The Phase 3 Medicine student won the 2019 Medical Students’ Aid Project Electives Photo Competition with his picture “Simba” featured above. He reflects on his elective experience at the foothills of Mount Kilimanjaro.
Tell us about your elective term? Where did you go?
My medical elective was at the Kilimanjaro Christian Medical Centre (KCMC) in the developing country of Tanzania. Located on the foothills of Africa’s highest peak – the snow-capped Mount Kilimanjaro, KCMC is a tertiary referral hospital in northern Tanzania. As such it is required to provide healthcare for over 15 million people in the northern, eastern and central zone of Tanzania as well as patients from the southern parts of Kenya.
For four weeks, I was attached to the Emergency & Casualty Department. This is the first stop for every patient, emergency and non-emergency, who comes through the hospital. I had the opportunity to witness the wide variety of patients who access treatment in Tanzania’s healthcare system.
What were some of the key highlights of the experience?
It was a humbling opportunity to be able to witness first-hand and assess the complications of the different pathologies that I had only ever read about in textbooks. Due to factors including poor access to clean water and sanitation, limited access to health care services and low health literacy, I saw numerous presentations of poverty-related illness including malaria, schistosomiasis, tuberculosis and HIV/AIDs. Chronic diseases were often more advanced and displayed pertinent signs of being in the late-stages of disease.
The hospital chapel was located right outside the Emergency Department and every afternoon the sounds of gospel music from the church choir would flood through the ED department whenever the ED doors swung open. In an environment with so much sickness and disease, the music was beautiful and uplifting. We found out that one of the intern doctors that we were following would sing in the choir on his day off.
Doing an elective in a country as beautiful as Tanzania meant that we could easily take afternoon or weekend trips to experience the diverse culture and dramatic landscapes that the country offers. On a safari of Tanzania’s Northern Circuit, I was ecstatic to see the Big 5 – lion, elephant, buffalo, rhino and leopard, among countless other animals. Another highlight was climbing to the summit of Mount Kilimanjaro. This was by far the greatest mental and physical achievement of my life.
How has this experience influenced your degree work?
Comparing the healthcare system in Tanzania has given me a greater appreciation for the Australian healthcare system. Working in a metropolitan Sydney hospital with so many medical resources and interventions readily at your disposal, it’s easy to forget how far Australia has come in offering universal healthcare and the cost that it has on society. Economic and systemic factors can be barriers for equitable and compassionate health care. Therefore, as medical professionals we need to be advocates for our patients and their health on a broader systemic level. Furthermore, it is important to recognise methods of relieving the financial burden of healthcare through cost-effective interventions such as primary care, health promotion and disease prevention.
My experience in Tanzania has also taught me the importance of adapting my clinical assessment and management when information and resources are limited. I have learnt the importance of carefully considering alternative investigations and make clinical judgements that factor in pre-test and post-test probability. Ultimately, clinical decisions need to be made considering a holistic understanding of the patient, their concerns and their context. Hopefully I will be able to continue developing these skills so that I can become a better doctor, even when I am practising in areas with limited resources - whether that be rural, remote and Indigenous communities or overseas.
How you were able to get that fantastic photo?
The photo of the young male lion was taken on the third day of our Safari. We were on our morning game drive through the famous plains of Serengeti National Park after having camped there the previous night. We were actually on our way to see a leopard that had been called in when we stumbled across this lion sitting atop a mound of dirt, overlooking the surrounding grassland. The lion stared at our Landcruiser as we approached but did not move even when we rolled up right beside it. Our guide David said that the lion was probably quite tired from a recent hunt, given the fullness of his stomach and how heavily it was breathing. As I snapped the photo, I remember noting the heavy stench of wild lion that had suddenly filled the Landcruiser.
Would you recommend an elective like yours to other students?
Doing an elective in a Tanzania was truly a fulfilling experience and I would highly recommend it. Whether you want to learn more about obscure pathology, experience a culture change or you have a passion for global health seriously, take the opportunity to do your elective in a developing country.
The UNSW Medicine Elective Term is a compulsory component of the UNSW undergraduate medicine program for students in their final year of study. Phase 3 medical students can choose to partake in a medical placement in Australian or overseas. Some students, like Terence, may choose to do it in a developing country.
The Medical Students’ Aid Project (MSAP) is a student-run charitable global health group at UNSW who connect and empower students to positively contribute towards healthcare equality through educational events, fundraisers, and by supplying grants to students for the donation of medical supplies to hospitals in developing countries through the Elective Aid program. Terence entered and won the 2019 Electives Photo Competition. See the 2019 photo entries.