Dr Millie Wood / FY1 Poole Hospital NHS Foundation Trust
With the world’s population becoming increasingly interconnected, an understanding of global health is an important component of undergraduate medical education. In recognition of this, medical students in the UK are required to undertake an elective placement as part of their bachelor’s degree. Throughout my training to date, I have been excited about this opportunity to see how healthcare differs in a culture and setting of my choice. During the last six years, I have discovered a taste of remote, rural and expedition medicine and have become increasingly inspired by these fields. To try and get the most out of this elective period I began planning two years in advance.
Throughout my medical degree, I have been very involved in my university’s Wilderness Medicine Society. I have attended many educational and networking events, including the Extreme Medicine Conference held in Edinburgh. It was at this conference where I met the connections for my elective and I was fortunate enough to be accepted by World Extreme Medicine (WEM) to join one of their medical teams that provide healthcare in various global settings. I joined the WEM team in Fiji, who run a clinic on a remote island two hours from the mainland
Having never been to Fiji before I was excited to have the chance to learn about the culture and how the healthcare system works out there. The experience offered huge learning opportunities for me, in particular to see how the medical team worked in this remote environment and also to learn how the burden of disease differs between the Fijian and UK populations.
Another area of interest of mine is childhood obesity and declining physical activity levels amongst children. Knowing that Fiji has a particularly high prevalence of obesity, I was hopeful that I would be able to get involved in education and health promotion initiatives to combine both my medical interests.
The medical team I joined consisted of three doctors, two nurse practitioners and three paramedics. Having a medical student joining the team was a novel experience for them, but I couldn’t have felt more welcome. In addition to my team members, Fiji itself must be one of the friendliest countries I have visited, so any apprehension about spending time in an unfamiliar environment on my own quickly diminished.
We ran a daily clinic from 7am until 6pm. During these clinics we would see a great variety of primary care and tropical medicine presentations. I was able to consult individually and then discuss with the team to decide on the best management plan for each patient. Outside of clinic hours, the team were fantastic in taking any opportunity to teach me about some of the medical equipment they use in remote environments. It was an invaluable chance to become familiar with pre-hospital care kit, and I am grateful for getting exposure to this at such an early stage in my medical career.
One particular clinical incident with which I was involved will stay with me as both an emotive personal experience and also as a memorable clinical learning experience. Whilst in clinic one day, I received a phone call reporting that a woman had collapsed in the local village. With two of the on-call doctors, we headed down fully equipped for any eventuality. We were unaware of the gravity of the situation until we arrived. A 47 year old local woman had collapsed and witnesses had commenced CPR. The next 40 minutes flew by. We were joined by our experienced paramedic and a very smooth and professional resuscitation effort proceeded. I wanted to be as helpful as possible without getting in the way. I took control of getting an ECG and then controlled the oxygen bag-valve mask. I felt comfortable in this role whilst others got on with their individual tasks. CPR is exhausting at the best of times, even more so in near 40 degree heat, so it was very important to rotate this role frequently. Unfortunately, despite the best efforts of the team, we were not able to recover the patient. This was distressing, especially so with the husband watching over us. The decision over when to stop CPR is a difficult one in any setting. Communicating this decision sensitively to relatives is also critically important. The woman’s husband was sensitively taken aside by the team. I sat with him for his last moments with his wife. This was very upsetting, but again a poignant experience which I will never forget.
All in all, this situation proved how teamwork and communication are essential for effective, professional and empathetic medical care. It emphasised to me the importance of a team leader and clearly delegated roles in such scenarios. I will take my learning from this experience on board as I start out in my medical career.
As well as being involved in the running of the clinic, I was given a fantastic opportunity to take part in some health promotion during my stay. I was keen to direct my teaching efforts towards healthy lifestyle advice and inspiring increased physical activity in children to help combat childhood obesity. I made links with the local primary school and planned an education session for the school assembly. I made leaflets with simple language (including the Fijian translation) and images for the school children aged 5-13. I also obtained posters with national guidelines for children about diet and exercise. I gave a very interactive presentation to the children, allowing them to discuss their own thoughts on healthy living. The children seemed to really enjoy themselves and took the leaflets home to pass on information to their family and friends. I really relished the opportunity to be given an audience with these young children. I realise that I cannot combat this global epidemic through one teaching session, but hope that I instilled a positive change in thinking that the school teachers can continue to build upon in my absence.
I had some apprehensions before I travelled about where I, as the team’s first elective student, might fit into an already well established and efficient working team. I need not have worried; I felt extremely welcomed by the WEM medical team out in Fiji and settled in very quickly. I was a member of the daily rota and had a clear role, which instantly made me feel valued. During any downtime, we were all equally busy. I was relieved to be surrounded by others that also struggle with sitting still! Multiple watersports, tennis and fitness sessions were undertaken!
This experience taught me invaluable skills and provided memories that I will continue to draw upon both in a personal and professional context. It was a pleasure and an honour to work with the WEM medical team in Fiji and I hope I could be lucky enough to work in a healthcare team like this in the future.
Starting work as a doctor is an intimidating prospect, but I am confident that the skills and characteristics I have developed on this elective will help me in my future medical career. I am very grateful for this unforgettable opportunity and am very inspired to start working towards a future career in rural, remote and expedition medicine.
The World Extreme Medicine Conference, now in its seventh year, is being held from 23-25 November 2018 at Dynamic Earth in Edinburgh, UK. The three day event promises to be a festival of inspirational talks, workshops and networking opportunities and a bringing together of some of the best minds in humanitarian, pre-hospital, wilderness, expedition and extreme medicine. To register and secure your place, please visit their website.
