LINKS case study competition

below is a copy of the essay we wrote to win first prize! it hasnt copied well unfortunately but maybe you get the idea!

xxx

LINKS case study competition

Medicine in Malawi - Enhanced Electives in Developing Countries
Neil Merrylees, Jon Dowell (Staff) Rebecca Acquah (Student) Dundee Medical School, UK
Dan Namarika Director of Medicine, Kamuzu Central Hospital, Lilongwe, Malawi
Introduction
Medical student electives are a memorable learning experience and approximately 40% are spent in a developing country. With around 8000 students a year from the UK alone participating in medical electives this equates with 500 years of student time annually. Students often have laudable motivation but are rarely helped to learn or contribute most effectively whilst away.
We have sought to create an ethical trade elective experience specifically to challenge the existing ‘health tourism’ norm. Academic publication is pending and we are now seeking publicity for the concept to encourage dissemination. Start up funding from the Scottish Government International Development Fund and NHS Education for Scotland has been secured along with support from Dundee Medical School.
Methodology
We have established a program of placements for senior medical students in Lilongwe through a twinning arrangement with Dundee University, Malawi College of Medicine (COM) and Kamuzu Central Hospital, Lilongwe (KCH). The normal six week elective has been extended to four months for selected students at Dundee Medical School. Students must demonstrate suitability through participation in an international health module (or significant previous developing country experience), a sound academic and health record, appropriate understanding of the programme aims, participation in tropical medicine training, cultural/safety briefings and fundraising for KCH (£500 each).
The aim is to provide an exceptional learning opportunity for students but, crucially, also clear benefits for their Malawian counterparts and host hospital. Overall the approach aims to be sustainable as a form of ‘educational trade’. Hence:
• Student contribution to patient care is improved by arranging extended placements, throughout the year, based in one clinical area.
• Learning and supervision is coordinated by a senior clinical tutor for both elective and local health care students together.
• Practical support with educational resources and medical equipment is provided by project/student fundraising.
There is scope for a number of other health service connections to expand as a result of this project, especially the high profile of student fundraising activities and prospect of ‘twinning’ of an NHS trust with a specific hospital overseas. This could be replicated at many centres.
Activities
The first cohort of students is currently in Malawi, something which has been three years in the planning. To date we have:
• Secured £60 000 start up funding (NHS Education Scotland and the Scottish Government International Development Fund)
• Established formal support (via a memorandum of understanding) with KCH, Dundee Medical School and Malawi College of Medicine (CoM)
• Selected and prepared the first two Dundee student cohorts. (7 in first, 8 in second)
• Benefited from two pairs of Malawian students visiting Dundee for 6 week electives.
• Supported anaesthetic Clinical Officer training in KCH via financial support for courses, books and equipment.
• Funded a visit by two medical physics technicians to KCH
• Sent 2008/9 cohort of students to KCH. These students are now established participants in providing care and promoting educational meetings for staff in the medical wards. Typically our students:
o Share responsibility for a bay of 4 patients with local junior clinical staff.
o Learn about conditions they rarely encounter, do procedures and take responsibility rarely available in the UK.
o Encourage (by their presence, provision of equipment and attitude) an enhanced program of clinical meetings at which both they and local staff (clinical officers and interns) benefit from training provided by local consultant staff.
• Agreed how the first years support funding (£5000) will be spent to provide enhanced basic equipment for the ward area.
• We are considering how start up funds can best be used to support a planned expansion of CoM via the creation of a new campus in KCH. This will enable support increased medical training in Malawi.
Outcomes
The first year of this scheme will transfer approximately £10 000 of resource to KCH and students will spend a further £12 000 in Malawi. Dundee Medical School benefits from a course offering innovative and exceptional opportunities (Program is heavily oversubscribed). Specific achievements of the program to date are:
1) Motivation for both staff and students in Malawi and UK.
2) Equipment has been provided (projector and laptop for continuing medical education) and will shortly be ordered locally for medical department (e.g. Patient trolleys, sphygmomanometers, oxygen concentrators etc.).
3) First audit in KCH looking at outcomes of admissions of patients on HAART (HIV treatment)
6) Change of attitude and sense of accountability in patient management imparted to Clinical Officer (CO) Students
7) CO students learnt how to use powerpoint and lead case presentations
8) Bedside teaching: Dundee students teach local students on examinations, procedures, and specific western diseases like stroke. They receive specialist HIV and tropical disease training, for instance, managing acutely toxic patients with sepsis or malaria.
9) Exchange students report increased awareness of health care provision in a different country and many new clinical experiences.
Challenges
To establish a sustainable trade we must prove there is sufficient educational benefit to persuade those funding medical education that resources should follow students to centres overseas which demonstrate an enthusiasm and ability to provide excellent clinical education for UK students.
To make a significant difference this process requires publicity. There is a clear demand from UK students for more ‘ethical electives’. An alternative model may well help this process.
There are associated risks. Forming partnerships requires time, effort and some resources. Culture shock causes distress and problems with excessive responsibility, culturally inappropriate behaviours, and personal risks (HIV, RTA) can arise. Unrealistic expectations may be created.
Conclusions
In summary, although electives are a popular and successful aspect of undergraduate medical courses we suggest they can be improved and negative effects minimised using a fair trade ethos within a formal institutional link. Though currently small scale we believe this concept has great potential and is now ready for increased publicity.

