31 minute read
HANDS UP FOR A GREAT EXPERIENCE
from RCSI Alumni Magazine 2023
by RCSI
Overseas electives are a rite of passage, say alumni, with opportunities that are variously career-boosting, character-building, humbling and always memorable.
Alumni who graduated decades ago will recall TOES (The Overseas Electives Scheme), whereby students brought aid in the form of their help and medical supplies to developing countries. The students fundraised throughout the year – cake sales, raffles, quizzes and other japes – and approached hospitals and drug companies to give them unused supplies and medicines they could take with them to Zambia, Nepal, India, Thailand and other locations. Electives undertaken as part of TOES had a humanitarian aspect that was based on gaining insights into life and medical care in underprivileged settings. Students helped in local hospitals and clinics and took with them a generous donation for their host institution in return for accommodation. As Dr Shanthini Raju (Class of 2001), TOES President in 2000, says: “It was about doing your bit.”
While electives with a humanitarian focus are still very popular, in more recent times, the pursuit of other types of overseas electives can be a higher value proposition. Dr Ann Hopkins, Senior Lecturer and Director, RCSI Internal Electives Programme, explains: “The process of securing an overseas elective is now altogether more formalised and more nuanced.” RCSI offers a significant number of overseas electives that are competitively applied for. Students are ranked academically but there are other factors at play.
“The present-day Overseas Elective Programme allows the big hospitals and institutes in the US and Canada audition the brightest and the best international students with a view to recruiting them after graduation. So, getting a highly sought-after post is effectively a passport to getting a job in the institution you want, and perhaps in the specialty you are interested in,” says Hopkins. For talented non-EU students, an overseas elective is an even more vital step on their career path, it is not only a way to expand their clinical knowledge and skills but also to enhance their employability.
Internationally renowned hospitals have excellent clinicians, whose time is valuable, so these institutions believe in charging for it. It is a privilege to be trained by these clinicians in these institutions, and the prestige comes at a price. “For some of these electives, the cost of tuition is considerable (as much as $5,000 over the four weeks) and the overall financial burden when you factor in travel, accommodation and expenses is very high,” says Hopkins. “We try and alleviate the burden for students as much as possible through grants, which are kindly supported by alumni.” As a response to this financial model, RCSI now allow students up to two months on an overseas elective as academic credit.
Aside from the approximately 100 students who undertake an elective in North America, more than three times that number organise their own electives or apply for other programmes including those run by the College of Surgeons of East, Central and Southern Africa (COSECSA). For students who have an interest in global or humanitarian medicine, a stint in Malawi, Ethiopia, Tanzania or Kenya is a popular choice. Whatever the elective and by what means the route, RCSI aims to facilitate all students and to help with paperwork and the provision of all-important letters of recommendation.
“Overseas electives are career-boosting and network-building, students get valuable clinical experience and an operational, not just experiential, flavour of what it’s like to operate in a healthcare system that is different to the one they are used to,” says Dr Hopkins.
DR MARY DAVIN-POWER
Class of 1982, retired GP and Clinical Adviser, Ireland. OE: Mission Hospital, Ortum, Kenya.
“There was an RCSI connection with the Mission Hospital, Ortum in Kenya, so myself and a student from Queen’s University flew to Nairobi. Our instructions were to meet at the Thornfield Café in the city, where we would be taken by a volunteer to our destination. The journey took days – there were barely any roads for most of it, our Toyota Land Cruiser traversing rough terrain and river beds. We stopped for the night at a priest’s house where there was a set-up with dormitories for volunteers such as ourselves. They were lovely to us. There were only two doctors in the hospital, so they were grateful for any help they could get. The first day there was a queue a mile long for the outpatient clinic. We would pluck out the sickest – perhaps a mother whose baby was very dehydrated, or someone suffering from malaria, or a knife wound – we would offer fluids, very basic medicine. Although clinically inexperienced, we were helpful, taking the drudge tasks off the busy doctors and allowing them small breaks. I suppose you would call it a sort of sophisticated triage. The mostly local nurses were extremely knowledgeable and we learned a lot of medicine from them, from setting up drips, suturing and minor surgery to learning to spot the symptoms of tropical diseases. All this using non-verbal clues – we didn’t speak the language so we learned quickly to communicate in other ways. These skills fed into your confidence, we learned a million things every day.
