Articles and Case Studies

Electives in Developing Nations - Be Prepared!

04 Nov 2014

If you are considering joining the many Australian medical students who undertake an elective in a developing country, there is much that you need to prepare yourself for. Therese Chapman explains how the experience is very different from home, and finding the right visa and arranging travel insurance is only the beginning.
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Do your research before you leave

Many hospitals in developing nations do not have access to modern equipment, therefore when treating patients you will need to use basic clinical skills. Learn and practise any skills you will require. Also, before leaving for your elective, research common conditions likely to be seen at your intended destination and, if you can, find how they’re managed locally.

Breaking the language barrier

A lack of familiarity with the local language can significantly reduce your ability to learn and contribute during an elective, as well as imposing a greater burden on your hosts. This is something to keep in mind when planning your elective. If you don’t speak the language already, make every effort to learn as much as you can before you arrive.

Health problems are common

Make sure you understand the prevention and management of infections and diseases that are prevalent at your destination. Take your own protective equipment such as gloves and masks. Be careful what you eat and drink. Before you leave for your elective, discuss any pre-existing health issues with your GP and establish a management plan. Pack a personal medical kit and make sure you take sufficient supplies of necessary medications with you.

Vaccinations before you depart

Visit your GP or a specialist travel clinic at least two to three months before your departure. These professionals can provide advice on the vaccinations required for the places you plan to visit. Plan well in advance as some immunisations need to be adequately spaced.

HIV post-exposure prophylaxis

If you are travelling to an area where HIV is endemic, you should purchase a HIV post-exposure prophylaxis pack and know how to use it.

Be aware of your personal safety

Leave a copy of your itinerary and emergency contacts with your family and your university so they know where you are and how to contact you. Be aware of the political situation in your destination country. Register your details with smartraveller.gov.au and subscribe to travel advice updates. Once you arrive, take all precautions necessary to limit your exposure to danger.

How you can contribute

You will be challenged both professionally and personally

Ask your supervisor if there is anything you can do to benefit your hosts. Consider fundraising activities or ask if they want you to bring any reference materials (textbooks, journals), medical supplies or equipment. Don’t bring material without being asked as it might be more of a burden than a benefit.

 

Health systems in developing countries are under extreme pressure

Hospitals are often under-staffed, under-funded and over-crowded. You may witness critically ill patients presenting in the late stages of disease when it too late to intervene effectively. You may encounter hospital staff frustrated at their lack of resources. You may also see cases you have never encountered before, including tropical diseases such as dengue fever, malaria or leprosy.

Be kind to yourself

A formal orientation on arrival is unlikely. You are more likely to be thrown in the deep end, which is when many students report feeling out of their depth. You should certainly expect some culture shock. Don’t demand too much of yourself early on. Give yourself a period of orientation and acclimatisation.

Identify support systems

Communicate regularly with home if feasible. If you can, go on elective with a friend so you can talk and share experiences. It can be an intense experience, and it is comforting to have someone you can relate to.

Don’t leave your ethics at home

You should consider whether your presence will have any negative impact on your hosts and take steps to minimise any inconvenience to them. Be careful of presenting yourself to patients as a “doctor”. It is both illegal and unethical for medical students to work as a fully qualified doctor, even in the developing world.

You may receive limited or inadequate supervision

You may be required to work more independently than you are used to as a medical student in Australia. You may even be asked to undertake clinical tasks beyond your level of expertise. Ask yourself if you would be willing to perform the procedure at home and whether you are really capable of undertaking it. If not, politely but firmly decline and explain why you are unable to perform the requested task.

Cultural sensitivity

Learn as much as you can about the culture of the country, including local customs and traditions, religion, class structure, gender attitudes and local beliefs regarding health services. Conform with local practices as much as possible.

With the right preparation before you leave home, completing an elective placement in a developing country can be a positive experience for both you and your hosts.

 
Therese Chapman
Medical Writer for MDA National Education Services

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