Affordable Medical Electives Do Not Exist. Wrong. Having spoken to hundreds of students from diverse health backgrounds covering nursing, health and social care and medicine and human biology we have pulled together some of the main concerns and perhaps some myths that still exist surrounding your health elective abroad.
Contrary to popular opinion, low cost cheap medical electives are possible. You do not need to spend thousands of pounds for two weeks observation in a hospital. There are a wide range of affordable medical electives if you do your research. For example, Original Volunteers offer a hospital placement in Ghana £260 for 2 weeks accommodation and supervision.
An alternative option, although possibly more time consuming, is to contact a hospital directly. Do not expect the hospital to help you find a hotel or home stay though, you should make your own arrangements at least for the first couple of weeks. It will be easier to find more permanent arrangements after you have settled in and networked with staff.
Here are some more myths exposed with ideas for your medical elective abroad.
You Don’t Need to Be Super Experienced
Did you know that junior nurses in southern Uganda are considered fairly well qualified if they have general school leaving certificates which are equivalent to GCSEs in the UK which are taken at sixteen years old.
This means pre-University and first year nursing and medical students may find they already have plenty of knowledge and skills ready for their elective. You may even find yourself in a position to pass knowledge on to junior local staff, although you may want to exercise subtlety and diplomacy when passing your knowledge on to prevent causing offence or embarrassment.
Hands-on Experience Might Not Be Guaranteed
Most hospital elective programmes which have been operating for awhile (ask your organisation how long they have been organising electives ) should be able to provide you with supervised patient-care experience. However, from the most expensive programmes to the free opportunities, direct patient-care may not always be offered.
Make sure you know what type of experience is offered, whether it will be mostly work shadowing a consultant on his ward rounds and sitting in on patient consultations or if you will be hands on alongside staff caring for patients. Sometimes clues can be found in the photos. Group of fresh relaxed looking students in white lab coats standing around a doctor in a ward (probably publicity shot for the company website)? Or sweaty student in scrubs smiling enthusiastically next to junior hospital staff or holding new borns?
If your organisation or hospital only offers work-shadowing on ward rounds and consultations or there is a language barrier getting in the way, ask about opportunities in the maternity unit. Maternity departments offer a wider range of experiences, are never very hands-off and language barriers less of a difficulty in the context of childbirth.
Expensive Elective Programmes May Not Be Ethical
Aggressively marketed organised electives in poorer countries tend to be offered in larger teaching hospitals which will be experienced in offering a timetable of work shadowing and tutorials on local health with mentoring by experienced physicians and consultants.
This does not suit everyone who may feel like they are back at University or College, distanced from patients and there may be some ethical questions to be asked about why such a structured programme is available at all when strictly speaking the staff should be by all accounts overworked and underpaid with no time to go off to run a tutorial class for voluntourists.
The availability of senior staff may be an indication that the hospital is not overstretched or that the hospital may be private. Perhaps more worryingly will be that they are willing to provide their time in return for the high fees paid by medical elective students rather than care for patients. However, a word of caution, when the average doctor’s salary in Africa is £1500 ($1700) per month, the appeal of an extra two months wages from a small group of medical elective students might be more easily understood if not agreed with.
Over-stretched under-resourced hospitals, patients lying two to a bed, staff muddling through an endless stream of patients with their foreign volunteers at their side helping with every day care as if in a disaster zone, except it isn’t, it is just a busy hospital in Africa. This is what helping should be and also where you will learn more. At the end of a two week placement you should be feeling like you have been through a six month placement.
If in doubt about any organised elective experience you are considering, ask to speak to previous volunteers and find out how much time was spent on the wards.
You Will Need To Organise Your Own Visa
Your hospital or sending organisation is not generally able to apply for the visa for you. It is also not uncommon for visa rules to change every year.
6 weeks before travel, find out what visa is currently recommended and the visa category previous volunteers have entered with. Ask the Embassy or Consulate in advance if any supporting documentation is required from yourself, your organisation or the local hospital or sponsors and allow extra time for this, especially if this is needed from the hospital team.
Although you may be officially required to have the correct visa for a hospital or community placement, depending on your destination, region or hospital, a tourist visa may be acceptable if you are not receiving a wage, or officials alternatively may not check or may be prepared to turn a blind eye.
Visa costs vary between £50 and £100 and some countries require you to visit the Embassy or Consulate in person for an interview or fingerprinting before issued so budget extra for any additional trips you need to make.
You Don’t Need To Stick To The Hospital To Help
In a developing country there will be plenty of opportunities to contribute first aid help to local people who cannot access a local nurse. Ask your elective organisation before travel what additional opportunities are available and if anyone will be able to help you to organise these.
With the smallest amount of confidence and a few first aid supplies it is straightforward to set up one-off health checks in relevant settings. Volunteers have visited poorer infant and primary schools and the tiniest of rural clinics to assist the local community nurse.
If you do not have the benefit of a local volunteer organiser to help you set this up, ask if your hospital has outreach nurses you could join, speak to your host family or visit the local free school. If you come across anyone needing to be referred to local services you might want to be aware of the cost for the patient to do this.
Many people will be too embarrassed to admit they cannot afford to visit a doctor or even if it will be free, that they know they will not afford the prescription they will be offered which could be as much as 20% of the family’s monthly income. It may be sensible to find out the fees for consultations are, the cost of a typical prescription and what wages and the cost of living is. You may like to consider offering the £5 or £20 treatment costs for any special cases you come across, it really can be that low.
You Need A Special List of What To Take
For the hospital? Take everything you can squeeze in to your luggage! It will all be used. One year in the Atibie hospital in Eastern Ghana they had one pair of rusty umbilical cord scissors for the whole maternity department. Another year there were no sterile gloves, another year no aprons.
Ask your hospital what they can spare, and do a little cash fundraising amongst your colleagues for the extra charge for luggage allowance.
For yourself? If you are not wearing scrubs or your uniform from home then it is essential to wear a set of clothes which will help identify yourself to patients as a uniformed member of staff. Dark office style trousers or skirt and a clean white shirt or polo shirt with a collar. A box of plastic aprons and sterile gloves essential.
Your Hospital Won’t Care For You If You Get Ill
Many underfunded hospitals in developing countries refuse care for their foreign staff when they fall sick. It is not because they don’t care.
Some hospitals in rural Tanzania for example will turn away any volunteer without notice who shows signs of a temperature or headache in the worry their limited staff will need to care for a volunteer with malaria.
It is assumed their foreign volunteer would always have arranged medical travel insurance which will pick up the pieces for them in a private hospital elsewhere.
They will also assume the volunteer wanting to make a difference, would not want to take up a bed space in a poorer hospital of a local person who needs it more.
You Will Need To Prepare Your Own Health
Check you know what the recommended vaccinations are for the country and region visited. For example, some countries may be listed as malaria-free zones yet have border jungle areas where the risk is high. In the UK the NHS website Fit For Travel provides comprehensive jargon-free advice for travellers including at-a-glance malaria maps.
The MDU offer elective-specific advice on staying healthy including advice on malaria and HIV prevention.
The British Medical Association have produced a leaflet on how to organise and prepare for your elective if you are organising one independently, although it contains useful advice for everyone.
You Can Bring Ideas Home
Surprisingly, elective volunteers often bring back something they can put into practice where they work at home. This could be something personal like greater patience or a particular technique. For example, whilst midwifery students in Africa may find some practices unsettling to a western eye, others could be replicated or trialled back at home.