A surgeon would fly in every couple of weeks to operate, but the doctors would take on the less complex caesarean sections and appendixes with us to assist. There were often three patients to a bed, the least sickest perhaps under the bed.
It was an eye-opening eight weeks. When I first helped at a birth, I couldn’t work out the anatomy: that was my first introduction to the brutal FGM [female genital mutilation] procedure. They called it female circumcision, but the term was far too benign. These women often had prolonged, extremely painful labours. It made sense of the sight I had witnessed of a band of girls roaming around in bloodstained white robes, singing. We also saw a lot of patients with a wasting disease that we couldn’t diagnose or treat. It was, of course, HIV AIDS.
We lived in tiny pre-fabs and when we had some time off, we’d catch a lift on a truck for a small fee and head into town. ere would be standing room only, the road crumbling away in places. We’d go to a ‘restaurant’ in a mud hut and go out the back to choose between two large vats of stew.
I felt I had died and gone to heaven just to get this experience. I came from a select group of people studying medicine – we had no concept of how people lived in our own country, let alone how other cultures managed. And to think we raised all the money to get there through cake sales, and a competition to guess the number of people you could stuff into a Mini Metro. It was brilliant.”
WE DIDN’T SPEAK THE LANGUAGE SO WE LEARNED QUICKLY TO COMMUNICATE IN OTHER WAYS. WE LEARNED A MILLION THINGS EVERY DAY.
DR MATTHIAS BRAB
Class of 1983, Ophthalmologist, Germany. OE: Sichili Mission Hospital, Zambia.
“In 1982, Peter Cantillon, a fellow classmate, and I went to the Sichili Mission Hospital in Zambia, a small hospital with a surgery, a TB ward, a leprosy compound, as well as a laboratory. The hospital was run by a Swiss order, and part of the Diocese of Livingstone. The doctors were from the Netherlands and Belgium.
On Thursdays we started up the generator to allow us to sterilise and prepare the materials for the surgery taking place that day. The range of tasks varied from tooth extraction (after having studied the textbook) to enucleation of a patient’s eye after he had been gored by a buffalo. I witnessed young people dying of TB because treatment had been discontinued. We met a young girl with congenital heart disease who couldn’t be operated on because of the limited treatment possibilities and severe financial constrictions. Many women more or less popped into hospital to quickly have their baby, leaving shortly afterwards to return to work in the fields. We made field trips around the villages to carry out the necessary vaccinations.
The most difficult question I was asked was put to me by a boy in a village who asked me to explain the term ‘time is money’. Time there was determined not by a clock but by the height of the sun – it was not necessary to wear a watch. No one was in a rush, but all were fascinated by the busy cities in Europe such as London. e big dream was to take a car trip to the capital city. It was a wonderful time for me and an eye-opener, experiencing a totally different world, fantastic nature and medicine based on limited resources, improvisation, a total lack of bureaucracy, and a completely different philosophy on life.
DR EDWARD ‘MARTIN’ HOLT
Class of 1983, retired surgeon, UK. OE: Monze Hospital, Zambia.
“The late Han Rademaker (1957-2016, Class of 1983) and I travelled to Africa in the spring of 1982, landing in the heat and humidity at the end of the rainy season in Lusaka Airport, Zambia. Having collected our rucksacks from the plane we were met by a nun who had a Land Rover to transport us to Monze Mission Hospital which was run by Sister Dr Lucy O’Brien. In all my years as a surgeon I have worked with many surgeons but none as quietly commanding as Sister Dr Lucy in her obs and gynae theatre. We were not even in Final Med but were promoted with the title of Dr. Surgery was memorable in many ways other than the specific procedures, the majority of which were related to obstetrics and gynaecology. The ‘reusable’ disposable gloves meant that you sometimes had to try on several to get a pair which did not tear. Bleeders in an operation were managed by tying off with cat gut or using ‘Zambian diathermy’ in which haemostats were used to lightly crush the vessel as there was no electrical diathermy. Anaesthesia with Halothane was provided by Dr Sicolletti which he used sparingly, so sparingly in fact that when Sister Dr Lucy finished the procedure, leaving us to close, he shut o the gas. The first time this happened was a big surprise as the patient started moving while we were closing. When asked what was happening, Dr Sicolletti said: ‘What’s happening is you are closing slowly.’
