WMS Elective Series 2019 (Pt 2)
More from our 2019 Elective Series! We got final year members of KCLWMS to send us an account of their global electives, to inspire our current students.
Louise Aaron
St Vincent & The Grenadines
Anaesthetics
Location: St Vincent and the Grenadines, Milton Cato Memorial hospital Speciality: Anaesthesiology Application: Form emailed directly to the office of the medical director
Medicine:
Milton Cato is located in Kingstown, a bus ride and short walk from where we chose to stay near the beaches. The hospital is fairly basic with only a few wards and 3 operating theatres although they're rarely all in use. There are also loads of local students so it's quite hard to get hands on - although on the flip-side they're so relaxed they also don't mind you taking a week off here and there.
The medical wards are very good for signs that we rarely see in the UK as the patients often present late, and there are opportunities to get involved with airway management and sedation etc in theatres depending on your experience and confidence. But generally - this is not an elective to choose if you want to throw yourself into Medicine!!
Holiday/travel:
We generally did 3 mornings a week in the hospital on St Vincent and then visited different islands each (long) weekend.
Bequia is the picturesque Carribbean island with loads of bars and cafes and there's great sailing around the coast - see if you can blag a lift to the floating bar. Union island has kite surfing and you can walk to some completely secluded beaches. We watched the kite surfing show from happy island - a manmade island bar a 5 minute water taxi from the coast. It's definitely worth a day trip on a boat to Tobago cays marine park from here to snorkel the coral reefs and swim with the turtles (breakfast, lunch and all drinks included!!). It's completely isolated and absolutely stunning.
St Vincent itself isn't that touristy but there are some sights to see in Kingstown and we enjoyed going to some local cricket and football matches. We also hired a car for the weekend and walked the Vermont nature trail looking for parrots, explored a few of the best waterfalls and spent a morning hiking the La Soufriere Volcano.
After the 6 week elective I'm spending a week in Barbados with a friend and then travelling to visit family in Europe. Some students I met here are travelling in South America for 3 weeks and in hindsight it would have been a great opportunity to do a bit more exploring - definitely something to look into!
Overall there are plenty of opportunities for water sports and a bit of exploration, but it's generally a very chilled elective and you have to get used to working on Caribbean time!! Also beware the 85% rum..."
Caitlin Rea
The Himalayas
Wilderness Medicine
Part 1:
My elective story started in 2017 when I visited Nepal for the first time. I did the Annapurna circuit, trekking across the himalayas over 2 weeks and staying in tea houses the whole way. I fell in love with the mountains, the food and the people. This inspired me to start researching Nepal electives. I came across many but the one that really stuck out to me was the IPPG (international porters association) one. I applied January 2018 and went to a selection weekend in the Brecon Beacons in April 2018.
I was selected to work as a medical student alongside 3 other doctors for the pre-monsoon trekking season in Nepal. I am working at the clinics in Machermo (4470m) and Goyko (4750m). We look after trekkers, porters, guides and Nepali people from the towns. We charge tourists $50 for a consultation and we treat porters for free. We mainly are there to help treat and reduce acute mountain sickness and stop it from progressing to pulmonary oedema (HAPE) and cerebral oedema (HACE). We also want to look after porters who get sick, aren't wearing the appropriate clothing or who are carrying too much weight (more than 30kg).
We work alongside the Himalayan Rescue Association and Community Action Nepal.
We have been getting some great high altitude medicine teaching in Kathmandu. We also work with the charity KEEP who help with Porter clothing. If you are travelling to Kathmandu and have any spare outdoor gear please bring it for donating.
I have loved meeting and bonding with my IPPG team and learning loads about high altitude medicine. I will keep you updated with some of my stories in my next post! Let me know if you are interested in a wilderness medicine elective in Nepal or if you want some information on trekking in Nepal!
Part 2
I’ve been living in the Himalayas now for over 2 weeks. The team have been working out of the Machermo rescue post at 4440m. We have been treating porters for free and trekkers for a charge.
We have had some interesting cases such as a porter with snow blindness, two trekkers with HAPE and one with HACE as well as some patients with AMS and chest infections. We have had to helicopter evacuate 3 patients so far for life threatening altitude illnesses.
As well as treating patients and teaching trekkers about altitude illness prevention I have also been exploring the mountains. Everyday I climb up the ridge beside the valley and have an amazing view of Everest and the other 8000m+ peaks.
Although we have no running water or heating and it’s -15 outside and inside- the spectacular mountains make it all worthwhile.
Callum Johnstone
Banff, Canada
General Practice, Urgent Care, GUM
Location: Alpine Medical Clinic, Banff, AB, Canada. Speciality: 4 weeks in General Practice/Urgent Care/GUM Application: Contacted the clinic via KCL Elective abstracts.
For my elective I went out of my way to find an elective location where I could do medicine in the weeks and ski on the weekends, and boy did I!
