Arav Gupta / Medical Student / Cambridge UK
Having just finished medical school in Cambridge, Arav is due to begin working as FY1 doctor in Manchester at the end of the summer. Last year, he spent his medical elective roaming on the beautiful continent of South America, combining his placement with time in a boat, time on some skis, and time spent brushing up on a little altitude medicine. Here, Arav gives us a brief insight into his time abroad, and follows it up with some handy information on how you might organise something similar yourself. Look no further for elective inspiration…
I ought to start this article with a confession, as it attempts to explain my choice of elective. Six years of medical school has done nothing to alleviate a condition that can only be described as a chronic case of FOMO*; my desire to be involved in a little bit of everything is somewhat of a class joke. I suppose it’s unsurprising that I see myself as a future generalist, albeit unclear on the specifics.
This, along with a taste for the outdoors and a (rusty) Spanish A Level, led me to that continent which is the feather in the cap of many a gap-yah traveller: South America. It’s easy to see why it’s so attractive; there are few places in the world where one can go from desert to jungle faster than Luis Suarez can latch onto an arm, or from metropolis to glacier faster quicker than it takes to order a cerveza in a Peruvian bar. I wasn’t in a thousand years going to miss out on the diversity of South America by spending my eleven weeks in one single location.
With that in mind I sought to organise a series of mini placements to experience some completely contrasting environments, while improving Spanish and travelling the gap year I never had. In the end, the two that excited me most were volunteering aboard the Amazon Hope in the Peruvian Amazon, and working at a ski clinic in the Chilean Andes. Both were completely different aspects of ‘wilderness’ medicine and neither disappointed.
Peru by boat
I found the well-advertised Amazon Hope Project on the Electives Network around the same time a friend mentioned his interest, and it seemed a great idea to go together. The Vine Trust is a Scottish charity that is the brains behind this fantastic sustainable project. It recruits clinicians and students from the UK who spend a fortnight sailing up the Amazon’s wider tributaries on a fully kitted boat, to help provide basic healthcare to remote riverside communities far beyond where the tourist cruises reach. Alongside a core group of Peruvian physicians, nurses and midwives, we ran daily clinics for locals whose only contact with doctors was a visit from the Amazon Hope three times a year. Presentations were surprisingly like those one might see in a GP surgery in the UK: I saw many cases of uncontrolled diabetes, upper respiratory tract infections, and back pain. Where the difference lay was in the management. With limited resources on board, the British National Formulary was more a starting point for treatment than bible, and with specialist care days away, referrals had to be thought through twice. Whereas in the UK a referral to secondary care is just another rung in the NHS care ladder, in the remote environment, referring a local who takes your word as gospel could mean them putting weeks’ worth of wages towards a potentially fruitless trip to the nearest town. As well as the ‘bread and butter’ cases, there were several opportunities to treat patients with parasitosis, malaria, and one memorable 8-year-old who had been suffering with a nasty-sounding chest infection since the last visit.
Of course, the geography of the landscape meant a significant amount of time was spent travelling between villages, providing ample opportunity to read, watch the birds and practice my Spanish with crew mates, especially the translators who doubled up as language teachers. The early mornings treated us to dolphin sightings and the evenings gifted us stunning sunsets and some intense games of village football. As an amateur photographer, it really was paradise for a fortnight!
Chile by ski
Unlike the Amazon Hope Project, which has a great set-up for elective students (they take 2 medical students and 2 dental students per trip), my experience in Chile was a steeper learning curve. I’m a self-professed lover of mountains, and having intercalated in clinical physiology I was keen to learn more about altitude medicine. After gaining some personal experience by climbing a 6000-metre peak in Bolivia, I organised a 4-week split placement in Chile: 2 weeks with the mining communities to learn about the chronic effects of altitude on labourers, and 2 weeks at a ski clinic to brush up on my management of high-impact trauma. As was probably likely to happen at some point, my plans didn’t quite come to fruition and my ‘chronic’ fortnight fell through, leaving me with 2 weeks in a Santiago hospital in the occupational health department! The time was just about well-spent, with my head buried in a dusty book on altitude pathology, which I read so overtly that the department decided to gift it to me at the end of my time there. Opportunities also arose to discuss high-altitude research with local doctors, which proved very interesting indeed.