The theatre needles were reloadable but blunt which meant that sometimes a lot of push was needed to get them through the tissues while avoiding self impalement; the same was true of needles on the ward, which were kept in a kidney dish of antiseptic.
Often the patients had tried the local medicine which included having small cuts made over the site of pain before they resorted to travelling to Monze – these scars would indicate the possible site and chronicity of their condition before they had presented at the hospital clinic.
Han and I learned so much during our short time, particularly how to manage problems and patients with very limited technology. We enjoyed the whole learning experience mainly because of the skill and teaching of generous, learned and patient teachers who I still fondly remember 40 years later.”
DR JONATHAN ROSS
Class of 1991, consultant neurologist, USA. OE: Mindinao, Philippines.
“At the time I went on an overseas elective, at the age of 21, I was in 4th Med, and the standard electives were to southern Africa or Mali. But our young professor of tropical medicine had just returned from the Philippines and he was anxious to organise some help for the inhabitants of Mindanao, the second biggest island in the Philippines, a massive, mountainous island with the highest concentration of different ethnic minorities. I went with my classmate, paediatrician Edwina Tabone. Our elective was facilitated by Catholic missionaries and it turned out not to be the ‘Third World’ hospital experience I had been anticipating. Not a hospital experience at all in fact.
We had a strange arrival. Our flight to Manila was cancelled, so the planned encounter with our contact never happened. We arrived three days late and there was nobody to meet us. We had been told that if we were ever in doubt to call the Franciscan monks. And so we did. The monastery near Manila was full of Irish monks, and they put us up and fed us and used their ham radio to get in touch with some people in Mindanao.
Laden with medical supplies and antibiotics we had sourced at home, we took a domestic flight. Sister Marie, a super-energetic nun, met us and took us to the northern part of the island, where her convent was located. It transpired that that we, along with a young doctor, were to embark on a number of expeditions to various far-flung villages via truck/hike, to circumcise the local populations of seven-year-old boys.
After a long and rough ride by truck, we would get out to hike the remaining distance to the village. It was mountainous jungle, sweltering, arduous, there were lots of bugs, the water was undrinkable (we used to procure coconuts just to sip the sappy liquid to quench our thirst).
The boys had been rounded up and were waiting for us, they would lie on a table, the doctor would administer a penile block or local anaesthetic, and remove the foreskin. We would watch a few times, then it would be up to us to carry out the procedure. The boys were stoical, none cried.
We were shown such deference in those villages. Thinking back, it was shameful how superior I felt. Ever since, I have felt a strong sense of my humble place in society. The people we met in those villages had just as happy lives as we did, just without the trappings – they had strong communities and the support of families. Who’s happier? One thing I learned over the many years I have worked as a neurologist is that even when people are faced with horrible chronic diseases, life is worth living no matter what your circumstances. This elective wasn’t fun. It didn’t follow the usual formula – hospital/ expats/beers/great time. It was tough hiking through inhospitable jungle for miles, it was arduous. But I would urge undergraduates to take a chance, have an adventure, aim for personal growth. Our job is a social job – if you don’t have empathy you will make wrong assumptions and bad decisions.”
DR BISOLA LAGUDA
Class of 1994, paediatric dermatologist, London, UK.
OE: Bethania Hospital, Sialkot, Northern Pakistan.
