Applying for an elective can be a daunting task, where the world really is your oyster! For me, a number of criteria narrowed my choices to the Caribbean and then Saint Lucia.
I wanted a country with great weather, where English is the main language, and one that was not developed, but not completely developing. Saint Lucia gave me the best of both worlds of the Caribbean islands, being large-ish in size but small enough to visit almost all areas, along with a good safety profile and a reasonably-sized hospital of roughly 200 beds.
More than meets the eye
Saint Lucia is in some ways just how you'd imagine, but in other ways not. True, in parts it's just as it is in the holiday brochures – a beautiful island with a laid-back way of life and idyllic sandy white beaches.
However, maybe naively on my part but very surprisingly, there is still a fair amount of hostility and feelings of resentment on the island towards the British and its tourists due to the days of British colonisation, up until 1979. This is something that most tourists will not experience in the all-inclusive resorts. However, after finding that you work at the hospital, locals are mostly welcoming and friendly, pleased that outsiders are helping the island.
My time at Victoria Hospital was split between paediatrics (three weeks) and the emergency department (one week). The placement provided an excellent opportunity to see patients with conditions rarely encountered in the UK, such as sickle cell disease and thalassemia to name a few. A typical day in paediatrics would involve mostly ward rounds that would finish by late morning; the emergency department involved mostly clerking patients all day.
Being on the wards took a little bit of adjusting to and was much less regimented in comparison to the UK. There would always be a morning ward round, but the time it would take place would be variable! The children and their families were extremely happy to chat to us about their hospital stay, and the consultants leading the ward round would often give us teaching and encouraged us to pick up clinical signs.
The placement provided an excellent opportunity to see patients with conditions rarely encountered in the UK.
An interesting case
There were two particularly memorable cases which presented during the paediatric placement – the first, a young infant with congenital lupus and the second, a newborn with congenital syphilis. Both conditions are extremely rare in the UK, so seeing them was educational. What I found particularly interesting in the case of congenital syphilis was the stigma attached to finding that the disease is transmitted maternally to the newborn following previous sexual transmission.
Patient education in Saint Lucia is not at the forefront of healthcare provision and neither parent knew anything about syphilis and wanted to know how their baby had contracted it. After being told the route of its transmission, both presumed it was a disease similar to HIV, the only sexually transmitted disease they were aware of, and presumed that the life expectancy of their newborn would be greatly reduced because of this. It was certainly a stark contrast to the system in the UK, with sexual health education and specialist clinics being provided nationally.
Patients often had little understanding of their conditions and how they could help themselves, leading to frequent hospital visits.
Although the healthcare system in Saint Lucia is not privatised, patients still have to pay for basic investigations and treatments, something which was quite difficult to accept when patients could not afford the healthcare needed. The doctor-patient interaction was completely different to that in the UK – a more paternalistic approach was taken by the doctors, with a hierarchical feel. This, at times, was also transferable to the doctor-student interface, where not all seemed enthusiastic to have overseas students.
Patients often had little understanding of their conditions and how they could help themselves, leading to frequent hospital visits. It certainly highlighted the importance of patient-centred care and education, something which the UK actually seems to provide very well in comparison, and an important lesson for future practice.
The island itself really does have so much to offer, with activities to suit everyone. It's an obvious choice for sun worshippers, but also great for active types with water sports, zip lining, boat trips, guided walks up the island's volcano, and a weekly street party, Caribbean-style, for those who enjoy their nightlife! The island has a good safety profile in comparison with the other Caribbean islands, with mostly petty crime being reported.
Despite this, I would probably not recommend doing an elective programme in Saint Lucia as a lone individual. Travelling together in groups is recommended, particularly at night, where the capital, Castries, often felt unsafe after dark.
If you are looking for a placement that is 9-5 with more hands-on practical experience, then Victoria Hospital is probably not for you, as your role within the hospital is more of an observational one. However, if you are looking for a programme that is more balanced, with the opportunity to simultaneously experience the healthcare of a developing country and also its culture, then Saint Lucia is a place you should most definitely consider.
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