Like many medical students, I wanted to use my elective to gain valuable experience in an area of medicine I'm most interested in.

Emergency medicine is an area I'm considering for my future career, so I was advised South Africa would give me lots of hands-on experience. I also wanted to use my elective as an opportunity to visit more than one country. With Cape Town confirmed for a month, I looked into where I could do my first month within Africa.

After a lot of research, I decided to go to Zambia. There are lots of beautiful sites I was keen to see in the country. Zambia also runs a mixed public and private healthcare system, which would be interesting to observe. There wasn't an option for elective students to do emergency medicine, as it's not a specialty in Zambia like it is in the UK. I selected general surgery, hoping for interesting pathologies and first hand opportunities. I certainly got those in abundance.

Learning about general surgery in Lusaka, Zambia

My first stop was a hospital in Lusaka, the capital city of Zambia. We weren't sure what to expect, turning up to on our first day at the dean's secretary's office. The whole process of organising my elective in Zambia was far too easy, so some part of me expected us to turn up and the hospital to have no idea who we were or why we were there!

Intensive care, Lusaka

Photo credit: Alice Gwyn-Jones

Most ward rounds on general surgery involved a visit to ICU. Compared to the rest of the hospital, the ICU felt most familiar to my experience of the ICU back in the UK. However, compared to my experience of ICUs in the UK, there was less sedation used on intubated patients.  Just oropharyngeal airways were used with an endotracheal (ET) tube to stop the patients biting down onto the ET tube and obstructing their airway.

One patient really stood out for me; a doctor who had an ischaemic leg. It was too late for treatment and unfortunately the leg needed to be amputated. During this operation and subsequent treatment, the patient suffered a stroke and was left with minimal neurological function. It was too early to determine how much was lost.

This patient was on the ICU for the entire length of our stay, so I don't know what happened to them. It made for a heart-breaking ward round every week, especially as they had suspected something was wrong earlier based on the signs and symptoms of such a serious pathology.

Emergency theatre, Lusaka

Photo credit: Alice Gwyn-Jones

We also spent a lot of time in emergency theatres, where many patients had been involved in road traffic collisions. The WHO says globally more people now die as a result of road traffic injuries than from HIV/AIDS, tuberculosis or diarrhoeal diseases.

This is particularly high in Zambia. Data from 2013 indicates Zambia's road traffic death rate is 24.7 people per 100,000 population. In comparison, the UK's road traffic death rate was 2.9 people per 100,000 population in the same year.

It made me think about the role poverty plays and how we take for granted our ability to access healthcare within minutes of medical problems arising, not months or even years.

General surgery ward for women, Lusaka

Photo credit: Alice Gwyn-Jones

This is a general surgery ward for women, quieter than usual. Beds were often close together because of the lack of space. This also meant it was also hard to have privacy.

My placement in Zambia was definitely an interesting experience. I was able to see pathologies no textbook image could accurately convey. The length of time patients left their injuries and illnesses before presenting to hospital was the most shocking. It made me think about the role poverty plays and how we take for granted our ability to access healthcare within minutes of medical problems arising, not months or even years.

On to emergency medicine in Cape Town, South Africa

Zambia was a great insight into a different type of healthcare system, as well as allowing us to get hands on and clerk patients in the surgical assessment unit with pathologies I'd never seen in real life, but only heard about. My next stop was Cape Town in South Africa to work in a trauma unit.

Alice outside her placement in Cape Town

Photo credit: Alice Gwyn-Jones

Here I am on the first day of placement, ready with my new name badge outside the hospital.

After only a week of being on shift in Cape Town, it was time to get stuck in, straight into removing this bullet from a leg. Luckily the bullet only created a superficial wound so we were able to take it out under local anaesthetic in a side room.

Bullet extracted from patient leg, Cape Town

Photo credit: Alice Gwyn-Jones

Suturing up the incision we had made, we left the entry wound of the bullet open so any infection could drain, and gave the patient clear instructions for cleaning the wound before being discharged.

Trauma unit, Cape Town

Photo credit: Alice Gwyn-Jones

The trauma unit was usually packed so this is surprisingly quiet. It would often take five minutes just to walk to the other side of the unit, having to squeeze between the patients, jump over chest drains and move at least three patients on trolleys out of the way just to get through!

My placement in Cape Town was a whirlwind. It involved a lot of quick thinking, like setting up and handling patients with severe trauma without being guided or stabilising patients until the doctors were free to help treat them.

The sheer volume of incidents of trauma in Cape Town blew me away despite what I had been told beforehand. Hundreds of patients came through the door in the four weeks I was there, with gunshot wounds, stabbings, community assaults and road traffic collisions.

Enter the MDU photo competition at themdu.com/photocomp

Work hard, play hard

An elective isn't just about being in the hospital. There's a chance to use your time off to explore the country. We used our weekends to explore the beautiful places we were in.

While in Zambia, we were able to escape from the capital for a weekend to go down to Livingstone. An adventure-filled few days involving white water rafting on the Zambezi and bungee jumping off the bridge over Victoria falls.

Photo credit: Alice Gwyn-Jones

After a horrendous 12-hour bus journey, we reached South Lwanga National Park. Staying at a lodge just outside the national park didn't stop any of the wildlife from stopping by. This bull elephant decided to join us in the bar for a beer one afternoon. The most magical time of game drives, checking for hippos before leaving our tent and visiting the local community who seriously tested our dance moves.

My elective surprised me. Not only did I witness lots of pathologies I'd only seen in textbooks, I learned about how different societies supply healthcare, with different patient needs and pressures on resources. It's an experience that will stay with me for a long time as I continue to train to be a doctor.

Planning an elective? MDU student members can also access our free downloadable guide to elective planning to help create a memorable experience.

MDU student members have exclusive access to TEN, the ultimate online elective planning resource.

Have you been on elective recently? Did you take a photo that captures the essence and experience of your time there?

The MDU elective photo competition is open to all student members enrolled at a UK medical school. Send your photo, along with a brief description of the scene and location, to photos@themdu.com.


This article was correct at publication on 04/11/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Alice Gwyn-Jones

Alice is a final year medical student at Keele University. Prior to doing medicine she completed a medical biochemistry degree at the University of Birmingham. Outside of medicine, Alice is a keen scuba diver and is an instructor in her spare time. She hopes one day she can combine her passion for medicine and diving. Wanting to pursue a career in emergency medicine, Alice is planning on returning to South Africa in a few years time to gain more experience prior to speciality training.

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