“In 3rd Med, after fundraising (by taking blood pressure in the St Stephen’s Green Centre among other things!) I went with classmate Mark Butterfield to a general hospital with a dedicated TB unit in Northern Pakistan, run by nuns. It was a brilliant exposure to general medicine and the local doctors taught us a great deal. For TB cases, who were treated free of charge, we helped with canulation, chest and abdominal cavity drains, and we saw many very sick people from the surrounding villages. The doctors treated everybody with respect, including us, inviting us to their homes and taking us out to dinner. We lived in the hospital so it was a total month-long immersion. To do something completely outside your comfort zone and challenge yourself is very rewarding.”
DR LINDA JOHNSTON
Class of 1997, consultant radiologist, Northern Ireland and Dublin. OE: Murgwanza Hospital, Tanzania.
“My classmate Loretta Nolan and I flew to Nairobi, in Kenya – from there we had been told to catch a ride on a UNHCR Red Cross plane to Tanzania. It wasn’t that easy! Luckily my sister had given me a credit card so we were able to buy two plane tickets. The rural hospital was small and tight on resources – gloves were recycled and the hospital relied on a generator for power. I remember being instructed to look up a textbook in the middle of the night when a difficult surgery was being performed by the doctors, and how, when the doctors held clinics in villages in the area, the scale for weighing babies was hung from the branch of a tree. Mostly, we were observing but it gave us a great insight into the challenges a hospital in the developing world faces every day. Go somewhere you won’t feel comfortable, is my advice to any medical student. You will appreciate anew the resources we have in the developed world.”
DR NOURAH ALMUBARAK
Class of 1998, consultant cardiothoracic radiologist, Kuwait. OE: El Menshawi General Hospital, Tanta, Egypt.
“I went to El Menshawi General Hospital, in the city of Tanta. I brought with me a duffel bag full of supplies of sterile gauze, IV-line tubes, dressing kits and so on, that I donated to the hospital. ere was a high number of belharziasis cases due to poor water sanitation in rural areas. I spent three weeks there joining rounds and OPDs, and it was a great experience.”
DR SHANTHINI RAJU
Class of 2001, paediatrician, Australia. OE: St Francis’ Hospital, Zambia.
Dr Shanthini Raju was President of TOES in 2000, coordinating fundraising efforts and persuading hospitals and medical supply companies to donate unused supplies that she and her peers could take with them on their electives to Africa and beyond.
“Myself and Dr Nicole Walsh travelled to St Francis’ Hospital in Zambia for six weeks, laden with equipment and medicines we sourced and funds we raised for the hospital. In the malnutrition clinics, the children weren’t starving but they were protein-starved. We educated the mothers in how they could integrate protein using what was available, for instance, by crushing nuts into a paste. The infant mortality rate was 20% – babies died because they didn’t have oxygen, simple things. During outpatient clinics, we would take bloods as the patients waited in a simple wooden hut; the sample would be looked at under a microscope, the diagnosis given, the anti-malarials provided, and the patient would begin a perhaps four-day journey back home. The ward rounds were humbling – these people were so sick, and there were no fancy tests or treatments. It was very desolate yet there was so much beauty – the people were so generous, inviting us to share their small amount of gruel or porridge. It was a well-rounded experience. I realise now that even back then, I gravitated towards paediatrics.”
DR CHELSEA GARCIA
Class of 2015, founder of LivHealth, Trinidad & Tobago. OE: Cleveland Clinic, Ohio, USA.
“I was six months’ pregnant when I got the opportunity to spend four weeks at the Cleveland Clinic, Ohio. During that time, I never left the hospital – not just because my accommodation was in the hospital but because this was my shot at US residency and I gave it everything.
I did two rotations under two consultants. It turned out that the second consultant was the former director of the residency programme and he still had a lot of influence. He said he’d love for me to come back as a resident – I told him that I dreamed of working in a sunnier place, what about Cleveland Clinic, Florida? I know, the confidence!
I really didn’t think I had a chance, there were 5,000 applicants for nine spots. I said to myself to enjoy the interview, to see what the Clinic was like. I had no expectations. I would just be my bubbly self. I got in the elevator and said: ‘Good Morning!’ When I went in to my interview, lo and behold, the man in the elevator was my interviewer. He remembered my ‘elevator pitch’. He seemed flustered, unprepared and had just been notified that a patient had had a setback on the ward … He asked me to tell him about myself. The icing on the cake was that while he was the assistant programme director, he was sufficiently impressed to introduce me to the programme director. That was all it took – five seconds to make an impact.
