Senegal, 2010

Amira Dkeidek
University of Melbourne, Medicine

I arrived in Dakar on the night of December 12th and started my clinical placement at Hopital de Fann department of Infectious Diseases shortly thereafter.

Dakar, the capital city of Senegal in West Africa, lies on the tip of a peninsula jutting into the Atlantic Ocean. It is home to some 3 million people, with infrastructure to accommodate perhaps only a quarter of that number. Well-used taxis ply the streets, contending with horse-drawn carts, crowded mini buses and anything else that can be plausibly wheeled down a busy freeway. Fruit stands and vendors of live chickens, shoes, and mobile phones line the streets, and the wanderlust of the locals and tourists alike makes for a city that never sleeps. There’s a pulse that does not subside, and that is what truly made my time in Dakar a memorable experience.

The vibrancy and abundance of humanity to be found on Dakar’s roads is representative of Hopital de Fann, where committed medical staff tend to the needs of thousands of patients within the catchment. The grand majority of these patients subsist on less than a dollar a day and can ill afford the medicines they are prescribed. Basic resources are scarce at Fann, and the patients are gravely ill and often undernourished. I was able to participate in the care of patients with faltering immune systems secondary to HIV infections and rampant tuberculosis and bacterial meningitis. Tetanus, measles and malaria were an observable reality rather than unwitnessed diseases of other places.

I spent half of my time in Fann in inpatient care and the rest was spent in the outpatient clinics. From an educational perspective, the latter setting was more beneficial, as I was exposed to a wider variety of patients. Language and communication were more problematic than I had expected they would be. While French is ostensibly the official language of Senegal, many of the patients at Fann spoke only local indigenous languages (mostly Wolof), and so complete autonomy in the care of patients was often difficult. With so many of the doctors and students coming from surrounding countries, such as Mauritania and Burkina Faso, communication was a rate-limiting factor not exclusive to myself. My advice to future students would be a thorough touch-up on both French and Wolof prior to arrival in Dakar.

Everyone at Infectious Diseases at Fann expressed immense gratitude for the medical supplies I carried over to them from VSAP – for that, our donation was worth every bit of the effort it took to plan and pack the goods. Most of my luggage was filled with syringes, cotton wool and gloves – not sophisticated medical equipment by any means, but much needed nevertheless. With characteristic Senegalese hospitality, everyone at Fann welcomed me, the Australian student, and extended the invitation to any diligent, curious Australian who might wish to work in Dakar.

Malaysia, 2009

Daryl Cheng
Monash University, MBBS V

A healthcare team, including medical and dental students, journeyed to the tropical outback of Sarawak, Malaysia in December 2009 for two weeks. We were based at Kampong Sengkalan, a rural village 2.5 hours out of the capital Kuching.

There was a cluster of villages around our area – a total of four within a radius of 2-3km. Together with a multi-disciplinary team of healthcare professionals, we were able to do basic medical health checkups for the villagers; adults and children alike. This was followed by health education talks given in the evening.

Despite having relatively easy access to medical care – the nearest hospital was a 30-45min trip by car, there was a generally poor understanding of hygiene and health amongst the villagers. Furthermore, there were limited resources available – both in terms of finances but also medical supplies. Many villagers would simply wait and hope if they ran out of prescription medicines, or endure the pain and suffering until it became unbearable, because they did not have a car to get to the hospital.

As such, VSAP medical supplies were much appreciated and used to provide basic first aid and care to the villagers. The blood pressure cuffs were extremely useful, as were simple things like band-aids, cotton swabs and even bandages! Even a tongue depressor was used in a minor surgical procedure!

It was a privilege to have VSAP provide medical equipment for our trip, and we look forward to working with them in the future.

Zanzibar, 2009

Jesse Randall Zanker
University of Melbourne, Medicine

During December 2009, and January 2010 I undertook my four week medical elective at Mnazi Mmoja Hospital, Stone Town, Zanzibar Island, Tanzania. Zanzibar, or Unguja in Swahili, is an archipelago populated by approximately 1 million people, situated 80km east of the Tanzanian mainland. The most populous island of the archipelago is Zanzibar Island, of which the capital is Stone Town.

Zanzibar has an intriguing and tumultuous history. The paved, bustling, haphazard streets are lined with faded, peeling buildings that offer some insight into the island’s past. The people of Zanzibar have formerly been under the rule of the Portuguese, the Brits, and the Arabs, and this is evident in the eclectic architecture of Stone Town. The island’s past is also brought to mind five times daily when the many Mosques of Stone Town loudly project their prayers and sermons, competing for the attention of the townspeople.

Mnazi Mmoja hospital is located on a stretch of turquoise beach, on the Southern fringe of Stone Town. It is known as a tertiary hospital. For those coming from an established health system, with health indicators differing nominally from the best in the world, ‘tertiary hospital’ can generate some crude assumptions about the hospital’s facilities. The hospital is a 440 bed, government-run establishment with both local and international doctors. Departments include internal medicine, surgery, obstetrics, paediatrics, ophthalmology, ENT, occupational therapy, and physiotherapy.

I spent my rotation on the male medical ward. Those ills that once were the ominous unknown were encountered in full force on the inducting ward round. Patients with TB, malaria, cholera, HIV-AIDS, rheumatic heart disease and many others occupied the beds on the ward. Fans would occasionally rotate above, whilst the 3-wheeled trolley moved from patient to patient, its contents being distributed amongst those on the ward. My role here was initially an observational one, but as time passed this evolved into a role enabling my contribution to the care and treatment of patients. I felt enthusiastic, yet exasperated at the chronic shortage of supplies and expertise available to those requiring it.

