complete an MSc module on the Global Health MSc offered by the University of Plymouth. This is funded by the programme, but as a result, the deployment to Kenya will be 7 weeks as opposed to 8 weeks.
The fellowship also provides a week of in-house teaching on global health and humanitarian medicine, culminating in the Bristol Global Emergency Care Conference which draws an audience nationally. Fellow leads, Dr Andy Lockyer and Dr Chris Hook have an incredible wealth of knowledge and experience in Global EM and provide excellent teaching and career advice.
General review: best bits, workplace environment, senior support, usefulness in career progression etc
This fellowship, in my opinion, is the best job in the NHS. In particular, the deployment to Nanyuki has been the highlight of my career. If you have a keen interest in humanitarian medicine or global health and would like experience in an LMIC that is sustainable and ethically delivered, then I’d implore you to apply.
I went to Nanyuki from Nov 2021 to Jan 2022 and conducted a Quality Improvement Project on observations in the ED, implementing a new observations chart with an Early Warning Score and delivering teaching on their importance. As a team, we were really happy with our outcomes, and on handover to future fellows, the project has since developed with a focus on triage.
On the weekends, we were off on safari, climbing Mt Kenya, shopping at Mitumba market, and stuffing our faces with nyama choma and ugali!
The fellowship does come with some challenges. Moving to Kenya for two months can be emotionally demanding, especially as you’re far from home in a new environment away from creature comforts. There are glaring health inequalities, and certain cases that presented to the ED were incredibly saddening. Nevertheless, Andy and Chris were very supportive and were easily accessible via video call to debrief. Janet, the lead nurse in the Nanyuki ED, was an absolute blessing and would help with anything she could.
Though the 8-week deployment is an obvious highlight of the fellowship, the remaining 80% is spent on a full-time ED rota at the Bristol Royal Infirmary (BRI). As I’m sure we are all acutely aware, working in the NHS is stressful, and an ED rota consists of a lot of on-calls. However, the BRI senior team is supportive and engaged in teaching, and there are drop-in sessions for mental health and burnout support. The rota is organised on a self-rostering system, meaning you plan leave in advance and are often granted the dates that you want. Furthermore, the rota team (and I can only speak for the SHO rota) were really helpful in trying to arrange shifts if needed to get time off on short notice. The BRI ED has a welcoming environment despite being under immense pressure.
Any beneficial outcomes from the fellowship (e.g. publication, future career opportunities, qualifications)
This fellowship has definitely opened up career opportunities for me. Following my deployment, I was invited back to Kenya to conduct a health scoping mission with Northern Rangelands Trust (NRT) and Dr Lucy Obolensky in remote communities near the Somali border. This was a super exciting experience, and I am still working in collaboration with NRT on future projects. I have also started teaching with Endeavour Medical on some of their first aid courses.
Other fellows have gone on to work for MSF or enrol in a Diploma in Tropical Medicine.
If you’re more organised than me, then there would certainly be scope to publish the results of any QIPs conducted in Kenya, and if you opt to do an MSc module in Plymouth then that would count for credits towards a Global Health Diploma or MSc.
Potential costs (e.g. travel, accommodation, higher degrees and courses)
Fellows would have to factor in costs when in Kenya, which includes flights and accommodation but you remain on your UK wage during this time.
Potential funding (e.g. study budget, travel expenses, higher degree modules)
The MSc module is included in the fellow study budget, and there is also an additional budget provided by the ED for any conferences or courses. For example, I did a presentation on the fellowship at a global health event hosted by GECCo (reviewed by Adventure Medic) in Manchester and had my travel costs and conference fee reimbursed.
Anything else you wish you’d known beforehand?
This is such an amazing clinical fellowship, and I can’t recommend it enough to anyone passionate about global health, humanitarian medicine or EM!
I don’t think I realised just how intense working in ED on a full-time rota would be, so it might be something worth considering before applying.
Link to the fellowship job advertisement and further information
Information about the fellowship can be found on the BRI ED Global Health page and University Hospitals Bristol and Weston ED recruitment website. The deployment is run through the BRI ED charity Dharura: Global Emergency Care and the role is advertised on Oriel. First round applications open in January with a second round for remaining places in April.