My elective in Cleveland Clinic, Ohio led to my job in Cleveland Clinic, Florida and that led to a lot of my success today and to founding LivHealth. As an international student who was not a US citizen, I needed a strong letter of recommendation from a US institution to allow me get residency. I owe that vital step to my Overseas Elective.”
DR PÁRAIC BEHAN
Class of 2017, Haematology Specialist Registrar, Beaumont Hospital, Dublin, Ireland. OE: Community Hospital, Richmond, Virginia, USA.
“I completed four clinical electives while at RCSI, the first at the end of 3rd Med, at a community hospital which was part of the Johnston-Willis Hospital Group in Richmond, Virginia. It was a four-week elective, two weeks medical rotation (rheumatology and endocrinology) and two surgical (cardiothoracic neuro and general surgery).
In the Johnston-Willis Hospital Group there are no interns, so we had incredible one-on-one time with consultants. When I attended procedures with the general surgeon I was very much scrubbed in – he also allowed me to independently review the patient which was extremely helpful for my examination skills.
I went to the US with classmate Daniel Creegan – we lived with two medical students from University of Glasgow and two from the University of Rwanda, rotating at the same hospital, so we gained valuable insights into different education and hospital systems. We had a lot of fun, the six of us, living in a condo together and taking weekend trips in a van provided by the hospital. We had a liaison officer – we called her our “hospital mom” – who was very helpful. We also met Dr Charles Bonner, an orthopaedic surgeon who had studied at RCSI, graduating in 1976 and had spent ten years in Dublin with his wife, and he kindly invited us to his house on Virginia Beach.
In the summer of 4th Med, I went to Ethiopia with classmate Aoife Casey, sponsored by COSECSA. This was the most affecting of my electives. I remember in particular an instance when a woman needed a drain in her stomach. She was extremely distressed. I wasn’t providing medical assistance and couldn’t speak her language, but I held her hand, to support and comfort her. I realised then the value of non-verbal communication. As many patients in Irish hospitals do not have English as their first language, this is extremely important.
I also did electives in Philadelphia and Australia in 5th and Final Med. The diversity of experience I had on all my electives made me a more rounded medic. To learn about other hospitals but also to live, work and travel in other countries is an incredible experience. RCSI invests a huge amount of time into the electives programme and the hospitals they connect with. Even before you go, the groundwork has been laid. It’s a fantastic opportunity.”
DR SOHEIL AFSHARPOUR
Class of 2021, Paediatrics Resident, Rutgers Robert Wood Johnson Medical School, Toronto, Canada. OE: Mount Sinai Hospital, Tehran, Iran.
“Ethnically, my background is Persian but I grew up in Canada. Keen to explore my roots and see how medical trainees in a different healthcare system operated, I secured an overseas elective at a tertiary hospital linked to Tehran University. I worked in the ED, a major trauma centre, 12-hour days, every day for four weeks. It was intense. I learned a lot from every single case. I had 15-20 cases every day of my own – a lot for a student. Even though through my years at RCSI I had been exposed to many pathologies, as a big trauma centre there were many critical cases – everything from motor vehicle accidents to knife wounds, shootings. I was very well trained from the moment I got there, and extremely carefully supervised – they appreciated my physical exam skills, a strong suit of RCSI students. The fast-paced environment taught me how to evaluate and manage patients quickly and efficiently.
I observed that the social skills, empathy and communication that is highly valued in Ireland does not have the same significance everywhere. Advancing through the years at RCSI, we learn how to build rapport with patients. I found the emphasis was not the same in the Middle East. But my experience there allowed me master so many basic skills that others starting out really struggle with and that was the reason I could hit the ground running in my first job. It was great.”
The diversity of experience I had on all my electives made me a more rounded medic. To learn about other hospitals but also to live, work and travel in other countries is an incredible experience.
