Jess Oliver
Tanzania
Zanzibar (Mnazi Mmoja hospital)
Speciality – paediatrics and maternity
30.05.22-24.06.22
My elective last summer has definitely been the highlight of Medical School so far for me. We’re offered a unique opportunity to see healthcare in a completely different setting if you go abroad as I did, or really immerse yourself in a speciality you love whilst staying in the UK. I loved going abroad and the Turing Fund which I applied for through my university really helped with the finance side of things. I found it a completely different experience to just going on holiday in a country as you are really accepted into the community and treated like a local. Whilst its great to get good clinical experience out there, sometimes this can be challenging with the language barrier and opportunities available, so the most important thing for me was to have fun and embrace the different culture and what I could take away from the experience.
I did the first half of my elective in a public hospital in Stone Town in Zanzibar, which was a far cry from what I was used to in the UK. The beds often had two people staying on them, with just a plastic sheet covering the foam ‘mattress’. When I did Paediatrics ward rounds, there were around 20 local medical students packed into a side room all craning their necks to hear what was being said by the doctors and patients. However the consultants on the ward round taught the students as they went along, and although Swahili is the first language on Tanzania and the patients were speaking it, all the medical students wrote their notes in English and often the consultants taught in English too. I often picked up the notes of the bed that we were heading for next to have a read before the ward round reached there so I had an idea of the background of the patient. Clinics were overrun with patients and we had to find any space we could to do the consultations, often perching on the nurses desks with patients not doctors having a seat or a private area to do the consultation. However the doctors usually found time in-between appointments to explain what the patient had said, as often only the bare minimum was written down in English in their notes book. It was a challenge not being able to speak to the patients due to the language barrier but even just smiling at a child brought in by their mum created a bond. I was exposed to a multitude of heart conditions which wouldn’t be seen in the UK very often at all and listening to these children’s heart was also good clinical experience.
The maternity ward was also a very novel experience for me - on my first morning I watched a 12-year old have a caesarean section, with very minimal counselling beforehand and afterwards even though she was clearly terrified. The women in these wards had no support from their partners and were sent home just hours after their birth with their newborn on the public bus. I saw a lot more births than I have seen in all of my medical training and I enjoyed holding the babies after the birth as usually the mothers’ did not want to hold them.
I was in the hospital from 8am to midday every weekday which I thought was a perfect amount to experience what it was like in the hospital but also left me time to do other activities around the island. Overall it was a very eye-opening experience seeing healthcare in a developing country where the resources available were very different from in the UK. I wasn’t able to communicate with the patients as much as I wanted due to the language barrier, however it is a great way to work on non-verbal communication skills.
Zanzibar is a small island off the coast of Tanzania, which you can reach by flying to Dar Es Salaam on the mainland then either getting a boat or a flight to Zanzibar which will take you to Stone Town. It is the most populated area on the island and the least touristy. As well as numerous beachside cafes with fresh juices, you can visit Prison Island, go on a sunset tour, do a cooking class, get a boat to a sandbank and visit Freddie Mercury’s house. Everything was very cheap, with a meal in a restaurant costing less than £3. On the weekends I visited different areas of the island by the local bus called ‘dala dala’ which again was very inexpensive. I went to Paje for windsurfing and kite surfing on the east side of the island and Nungwi in the North which is famous for its stunning white sand beaches, snorkelling with dolphins and Full Mood Parties. I also took an extended weekend to do a safari trip on the mainland, which was the best experience of my life, it is expensive (£800 for a 4 day trip) but definitely worth it if you are able to. Zanzibar has a higher Muslim population than on mainland Tanzania so make sure you are prepared in terms of clothing that is suitable and provides coverage.
My experience of applying for my elective was a little different to normal due to COVID meaning a lot of countries were on the red list at the time. I found the electives.net website really helpful to search by country and then find a list of hospitals which had email addresses on which to contact them by. I did receive a lot of ‘no’s’ and a lot of no replies also, so I would suggest firing off as many emails as you can to increase the chances of getting a positive response. If you have family/friend contacts you could use then these would also be good to make use of. Once I had a few positive responses I went about deciding where I would like to go and these are some of the points that I considered:
- The location of the hospital: is it rural or in a town/city where it would be easier to activities in my spare time?
- How much are the hospital asking for to do the elective per week?
- What language does the country speak and how well will I be able to communicate with people?
- Where are my friends going/will I know anyone else out there?
- What is my budget for the elective: how much will food/activities cost in each country? What will the cost of a return flight be?
- What kind of things do I want to do in my spare time (e.g. a mountain trek)? Is it near another country I would like to travel in after/before?
The timeline for the elective from emailing your first hospital to having it confirmed is a reasonable amount of time, however with hospitals often taking a few weeks to reply to emails it can slow things up. After my elective was confirmed, I went ahead and booked my plane tickets to ensure the lowest price I could possibly get. I then looked at the vaccinations I needed for the country and was aware of these before I attended my infectious diseases appointment at the RVI organised by the medical school (don’t leave this to the last minute as sometimes it takes multiple appointments to receive all the vaccinations you need). Accommodation is often provided for you by the hospital which is usually with other people from around the world doing their electives also so this is a good way to meet people. If accommodation isn’t provided then you could consider getting an Airbnb or a hostel for your time there.
I would really recommend Stone Town as a place to do your elective because of the vast travelling experiences whilst on an island, the opportunity to do a safari and the fact that English is the second language so you can communicate with the doctors and other medical students as well as the locals.
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