Ethiopian Elective
Jennifer Woods went on her elective from July to September 2007 and describes her experiences in Ethiopia here
Gondar market
If I say Ethiopia to you, what is the first thing you think about? Is it those pictures on the news of starving children in a desert land? This is certainly what I thought before I went, however what I came across was completely different-Ethiopia is the most beautiful, green, picturesque, welcoming country I have ever come across.
Ethiopia is a poor country, in-fact one of the poorest in the world. It spans an area of 5 times the size of the UK and has a population the 3rd highest in Africa. 2.5 million people are estimated to be HIV positive and the average life expectancy of 45 years is rapidly decreasing mainly due to HIV and infectious disease. Gondar lies in the north of Ethiopia and has a population of which 90% is rural. The main language spoken here is Amaharic though there are 70 other languages present as well.
Before I went on my elective I knew I wanted to go to a place and culture I had never experienced before-Ethiopia seemed to fit the bill. I also wanted to improve my confidence in practical skills, I had heard developing countries were a good opportunity to do this. Ethiopia was certainly not a disappointment in either aspect.
The elective experience in the hospital is very much down to yourself-initiative is definitely needed. Despite immense planning on our part before arriving in Gondar- on arrival I found that I was not expected and the doctor who had organised my trip over had gone to India and not told anyone we were coming! However this posed no problem as after a quick chat with the dean I was accepted and told I could go anywhere in the hospital and what I did was up to me-no plan or timetable. I started off in the surgical department and became good friends with the house officers who ran the show. The medical students studying at the hospital were on there holidays during our whole placement so their was no competition for teaching or clinical experience-I was treated as one of the HO’s. Medicine in the hospital is conducted in English, however none of the patients speak it, so history taking was out the question-my main activities involved examining and observing and performing procedures. As the house officers would start a new shift at 8 am we would start my day with them and stay till about 5 or whenever things had slowed down. There were 4 main operating rooms and all patients would arrive and leave the operating theatre via a stay in the recovery room next door- this was a good place to hang around and observe going’s on-it also acted as intensive care and an emergency room. As there was only 1 house officer and two nurses running the whole of the room which usually contained 20 critical patients there was lots of experience available. Even though this room acts as intensive care there is not a single difibrilator or oxygen supply available, patients who enter the critical stage would usually be left to die slowly by themselves with no-one really observing them. One day I spent the whole day observing a man who had just had burr hole surgery - I was the only one who performed observations on him that day and it was scary to watch him slowly deteriorate in front of my eyes. Unfortunately this was a common occurrence- once patients go past a certain stage there is not much the doctors can do.
In the main operating theatres you could wander between surgeries, and observe whatever interested you, will it be obstetrics, parotid surgery or orthopaedics-there was pretty much everything. On most occasions you would be asked to assist in the operations- I was particularly proud of performing a masectomy as the main surgeon with the consultant assisting me! Where I got most of my practical experience was in minor operations. Here we learnt how to do circumcisions, lipoma removals, breast lump biopsies and breast abscess reductions- all under local anaesthetic. By the end of the attachment the house officer would leave us with a nurse in minor ops and I would do the circumcisions by myself.
I also did a stint in internal medicine- however after the fantastic experience in surgery it was all a bit of a disappointment. Here is where histories matter- and unfortunately there was little opportunity to learn about the patients history, house officers were to busy to tell us what was going on, and the patients couldn’t tell us much. Saying this though I did get a lot of experience in observing clinical signs- heart murmers in particular. TB and AIDS related disease were also very common place so a lot of chest signs were present and x-rays to look at. Infectious diseases were also common with schistosomiasis, malaria and leishosomiasis topping the bill. I also saw a case of tetanus, something I will never forget.
You could have as much or as little teaching as you liked on this placement. I became good friends with most of the doctors in the surgical department so consequently felt very comfortable in asking about stuff I didn’t understand. I also set up our own teaching session with a German house officer who was also on a placement at the hospital, so everyday I covered with him a different tropical disease and found a patient to examine with it. I also attended the house officer teaching sessions which were run once a week- this proved very useful.
I didn’t really encounter any problems with the attachment once I got past the hurdle of them not expecting us. I did however asuffer from illness during my stay in Ethiopia- mainly diarrhoea and vomiting, and fleas were a particular nuisance.
Every weekend I would go on small excursions to other parts of Ethiopia. With the help of some of the doctors I would usually hire a minibus for ourselves and a driver and go were I pleased. Bahir dar (about 4 hours drive away) was beautiful, the source of the blue nile arises here and there are absolutely fantastic waterfalls with rainbows in every direction. Close to Gondar are the simien mountains- a national park which is famous for being the home of the Gelada baboon, which lives in Ethiopia and nowhere else in the world. The scenery here is amazing, walking along the mountain tops through clouds with the most green landscape is an experience I shall never forget. I also took a 1 hour internal flight to Lalibela-home to the famous rock churches (also known as the eighth wonder of the world).
Ethiopia has a culture that is unique. The people of Ethiopia are the most friendly I have ever met and we were always being invited to peoples house to have coffee ceremonies with them (Ethiopians adore coffee). The food-injura, is like a huge soggy pancake on which lumps of meat and sauce are eaten off. It is eaten for breakfast, lunch and dinner and becomes extremely wearing after about 2 days. Coincidentally sigmoid volvulus was extremely common in the hospital (around 3 cases every day), this is mainly thought due to the injura! Ethiopians love to dance and a night out at a traditional dancing place is a must see- and you have to join in otherwise it is considered rude. I felt very safe in Ethiopia and did walk around at night with friends on the street with no problems.
I fell in love with Ethiopia and would recommend to anyone an elective there, the culture, the people, the scenery is out of this world and I will certainly be returning in the near future!
Jennifer Woods
4th year medical student
Southampton University
UK
jsw403@soton.ac.uk