DR THARMEGAN THARMARATNAM
RCSI Bahrain, Class of 2021, Family Resident, University of British Columbia, Vancouver. OE: Jaffna Teaching Hospital, Northern Province, Sri Lanka.
Curious to return to his birthplace and to get experience working in a limited-resource setting, Dr Tharmaratnam found his two-week overseas elective in Sri Lanka illuminating. “It was eye-opening, an introduction to how to adapt to a low-resource clinical environment, where just two cardiologists serve a vast province with high volumes of patients and few diagnostic tools. We had one ultrasound and a single echocardiograph and each would be used on 40-50 patients a day, compared to fewer than ten patients in the hospitals I had been exposed to previously. The teams worked productively, scheduling efficiently and making excellent use of the resources they had. The week I spent in tropical medicine was very interesting as I encountered pathologies I hadn’t seen. One parasitic condition caused by Entamoeba histolytica seemed to be very prevalent and I got to collaborate on a review paper. I think the elective widened my perspective, helped me to be a better researcher and stimulated an interest in rural medicine. I see myself in the future in a rural or semi-rural setting, caring for and having close ties with the local community.”
DR ABDULLA JABR
RCSI Bahrain, Class of 2022, PGY1 Internal Medicine Resident, Metrowest Medical Centre, Framingham, Massachusetts. OE: Lahey Clinic, Massachusetts, USA.
“My month-long elective in diagnostic radiology at Lahey Clinic in Burlington, Massachusetts, was by far my most memorable. I rotated at the diagnostic radiology department and worked closely with both residents and attendings. A large number of RCSI alumni work at Lahey and from them I learned about the hospital before even stepping foot inside the building. Once there, I saw the collegiality between staff members and the quality of patient care they provided. Four friends from my graduating class were working in different departments at Lahey at the time – Dr Omar Al Qassab (who now works in the IM department), Dr Muhammed Qasim Bhatti, Dr Ibrahim Al-Saadi and Dr Yusuf Mahdi. We explored the city together during our time off.
I assisted with interventions, including fluoroscopic-guided biopsies and injections. Lahey is well-known for abdominal imaging, and I assisted in many barium swallow studies.
Thanks to the teaching skills of one of the radiology technologists, from whom I learned so much, by the the end of my month at Lahey, I had really cemented my love for radiology. The impact a radiologist has on patient care is huge. A typical hospitalist might have as many as 20 patients to care for in a day. A radiologist can easily read upwards of a hundred studies during that time. Every study a radiologist reads will influence the next steps in the management of a patient. That level of impact on such a large scale is what drew me to the field to begin with.
Lahey maintains an amazing work culture, given the scale of the institution. Typically, in large institutions, you lose that sense of collegiality. However, I did not observe that during my time at Lahey. Many of the former residents of the radiology department end up working there long-term, which helps maintain the continuity of the workforce culture.”
DR JUAN LOPEZ TIBONI
Class of 2022, PGY2 Internal Medicine, Pennsylvania Hospital.OE: Floating Doctors, Bocas Del Toro, Panama.
“On the morning of our first deployment, with all the fortified rice, reading glasses, soap and food we were preparing to give away, the boat was so full we almost had no room for ourselves. While the vessel skipped across the water, I tried to appreciate what I was about to do: act as a lead medical practitioner for the first time in my career, in a health system I didn’t know, with a population I had never met, in a country whose customs I didn’t understand. All during the worst global pandemic since the Spanish Flu. The first community, La Sabana, was one of the most inaccessible, isolated communities in our rotation, on a plateau high up in the mountains. Dr La Brot [founder, Floating Doctors] told me that when his team first got there ten years ago, it was the first time many of the elderly people had seen a doctor. For some, it was their first time seeing a white man in a generation.