Banff is a small tourist ski resort in the middle of the Rocky Mountains in Canada, it’s a bustling place full of tourists, friendly locals and half of Sydney's under 25s.
I contacted the clinic directly 15 months ago and was lucky to get a place there and then, I only had to pay for my rent out there ($600) (which I arranged through a contact at the clinic) but it is a similar price to stay in one of the many local youth hostels.
The medicine is varied, the clinic is a walk in centre so sees everything from coughs and colds, to ski related injuries and has a big focus on sexual health. For someone who didn't have the best 4th year women's health placement this was the perfect place to gain the experience I wasn't able to get in London by clinical staff who were very keen to get me involved. The teaching was hands on and the supervision was as intense as you made it, they were very keen to get me in clinic whenever I wanted, but also happy to give time off to ski if I asked for it! I was able to suture wounds and fix breaks I'd never done back in the UK and it was great!
And the real reason I was there, the skiing!!! Banff sits between 10 and 45 minutes free bus away from 3 large and varied ski resorts, for those looking for big wide, long pisted runs go no further than Lake Louise!! Those who want big backcountry off-piste need to bring their avalanche beacons and shovels and head off to Delirium Dive in Sunshine Village, a 500m vertical cliff off the back of the resort which once the initial steep sections are done opens up into a stunning untouched powder bowl! It's champagne skiing for those who can reach it! Just bring your avalanche beacon or they won't let you through the gate!
The town is lively and fun, lots of people the same age looking to make friends and meet new people, it's easy to fit in and join groups. However, as a small town clinic you'll have to accept that you'll see you patients in your favourite coffee shop and expect the odd strange looks and blushes!
Exploring Canada is a must afterwards, I spent a week in Whistler skiing some more after I left Banff and I’m currently enjoying the sights of Vancouver till head home this weekend.
Its the perfect elective for those who want to get stuck in to medicine but also want some awesome skiing on the weekends, just pack warm because skiing in -35C can lead to frostbite as I discovered to my horror!
Adnaan Gnanchi
Peru
Iquitos is slap bang in the middle of the rainforest nestled in a soupy delta of the Amazon river. It’s completely inaccessible by road creating a unique culture of river boats and zipping tuk-tuks, so prepare to have a near death experience on your morning commute to the hospital.
PROS:
Peruvians can cook better than your Mum, there I said it! Expect to be inundated by the most beautifully alien juices, fruits and vegetables fresh from the rainforest. On the flip-side the bush meat trade is thriving and its quite easy to get Turtle Tagliatelle if it tickles your tastebuds.
The hospital environment is radically different from anything you’ve seen before. You’ll see ingenuity which’ll make you chuckle, but at the same time you’ll see things that’ll make you deeply uncomfortable. Your bread and butter medicine goes out the window when you can’t order biochemistry or the doctor hands you a sagittal chest X-ray.
Peruvian people are the definition of chill. They are so friendly and helpful that you will always land on your feet.
The patient load is hugely different from that of the UK, many present extremely late meaning you get to see late stage TB, Neurosyphillis and HIV. Additionally Tropical diseases are commonplace exposing you to Dengue, Malaria and parasite management which is new and wakes you up on a Monday morning ward round.
The rainforest is round the corner: Pirahnas, alligators, snakes, sloths, manatees, jaguars, toucans, the whole gang is here and you’ll easily be able to see all of them. The Amazon and specifically deforestation is something you hear a lot about as a kid and it was interesting to see the difficulties first hand for the people living in this environment from a socio-economic stand-point
CONS
Language, we were saved by the kind translations of American students as medical Spanish flew gracefully over our heads and out of the window.
The insects are fluent in English and drink insect repellent like koolaid so prepare to sacrifice every piece of exposed skin to them.
We all ran a constant 0 on the Bristol Stool Chart known colloquially as ‘AGUA CON GAS’. By the end you’ll wonder if this is a permanent change or whether your relationship with your sphincter is irreparably damaged.
Hospital:
Loreto General Hospital is huge, almost as large as King’s and houses almost every department you can think of. The resources that these departments have are however extremely limited; no basic blood chemistry, x-ray as the only imaging modality and a tendency not to intubate leads to a challenging work environment.
Accommodation:
We stayed with the only Neurosurgeon in this region of Peru and his lovely wife. They have adapted their beautiful home to accommodate up to 8 guests along with a menagerie of entertaining dogs and cats. We ate dinner with them everyday and our dinnertime conversation helped us better understand what we had seen in the day.
Post-Elective:
Next off to Chile to visit the Chilean Lake District followed by Patagonia and then to Argentina to visit the southern most tip of the world (the closest point to Antartica) before heading to Buenos Aires and then home. We’re essentially following in the footsteps of fellow medical student Che Guevera in the Motorcycle Diaries. Although we have the revolutionary tendency, we lack the long curls and the cool hats- more to come.
10/10 would do again.
