Dr Ben Tometzki / Foundation Doctor / Liverpool, UK
Keen to experience the challenges of medicine in a resource-poor environment, Ben set his sights on sub-Saharan Africa for his medical elective. Many emails and several months later, he found himself in Ethiopia. From the intense heat and volcanic landscapes of the Danakil Depression, to the hustle of Addis Ababa, Ben recounts his experiences on and off the ward.
It’s 52 degrees Celcius outside the car as the midday sun glares out across the barren wasteland of the Danakil Desert either side of the road. As you drive around the corner you see a lorry on its side, windows smashed and cabin dented into the dry earth. To the left is a small figure lying in the sand beneath a jacket. What do you do?
This was the situation I found myself in, driving in a tourist convoy through the Danakil Depression in northern Ethiopia, after my elective in the capital city of Addis Ababa. Thankfully the driver of the lorry was not seriously injured, just in a state of shock and grazed. This situation did make me consider what we would have done had things been more serious. We really were in the middle of nowhere in a way I’d never experienced before. The nearest town was hours away, the nearest hospital even further and helicopter evacuation would not have been an option. Experiences like this are a reminder of how hard it really is for some people in the world to access appropriate emergency medical care, something in the UK we often take for granted.
Why an elective in Ethiopia?
It’s not on your list of common elective destinations and I was the first from Glasgow University to go, which caused the medical school some stress. When looking for my elective post I targeted my research around low-resource countries, particularly those in sub-Saharan Africa. Seeing first-hand the challenges of practising medicine in a low-resource environment would give me such a contrasting experience to that of an elective in a more developed country. I feel that’s what electives are all about: seeing medicine done differently. I had previously been to Ghana and this experience developed my intrigue in this area of the world. I emailed any contact I could get my hands on and applied in Uganda, Tanzania and many more. Most went without reply. Finally, I made an interested contact in Ethiopia which I sourced through a friend of a friend. From there on it was no plain sailing. Convincing my medical school that Ethiopia was not too dangerous, getting all the correct vaccinations, obtaining a visa and finding accommodation in-country were all challenging experiences.
I was based in CURE Children’s Hospital which is run by an American charity and specialises in paediatric orthopaedics. It is the only hospital of this specialty in the whole of Ethiopia! Because of this, all manner of weird and wonderful things could present in clinic. We saw children with extra toes, giant thumbs, some horrendous burn contractures and all sorts of odd fractures. The most common condition CURE deal with is clubfoot. This is common globally, but in places like the UK, it is usually treated before early childhood. In Ethiopia, however, cases often present much later and subsequently can require much more drastic surgery to give children functioning feet. We also saw a multitude of fractures which had healed in very odd positions. This happens as many people first visit their local bone setter or ‘Wedisha’ who wrap up the fracture tightly in Bamboo, often making the situation worse. Problems like this are just never encountered at hospital in the UK.
I also spent some time in the local government hospital, the ominously named ‘Black Lion’. This was the largest hospital in the country and the only teaching hospital. In orthopaedics, the commonest injuries were road traffic accidents and, believe it or not, being hit with a stick! I stayed well clear of any man carrying a stick after seeing some of those x-rays. As I expected, this hospital was much poorer in resources than those I am used to in the UK, however I was really surprised by the conditions for trainee doctors. On a surgical placement in Glasgow I might expect to walk into a theatre and find one consultant and one registrar. In Ethiopia there would be at least eight trainees each crowding round one operation, jostling for prime position to assist or even to see!
Time off the ward
Whilst in Ethiopia we didn’t only visit the hospital. Weekends were spent escaping Addis Ababa for nearby lakeside towns like Hawassa and Bishoftu where we relaxed and enjoyed some of the amazing scenery on offer. These trips were not always relaxing, however. Public transport in Ethiopia was an adventure in itself, best summed up by our return journey to Addis after a weekend in Bishoftu. We got to the bus station that was full of many calm, well organised queues. We found the one for Addis and waited patiently like the locals. Then suddenly there was a shout and all the queues dispersed and chaos ensued as everyone ran onto the street, crowding and cramming on to any minibus in sight. Apparently, the bus station was now closed! Thankfully, we had made a friend in the queue who helped us onto the right bus and got us home. In Hawassa we also had trouble. We arrived at the guesthouse we’d booked online to check in, the woman behind the desk gave us a quizzical look and asked, “online?”. They were fully booked and had to their knowledge had no website! To further the problem, that night was the graduation ceremony for Hawassa University, so every place in town was fully booked. After five hours of wandering from hotel to guesthouse to lodge we were about to give up and were seriously considering the logistics of sleeping rough for a night in Ethiopia! Our last option was the very extravagant international hotel, where the only remaining room was the honeymoon suite! It took a huge hit on our budget, but beat sleeping by a lake full of hippos!
After our time in Addis Ababa came to an end, we headed up north to the Danakil Depression, a mysterious and harsh land, with sulphur lakes, salt plains, scorching temperatures and a big Volcano: Erta Ale. We joined a group to explore these places and trekked to the top of the volcano to camp there one night. Just in case it wasn’t exciting enough already, we had to be escorted by the army in some areas for fear of attack. This final trip was a perfect way to round of what was an elective full of excitement, odd experiences, questionable food, mishaps, difficult situations, some seriously scary bits but most importantly an adventure.
This elective has furthered my love of travel and working in extreme environments. On return I have organised an SSC in trauma in our major A&E department and also attended the World Extreme Medicine conference, which I would highly recommend. Next summer for my senior elective I will be travelling to a major trauma centre in Baltimore to see the other side of the coin and the state of the art care.
Where / Addis Ababa, Ethiopia
When / June – August
How Much / I managed to find return flights to Addis for under £400 (with a long lay over in Istanbul) however, with hindsight, flying with Ethiopian Air gives a huge discount on internal flights if you wanted to travel after an elective there. For safe accommodation a hotel/guest house would be recommended and ours cost roughly £500 for the four weeks in Addis Ababa. Any spending beyond that would really depend on the sort of travel activities you wanted to do. Food, drink and ground travel can be found very cheaply and easily.
Tips / Start planning your elective early! Particularly if you want to do one in a less commonly visited place. There are surprising amounts of admin to get through and it took a long time. This was stressful and time consuming for me as the deadline for travel approached. I would recommend trying to email and get hold of contacts as early as a year before you plan to go. This also helps build a rapport with the staff and hospital you are planning to visit before getting there. Internet connections in places such as Ethiopia can be troublesome and hence email correspondence can take a long time, however everything is much easier once you are in the country.
Contacts / Unfortunately I am unable to share contacts from this placement, however speaking to other doctors who have made similar trips in the past is valuable. Speaking to consultants you like on placement and just asking can bring up some very interesting opportunities. Universities often have previous elective reports and contacts and if you have medical parents, use them!