At the entry point to La Sabana, as we unloaded our gear and waited for the wheelbarrows, I felt an odd itch on my left leg. I looked down to find ants, the hot and hungry jungle variety, crawling all over my left boot. We spent a solid 90 minutes shuttling our gear over three bridges into the heart of the village. My back was sore; the heat made the metal handles searingly hot to touch. I was caked in sweat and exhausted before we had even started. I was flustered, completely out of my depth, and doing my best to show some mettle. These clinics usually had up to five or six doctors, and a dozen other staff – now we were just one medical student and two managers. The sheer number of people and my general inexperience were enough to make me tremble. The very first patient I saw, a diabetic with high blood pressure who needed a renewed prescription and regular follow-up, got nothing from me. Our blood pressure cuff was broken and all three of our glucometers were displaying different error messages. I made the best of it I could with a clinical exam and brief chat. The real purpose of our visit – to see if any of our chronic patients needed readjustment of their drugs – was basically null as a result. I put my head down and got on with it, although I didn’t recognise how truly overwhelmed I was. I felt sorry for the patients, and for the team.
I was flustered, completely out of my depth, and doing my best to show some mettle.
Neither the patients nor my teammates felt sorry at all though. They didn’t voice any concerns, didn’t ask me how I was doing, or if I needed help. Carrying on as usual, they saw me at work and what they saw was a doctor. They believed in me and that made me believe in myself. That was enough to get me through.
Over the next ten weeks, I would go on to counsel pregnant teenagers with pelvic inflammatory disease – completely untreated for months due to the absence of a healthcare presence in their village – treat malnourished children with oral candida who barely had access to emollient creams for their many bizarre rashes, run emergency trauma cases in the jungle, and counsel dozens of diabetics with no access to metformin because of a national shortage of the drug. I grew immensely as both a clinician and as a person.”
DR NANDINI NANDEESHA
Class of 2023, Senior Cycle 2, Medicine. OE: Floating Doctors, Bocas del Toro, Panama.
“This clinical elective experience was a once-in-a-lifetime unique learning opportunity and my most adventurous undertaking ever. New experiences pushed me to my limits, forcing me to think critically in situations where routine diagnostic tools such as ultrasounds, blood work or X-ray and imaging were not available to make a diagnosis.
I did the tasks a physician would normally engage in during a patient consultation: taking a thorough history, doing a physical exam and diagnosis, devising a management plan. One of the greatest challenges was conducting consultations with the aid of a Spanish translator. The importance of communicating clearly and using the teach-back method really helped.
We held clinics outdoors in the heat without proper rooms or curtains between patients. We ate and slept like members of the local communities; we bathed in rivers, slept in hammocks, used purified rainwater for drinking and had no air conditioning in sweltering heat. Being able to fully immerse myself in this experience helped me to understand the patient perspective and apply some of the social determinants of health when working with patients.
I aspire to be a paediatrician and this elective allowed me to work with children of varying age groups. This paediatric population presents as vulnerable, one we could target to prevent pathology which may come on in later years of life, diabetes, for example. Many children in Panama drink sugary drinks such as cola, which is cheap. Educating parents about the impact of sugary drinks, and the importance of brushing teeth or good dental hygiene, was important. I learned about Z scores and how to identify signs of malnutrition. I also taught patients how to consume the nutrition supplements we dispensed. In some cases, families with malnourished children have adult members with similar deficiencies, and nutrition supplements prescribed for the child are often shared within the family. It was vital to stress to parents the importance of ensuring that children received the necessary supplements.”
SAAD MALLAH, FARIS ALMADI, HEND ANWAR, ZAINAB ALDERAZI
Senior Cycle 2, Medicine and 4th Year Nursing. OE: RCSI Bahrain International Community Engagement Programme, Ho Chi Minh City, Vietnam.
Saad Mallah, Faris AlMadi, Hend Anwar and Zainab Alderazi embarked on a journey to Vietnam as part of the International Community Engagement programme. The students were accompanied by the Operation Child Life Team (with their diverse medical and nursing expertise) and Professor Martin Corbally, Head of Department and Professor of Surgery, RCSI Bahrain.
They took part in complex paediatric surgeries and were exposed to different cases of non-communicable diseases prevalent in Vietnam. The students visited the two leading hospitals in the capital, Ho Chi Minh City. Professor Corbally praised the students’ enthusiasm, motivation, cultural engagement and medical knowledge. They were, he said, excellent ambassadors for RCSI. ■