I was in Zanzibar at a unique time. Just prior to my arrival, the Island’s power supply was completely severed due to a catastrophic fault with the Island’s transformer. This rendered all of those without the means for a generator literally powerless, and those with a generator unwillingly burdened with the cost of running one. For the hospital, it meant limited hours of power – the stifling and stagnant nights were braved fan-less by the inpatients, important investigations (CT/XRay/Bloods) were painfully slow, and staff were burdened with minimal running water crippling their ability to maintain adequate hygiene.

In the villages, infrastructure development has allowed for running water through the provision of electricity. Conversely, this development has generated reliance on electricity for day-to-day living. Here, as it is across the globe, running water is an essential of life. With its cessation, cholera rapidly rose. At Mnazi Mmoja our experience was unfortunately a glossy anecdote of this problem. It is hoped that power will be restored to the island in May 2010.

VSAP and its donors were able to provide Mnazi Mmoja with some relief. The chronic scarcity of some health care essentials (gloves, cannulas, catheters, surgical equipment, needles, speculums, etc.) was temporarily supplemented. The hospital management, to whom the supplies were donated, were most appreciative for the support received from abroad. As one may expect, the need continues.

Interested students can access further information on Mnazi Mmoja hospital at; http://mnazimmoja.blogspot.com/
The website was put together by a medical student after completing their elective.

The experience was a remarkable one, and also a stark reminder of the grave challenges many endure.

Solomon Islands, 2009

Rami Subhi
University of Melbourne

Walking through the narrow concrete pathways of the National Referral Hospital in Honiara, the Solomon Islands I’m constantly met with beaming smiles and greetings of “morning doctor”. To the left a group of children are gathered, picking mangoes from the giant mango tree that shades the paediatric ward: a 30-bed ward that receives referrals from the rest of the country. There are 2 practicing paediatricians in the country, both working at NRH. The facilities are limited, timely investigations are difficult to obtain, and imaging consists of only ultrasound and x-rays. But the commitment of doctors and nurses means that high standards of care are maintained despite these obstacles.

To some extent, the organization of the ward reveals the Solomon’s way of life: communal, open and simple. A laid-back, welcoming and unpretentious people, they made us feel at home immediately. We learned that community goes hand-in-hand with life in the Solomons, and we quickly became accustomed to the sight of daily gatherings of extended family and friends over a bbq or drinks on the beach adjoining our house.

On the paediatric ward, I was made to feel part of the team. Joining ward rounds in the morning, I was given the job of the second intern, being allowed to examine, write notes, and depending on how brave I felt with speaking pidgin (the local language), take histories. I also joined the doctors in outpatients. The nurses were more than happy teaching me procedural skills, and I learned how to insert IVs in small infants and children, and how to insert nasogastric tubes.

The fun of clinical medicine and of being given more responsibility than I’m used to was a highlight. But what will remain with me are the lessons I learned from the children and parents I met. I learned that children are intrinsically vulnerable and fragile; that it does not take much in terms of resources to prevent a life from being lost; and that irrespective of how many children a mother loses, it never becomes easier losing the next. I realized how incredibly resourceful and skillful the doctors and nurses there were, and of the exciting prospect of how much improvement is possible if local individuals and systems are adequately supported.

I was fortunate enough to take with me some medical supplies, organized through the great work of VSAP. The most useful supplies were those which could be packed easily and so can be transported in large numbers, and those that supplement existing hospital supplies. As examples, we took latex gloves, alcohol swabs, Iv cannulae, needles and gauze.

I found the elective an incredible time of learning and reflecting. What was most helpful for me in having a good time was to go in with an attitude of respect and appreciation of the commitment of the individuals working daily in the challenges that we only get a glimpse of during the elective period.

Tanzania Jan-Feb 2010

Jasmine Koh
Monash University
My elective rotation took place at Mount Meru Regional Hospital in Arusha, Tanzania, from the 18th Jan 2010 to the 26th Feb 2010. The hospital was considered relatively big for the region, and it had laboratory and radiology facilities. I spent two weeks each on Paediatrics and General Medicine, and a week each on Obstetrics & Gynaecology and Surgery.

It was a real eye-opener and I could see the stark contrast between what goes on in Tanzania compared to back in Melbourne. Not only were the medical conditions different, the attitude of the staff members and the way they handled certain situations were quite shocking at times. I got to attend ward rounds and clinics, and also came up with management plans for patients. In addition, there was plenty of hands-on in O&G, where I got to deliver babies on my own.

VSAP gave me a lot of donated supplies to take over, including surgical equipment, suture material, glucometers, chlorhexidine solution and eye drops. I handed them over to the chief medical officer, and we sorted out the supplies in the office in order for him to decide what should go to each department. The supplies were greatly appreciated, and should go into good use given the limited resources of the hospital.

When I was on General Medicine, I found that the glucometers and accompanying lancets were very useful, because there was a lack of lancets on the ward and they were using needles to prick patients’ fingers to obtain the blood sample. When I was on Surgery, I found out that they have very limited orthopaedic equipment, so I was glad that I had brought something for them. Furthermore, by the end of my placement I still had plenty of masks left over (VSAP had given me 2 boxes for my personal use), so I passed them on to the staff in theatre as well.

Overall, it was a valuable experience observing the huge contrast between healthcare in Tanzania and Melbourne. Working in the hospital and discussions with staff members enabled me to understand more about the limitations they have, be it expertise or material resources. I am glad that with VSAP’s assistance, I managed to contribute more to the hospital by bringing supplies on top of myself being there as a human resource.