The fortnight in the Three Valleys ski resorts outside Santiago were exactly what I had hoped for and more. Upon arrival at the clinic I was immediately equipped with a radio and told to head out to the slopes! This set the tone for my days, which were spent hurtling down pistes and rushing over to the clinic whenever I got the call. On average, I would see 5 patients a day, giving me plenty of opportunity to practice my orthopaedic examinations and basic management. In contrast to the Amazon Hope, the clinics were private, catering to tourists from all over the world. Resources here were also limited because in a different sense, the ski clinic was also remote. However, the closest hospitals were just a 15-minute, £500 helicopter ride down to the capital (and I was very lucky to get my first HEMS experience on day two of this placement!). Perhaps surprisingly, the great infrastructure in Chile didn’t translate to easy organisation of this placement, which required a lot of pre-trip planning and the help of a God-send of a local surgeon who took me under his wing. Looking back on this particular placement, it didn’t feel like expedition or wilderness medicine per se, but it certainly ticked the ‘alternative’ box and provided me with an unforgettable and fun experience I would never have had through medical school.
In hindsight, I do think that that is what an elective should be all about. Not to decide on a place you like and find a medical placement there for the sake of it, but to push the boundaries a little and make sure that you experience something out the box in a place you’d love to immerse yourself in. For me, my elective certainly achieved that: at no point did work feel onerous – it really was a case of a working holiday. Returning to the UK after 11 weeks on the road was certainly a bump back to reality, but the plans for an FY3 are already bubbling away in the back (front) of my mind and show no signs of letting up! Within days of landing, I had signed up to the cauldron of inspiration that is the Student Wilderness Medicine UK Conference in Edinburgh, so here’s to the next adventure.
Where / Peruvian Amazon & Farellones, in the Chilean Andes
When / June-August
How much / You’re looking at over £1000 for an Amazon trip, excluding flights but including all else. However, much of this (almost half) is a donation to the charity, so Crowdfunding the donation chunk is doable with foresight and cuts costs considerably. For the Chilean/ski segment, I had to find a cheap place to live while in the mountains – Club Andino Gastón Saavedra provided cheap and friendly lodging for extended periods of time. The owner Ricardo refused to charge me for any ski equipment hire when he found out I was a medic.
Tips / In general, for any elective, I would suggest to try to speak over the phone or on Skype with someone when organising, especially if doing it through a ‘friend of a friend’. Emails sometimes get lost and misinterpreted, so best to be sure ‘in person’.
Peruvian Amazon Hope trip – do it as part of a larger trip, as a two week trip only means 9/10 days on the boat, and there’s so much to do in that part of the world! Spanish isn’t needed as translators are used; a little, however, goes a long way. Incidentally, the Amazon Hope work also accepts dental students.
Chilean skiing clinic – from Farellones, the clinic ambulance will happily pick you up every morning and take you to the clinic. Of the three ski centres that Farellones serves, Valle Nevado offers the best skiing but is a good 25-30 minute drive from Farellones. El Colorado is great and very close by, as is La Parva, which is the smallest. June-August is the best time to go, and the last couple of years have had fantastic snowfall.
Finally in South America, pack for all weather! I struggled to think of a climate I didn’t encounter.
Contacts / Info on volunteering for medical expeditions on-board the Amazon Hope, or their other ventures, can be found on the Vine Trust website (their website was easy to use, and their office very helpful if you give them a call). The Ski placement was organised through a lovely orthopaedic surgeon whose name I was passed on by a friend in Chile. If people are interested, they can drop me a message** and I can give them Sebastian’s details.
*For those of you not down with the kids, FOMO = ‘fear of missing out’ – editor.