Why I wanted to do medicine …

I was incredibly lucky to find this medical elective placement in Fiji; we were given opportunities to really get involved (within the realms of our capability) and I learnt a lot. Highlights included outreach clinics to villages far from the hospital and from other tourists, where we were really immersed into the unique medical and cultural practices Fiji had to offer. Whilst in the hospital, I clarked, reviewed and managed my own patients (under a doctor’s supervision) and started to feel like qualifying medical school was in reach! We were also able to help teach the medical students, allowing them to cannulate me and take my bloods.

The people of Fiji are known for their kindness and generosity, and it’s no doubt given the welcome we received, often being invited to people’s villages, homes, weddings and religious ceremonies.

Sigatoka hospital is a public hospital which serves more than 30, 000 patients along Fiji’s Coral Coast It provides both primary and secondary care as well as outreach clinics, screening and educational programs.  The hospital is staffed by 15 incredibly welcoming doctors and all the medicine is done in English.

I chose this program because it allowed me to not only work in the hospital with doctors, but on outreach programs with nurses providing and promoting health education in villages and schools.

Aims and Objectives• To gain valuable experience working in a low/middle income country and immersing myself in a new culture.• Become comfortable with common conditions in the population, including their pathophysiology, presentation, prognosis and treatment.• To understand how different social attitudes might influence health outcomes.• To gain insight into working in an environment with far fewer resources than we are used to – understanding how to cope and adapt to different settings.• To navigate a language barrier during consultations.
Religion and health, a case study – A 24 year old first time mum, 30 weeks pregnant came into Accident & Emergency saying she was pre-ictal, and expecting a seizure. Naturally, it evoked concern in the medical team, who admitted the patient into a waiting bay for monitoring of both mother and child. I started helping the doctors cannulate and prepare the medication (first line was based on what was available, rather than what was best or least teratogenic), however our progress in preparations was somewhat disturbed by the midwife, who stood by the patient’s side, and prayed that the ‘daemons inside her left her alone’. I was shocked to see a medical professional delaying things in such a way, and it showed me just how deeply religion runs in the community. It was not the only case that was left, temporarily at least, ‘in the hands of god’. Luckily, she was cannulated and given diazepam as soon as the seizure started and both she and her child were discharged the same day without any concerns.

Outreach programs• In Fiji, Non-Communicable Diseases such as diabetes and heart disease are an increasing issue for the local community. The major risk factors are obesity, lack of exercise, eating the wrong food, smoking and excessive drinking of alcohol and kava. The purpose of the outreach clinics is to tackle these.• Clinic is comprised of one doctor and two nurses, one from the village (the only healthcare they have easy access to), and one from the hospital, which is a two-hour drive over rough ground.• Simple measurements (BMI, blood glucose and blood pressure) were used to ascertain the patients’ general conditions and prescriptions for medications were given out accordingly, although the supply was quickly used up and patients at the end of clinic only received a prescription (which the nurses didn’t think they would follow up on).• While in the village, there was a nurse-lead education session on diet, exercise and the importance of medication compliance.• In Fiji, 1 in 3 adults have diabetes, and thus it is paramount that the healthcare educates as well as treats problems. I was continually surprised in hospital by how late some patients present, often with BM’s in the 30’s and diabetic foot sepsis.

Final reflections

1. Clinical – I gained an insight into working in a lower income setting. Gained exposure to conditions not common to England and their treatment. I felt my confidence and competence grow as I took part in routine clinical practices.

2. Cultural – I saw firsthand how different social attitudes to health (particularly traditional medicine) can influence health outcomes, both positively and negatively.

3. Personal – I have become passionate about the idea of working abroad and hope to be able to spend more time in different countries. I left Fiji with new friends and a renewed perspective that I’m sure will lure me back to the Pacific region.

4. Medical School – my trip reminded me why I wanted to do medicine and gave me a renewed enthusiasm to study and left me very excited about my final year.