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Medical Electives

Clinical Experience

What a student will be able to do

Competency in clinical skills - students will be observing and assisting with patient diagnoses and treatment, although the range is limited in a clinic without all the lab facilities. Much of their time will be spent in very close contact with patients.

Competency to perform practical procedures - students will assist with triage, vaccinations, minor surgical procedures, births, and a limited range of lab tests (malaria, TB, HIV/AIDS) but major procedures are almost always referred to the larger hospitals, although students will be able to accompany patients to these.

Competency to investigate a patient - much of each day will be spent in close contact with patients and in conditions very different from those in western clinics and hospitals. Students will work with local clinical officers, nurses, doctors and visiting consultants to investigate patients.

Competent to manage a patient - the students will be involved in follow-up procedures and visits, advising patients on use and dosage of drugs, and overseeing mothers through prenatal, birth and post natal counselling.

Competency to give advice on health promotion and disease prevention - many of the patients are suffering from endemic diseases and conditions specific to an impoverished and largely unsanitary environment, where tropical diseases are prevalent and education levels are low. Students are involved in giving advice to patients at all time, especially on issues of sanitation, hygiene, baby care and nutrition. The clinics are also voluntary testing and counselling centres for HIV/AIDS, so students can be involved in giving advice to the community on issues of testing as well as on contraception and STDs.

Competency in communication skills  - this is perhaps the most important skill for students dealing with patients from such a different culture and with a low level of education. Students will find that communicating properly and clearly is vital to doctor/patient understanding. Students will learn from the local staff how important this is, and how to modify their approach to a level which the patients will understand. Students will go on many home visits into the slums with bread and milk, to monitor patients. Their building up of trust and communication with the patients will be vital to the patients’ recuperation and welfare.

Competent to retrieve and handle information - students will be able to involve themselves in administration of the clinic to some extent and obviously to keep patients records, but there is little opportunity for research other than what the students bring themselves.

General Advantages to be gained from the placement

Understanding of social, basic and clinical sciences and underlying principles
Through daily interaction with patients in such a specialised and unique environment as a shanty town in East Africa or a hospital in Kathmandu, students will find their understanding of social principles challenged and the importance of basic clinical sciences forced home in a very practical and often emotional way, simply because of the cultural and environmental differences.

Appropriate attitudes, ethical understanding and legal responsibilities
Similar to the above, students will find themselves approaching the ethical side of clinical practise in a new way, which will only reinforce the need to act responsibly and have the appropriate attitudes. In a society where ethical protocol is often compromised by a lack of resources, poverty and socio-economic realities very different to those in the West, students will find their approach to these issues challenged.

 Appropriate decision making skills, clinical reasoning and judgement
Again, in a society where clinical judgement and decision-making is often dictated by practical resources at hand and the problems of mass poverty, lack of education and even basic Governmental support, students will learn to approach medicine on a far more basic level, without the huge support network that we have in the West. This is done through extensive patient/doctor contact, specific counselling and advice-giving.

Appreciation of the role of the doctor within the health service
Since most developing countries do not have a national health service, and even their governmental health support is rudimentary at best, students will discover the importance of the doctor in such a community where one doctor could be responsible for up to 100,000 people. In Nairobi alone, with a population of several million, there is just one paediatric consultant attached to the main State Hospital. There is no doubt that students will come away with a vastly enhanced knowledge of the sheer status of the educated person and 'Daktari' in Africa or Nepal.

Aptitude for personal development
Aside from the obvious steep learning curve that students experience in the clinic itself, there is the additional benefit of living within the community itself, and discovering the reality of life in such places, which is noticeably different (if not completely opposite) to the Western perception. The back-up, support and social assistance given through Adventure Alternative is based on Gavin Bate’s fifteen years of experience of living in Africa and Nepal. Students will find that every day brings a raft of new experiences. These will often be highly emotional as, faced with conditions often only seen in text books, and set in the environment of poverty and social or human rights issues, students find their own morals and principles challenged and hopefully reinforced