I chose to undertake my elective at the Royal Darwin Hospital, Australia. Australia appealed to me for my elective as I had previously travelled around the country and enjoyed the lifestyle and opportunities the country has to offer. Looking to the future, as I feel Australia is a place I could see myself working and living in, I wanted to experience the healthcare system to get a sense of what working as a doctor in Australia would be like.

I also wanted the opportunity to experience aspects of medicine I would not encounter elsewhere in the world, in an area of medicine I had not yet experienced where I am studying.

I used The Electives Network to have a look at the reviews of students who had done their elective at the Royal Darwin Hospital. All the reviews were very positive, which was a large factor in why I chose this elective. I also found useful advice on accommodation and how to apply to the programme.

Darwin is the main city in the Northern Territory state of Australia and its surrounding area has a large population of indigenous people. The diverse population was one of the main reasons I chose this location for my elective. I was also keen to have a placement in paediatrics, as at my university we don't get our paediatric placement until final year and it's a specialty I am interested in.

Meeting the locals

I was placed with the community paediatrics department in Darwin, which provides outreach paediatric services to many remote Aboriginal communities. As a result, I had the opportunity to go on outreach trips to indigenous communities with the team. Some of these communities are very remote and require small aircraft to reach them.

Once you arrive at the community, a typical day includes firstly being introduced to the local healthcare team, such as the administrative staff, nurses and Aboriginal healthcare workers. The clinic would then start as soon as the first children arrived. I had the opportunity to examine the patients, talk to their families and discuss with the doctors their diagnosis, investigations and management plan. I was also able to sit in with other health workers, including specialist nurses.

New experiences

I saw many disease presentations which are not as common in the UK paediatric population, such as rheumatic heart disease (RHD). On one of my outreach trips I saw patients who were on four weekly benzathine penicillin G injections as secondary prophylaxis for RHD. Some of the children were on the injections for more than 10 years, so education and an understanding of the disease was of paramount importance to ensure compliance to the treatment. The children would be seen by a doctor to assess their heart and then they would see the rheumatic disease co-ordinator for more education on RHD. This included a short video in the local language on the importance of diagnosing acute rheumatic fever early, and also adhering to the prophylactic treatment. For example, we saw a teenage girl who had damage to two of her heart valves due to RHD and required counselling for a double valve replacement. 

As well as RHD, failure to thrive and behavioural problems such as attention deficit hyperactivity disorder (ADHD) were common presentations at the clinic.

All in a day's work 

When there were no outreach trips taking place I was able to join the general paediatric and neonatal hospital teams. A typical day with these teams would consist of a handover meeting in the morning, followed by a ward round. I could then join teaching with the Australian students in the afternoon or follow up cases I had seen in the morning. I could also go to general paediatric clinics which were run in the hospital. Everyone was very helpful and keen to teach throughout my placement.

The highlight of my elective was having the opportunity to go on the outreach clinic visits. There is a considerable burden of RHD in the indigenous population and I learnt a great deal about the disease and the challenges faced managing it in remote communities. The remoteness poses a real logistical challenge; to reach one community we had to go in a small aircraft to an island to deliver a specialist cardiology clinic. The outreach visits were an opportunity for me to see how healthcare is delivered in different settings and the importance of building relationships with the indigenous communities in order to try and overcome the disparity in the levels of health across Australia. 

I would definitely recommend a placement in Darwin to other students. It's not your typical Australian elective, as the patient population is so different. If you get a community placement I would recommend getting in touch with the administration and medical team a month before you go, to ensure you have done the required cultural e-learning modules, and also to get your outreach trips approved.

So much to offer

Outside the hospital the area surrounding Darwin has a lot to offer. There are amazing national parks, such as Litchfield and Kakadu, with beautiful swimming holes, hiking and camping, as well as billabongs where you might spot a crocodile!

My elective was a fantastic and immensely valuable experience. I have been fully immersed in another healthcare system and have had many opportunities which I am unlikely to be able to repeat elsewhere. I have learnt a great deal through observing and assisting in remote outreach clinics, as well as gaining practical experience on the paediatric wards in the hospital. 

With thanks to Community Paediatrics at Royal Darwin Hospital.