Alexandra Victor - my elective experience

The clinical elective is one of the highlights of the MBChB course here at Birmingham Medical School. At the end of the 5th year, you are allocated a month do 'something that means something to you' – and it can be anything you like!

Students often take the opportunity to organise a medical placement abroad followed by the holiday of a lifetime – not bad considering it’s part of your University course. The placement is decided entirely by the students themselves and can be anything from air ambulances in Australia to trauma surgery in Canada.

This diary entry is from Alexandra Victor, a current MBChB student at Birmingham Medical School, about her elective at the Mnazi Mmoja Hospital in Zanzibar, East Africa. 

As part of the medical course at the University of Birmingham we are given six weeks straight after our 4th year exams where we are able to do a placement project anywhere in the world! Around half of students choose to do this at a hospital in another country, and use some of this opportunity to travel around after!

As I had previously had a gap year where I had been able to travel to Australia, New Zealand and South East Asia – I knew that I loved being exposed to different cultures and environments, so this was very important to me when choosing where I did my elective. In the end I choose to do my elective in Zanzibar, which is located off the East African coast of Tanzania. Zanzibar is one of the poorest countries in sub-Saharan Africa with a large majority living in poverty and the life expectancy 20 years less than back in the UK.

I attended Mnazi Mmoja Hospital (MMH) in Zanzibar; this is the main hospital on the island and receives referrals from patients across the island. I went with five friends, all fellow students, that wanted exposure to different things while on placement here. I spent most of my time on the Male General Medical Ward and in various Out-patient Clinics.

As imagined there was a massive disparity between this hospital and the hospitals back here in Birmingham. The hospital itself was situated on the idyllic coastline of Zanzibar with many of the wards having a beautiful sea view, however this was juxtaposed with the mayhem of the wards themselves. Many wards were packed full with patients with some of the women on the Obstetrics ward having to share a bed while they waited to deliver their babies or recovered after delivery, the regulations on ward hygiene and health and safety were very relaxed with multiple emptying medication bottles, emptying fluid bags and used sick bowls scattered around the wards.

To exacerbate this overpopulation in hospitals, there was a shortage of doctors working at the hospital with less than 1 doctor to every 20,000 people on the island, the hospitals relied a lot on foreign doctors coming over and volunteering at the hospital. I was taken under the wing by two Norwegian doctors volunteering in the hospital where they showed us around the hospital and helped to communicate what was going on during the ward rounds. The communication barrier was a major problem with the majority of patients only being able to communicate in Swahili, so the other medical staff had to be used as translators. This sometimes led to miscommunication and meant that the doctors were unable to take a full history as this would be too time consuming.

One example of severe miscommunication, was a case involving a 19-year-old boy who had acute kidney failure. When he arrived at the hospital he had severe swelling of his legs and was unable to walk. He was put on a high dose of steroids and the Norwegian doctors stressed the importance of continuing the steroid medication and regularly moving the patient to prevent any pressure sores from forming. However, when they returned to the ward after the weekend, the patient had not been given his steroid medication for 2 days and had started to deteriorate as well as developing a pressure sore on his lower back. There were times like this where the medical placement was quite difficult and I thought it was important that I was with friends going through similar experiences so we could exchange stories and support one another if we had a bad day.

Overall there were many highlights of the placement with exposure to a wide variety of rare tropical diseases that you would never see back in the UK and being able to take on a much more hands on member of team – where one of my colleagues was able to deliver a baby during her time in the hospital which she described as a life changing experience. Many of the patients were very thankful with any help you could offer so even just offering them some basic moisturising cream for their dry legs or some antibiotics to clear their chest infection left you feeling like you had invented the next cure for cancer!

Zanzibar in general had amazing culture, I was there during Ramadan and as the island is predominately Muslim the majority of shops, cafes and restaurants were closed during the daytime – however as the sun came down the island came alive with everyone coming out on to the streets to break the fast together. My friends and I were staying at a homestay in Stone Town and the lady running the homestay was so friendly and hospitable that she invited us to her evening meal every night where she served up an array of authentic Swahili dishes which could have fed a whole village– some more to my palate than others! One particular favourite was a banana and pork coconut milk curry which I couldn’t help but go back for thirds of! One evening she invited the local orphanage round for dinner and we were able to sit and chat with the children and help them practice their English. Being able to live with a local family and experience their culture was an amazing experience. 

After my placement was finished my friends and I grabbed the ferry over to mainland Tanzania where we joined a large G-adventures tour through southern Africa. Here we were able to go on multiple safaris and see the wonderful animals that Africa has to offer in their natural habitat. A highlight for me was a campsite we stayed in, in Namibia which overlooked a watering hole where the animals would visit to get a drink. You could sit in the campsite overlooking the watering hole for hours and watch the families of elephant messing around in the water and the herds of zebra trotting down to have a night-time drink. At the end of tour we had a few days to relax in Cape Town before flying back to Birmingham to start fifth year refreshed and with many stories about all of the wonderful and sometimes upsetting things we had seen.

Please note: Alexandra completed her elective at the end of year four, this has now changed to the end of year five.