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Two perspectives: experiences of medical students on electives

The practice of medicine in a remote area

[Photo: Orkney landscape] Medical student Philippa Turner wanted to see what it would be like to work as a rural GP where it is difficult to get quick access to secondary care and where you need a wide variety of clinical skills. Her placement in Orkney revealed that a rural location has a big effect on the way decisions are made, the use of clinical skills and the different priorities it raises from those of an inner city:

"I was struck by how small the hospital was – 96 beds, four wards, staffed by two surgeons – yet what a large responsibility it has. It seemed to be practising the medicine of an acute hospital with varied and complex problems yet with the atmosphere of a cosy cottage hospital.

"I was mainly based with Skerryvore practice in Kirkwall, with three full-time GPs and one part-time. With 27 GPs, Orkney has more doctors per head than in any other part of the UK. Healthcare provision is firmly rooted in primary care, so the relationship between patient and GP is all the more important.

[Photo: hospital, Orkney]

"While there are no long waiting lists or pressures on beds, a shortage of experts can mean a reluctant trip to Aberdeen, and sometimes specialist consultants need to fly in to deal with particular problems.

"Being in Orkney was a refreshing experience. The concerns of doctors are so different because of the isolation and geography. I feel I have been able to experience an old-fashioned style of medicine, where doctors have more time for their patients and there are beds in the hospital when needed, but no immediate access to all the latest technology."

Philippa Turner   

In the foothills of Kilimanjaro

[Photo: patients on ward] Jessica Cross knew that medicine in a developing country was hugely different to the UK. She wanted to experience this for herself and also to offer something back, however inadequately, given that she just had six weeks in Moshi, Tanzania:

"I worked in the three wards of the paediatric and obstetric departments in the Kilimanjaro Christian Medical Centre, a 700 bed hospital, partly government funded and partly funded by the church.

"Delivering my first baby, I was really nervous, having a panic. What if it all went wrong?  I saw the baby’s head rotate spontaneously, and I felt relief. But then so quickly, aahhh, the warm baby was in my hands and all the amniotic fluid splashed down my front. Such a mess but the baby’s cry made it worthwhile.  

"I also saw a sad case of abuse on a child with multiple scars and a large open wound on his leg. His poor mother looked about my age, and there was talk of an 'irritable' husband.

"With two other elective students I experienced Chagga tribe life in Mawella, where we were invited to attend a funeral bizarrely interrupted by news of a murder and a request for our help. Ankle-deep in mud we ran through the banana trees to see a boy, no older than 18, lying face down, eyes glazed, his back covered with many deep knife wounds.  

"Trying to check whether he was really dead and aware of the risk of AIDS I cursed the fact that my gloves and CPR equipment were back at the priest’s house when I had a life/death decision to make. Another boy, the murderer, had tried to take his own life, but was still conscious. The priest would not let us use his vehicle, so we managed to get the boy to the nearest four-wheel drive somehow and to hospital.

"After my six weeks was up I spent six days climbing Kilimanjaro before relaxing, watching sunsets, drinking passion fruit Fanta and eating barbecued barracuda in Zanzibar, paradise on earth!"

Jessica Cross

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Last updated: 2 October 2003 10:55
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