photos

hopefully you will be able to view some of my pictures by clicking on the links below, or cutting and pasting into the address bar....Granny -get fiona to help you!!

xmas and new year
http://www.facebook.com/album.php?aid=12333&l=4cd53&id=289400653


nkhata bay - malawi
http://www.facebook.com/album.php?aid=12327&l=2dc1f&id=289400653

Camels and Safari
http://www.facebook.com/album.php?aid=12329&l=dcebb&id=289400653

holidays part 3 - dar to zanzibar and back

We hadn’t heard many positive things in relation to Dar Es Salaam, and were warned about the heat and humidity and so we had tried to plan to go elsewhere but money and laziness I guess made us stay there for about 6 days in total. We were to be there over Christmas, and thanks to my lovely family and their donations we had planned to stay somewhere a little nice so we could enjoy our first Christmas together. Howevere our first shot at $40 dollars a night was not that great – with unfriendly staff, twin beds and the noisiest air conditioner you can imagine..not to mention the breakfast! Euch. So we headed to the popular back packers hostel where we were met by a similar room, but the friendliest staff you could ask for so we were happy.

Dar turned out to be a very friendly welcoming city…but yes it was hot and humid and the air conditioning was definitely necessary! Everywhere we walked we got ‘ jambo’, ‘habari’, ‘mambo’, ‘karibu’. People were genuinely interested in us, and we met people from all different backgrounds. We were staying in a predominantly Indian area, next to Mosque Street so it was quite fascinating just wandering around.

Christmas morning started off badly with me waking up 2am with projectile vomiting after eating a Chinese prawn dish a few hours previous! Anyway my lovely hubby, thankfully decided against the idea of taking pictures, and helped me with my situation, cleaned it up and we went to sleep to awake feeling perfect Christmas morning. We opened our two presents – an obama kanga for me and a Tanzanian football strip for Jose both kindly given to us from Annie and Gid in Arusha. The Obama kanga which has a big picture of himself between to maps – both of Africa, and America nowhere to be seen, was later to give us many laughs on Zanzibars beaches. The place to be on Christmas day was Coco beach, a surprisingly beautiful beach with white sand and blue waters. We arrived in time for lunch, traditional roast meat, and soon the beach was filling up with it seemed the whole of Dar! Huge families came down, and the children paddled and played in the sand while the adults enjoyed drinks and snacks. It was quite a scene seeing the whole stretch of beach crammed with people, and a different way to spend Christmas!

A very good friend from Uni had planned a long time back to come and join me over new year in Zanzibar. She was due to arrive on boxing day evening, so we were to head to the island first thing next morning. A couple of hours before we left to pick her up, a call comes through of a very worried sounding lyndsey who was stuck in Nairobi airport after her flight had apparently been cancelled. Not a good start to her very short holiday! Anyway she was put up in a lovely hotel and arrived the next morning, before we all got on a boat to paradise.

And paradise is the only word…. The whitest sand and sea that is nothing short of turquoise in colour, with picturesque dhow’s sailing past the glowing red sun – we knew we would be happy here. Stone town was a very pretty little place, with old weathered buildings, with tiny streets in between. The people here were absolutely beautiful, from all over the world originally now living side by side and producing gorgeous kids who were all very friendly, singing songs along the old crumbling streets. The only advice we were given about eating in Stone town, from everyone we asked was this street food bazaar. It is normally set in a garden, beside the ocean, but unfortunately it was closed for refurbishment, so for us it was along a side street. It consists of stall after stall of very cheap street food – from every kind of sea food you can imagine to meat kebabs, to different kind of bread and bhaji type things and fruit and salad on top! The problem was how to choose! I went for some sea food – lobster and prawn kebabs, with coconut bread and salad. It was nothing short of delicious and it all cost a couple of pounds! It was only a pity that we couldn’t go back for more!

Time was a big constraint so after one night and a morning of wandering the streets and getting a feel for the town we headed an hour north to Nungwe – the beach! My measly words trying to describe the beauty of this place could never do it justice, I will put a link to photos which I am afraid will also not do but will give you an idea and maybe the thought that you can go and see it for yourself. We had four days here, and a beach holiday is not something I have ever done, but I was surprised at how content I was to lie and read day after day! We enjoyed a good healthy breakfast every morning, headed to the beach, read some book, had a mid morning refreshing juice, read a bit more, enjoyed lunch, went for a swim/played volleyball, watched the sunset, had a shower and got ready for a delicious dinner followed by cocktails/drinks in a local beach bar. Bliss!

We did have a bit of excitement the morning we decided to swim when the tide was out and unfortunately Lyndsey got stung by a sea urchin which by the way looks to be a very painful event…I thought she was going to faint. Any Mr Fine from the diving shop came to our rescue and did his magic with some water and papaya juice as an antiseptic, and she was soon on the mend..although it was a couple of days before she could walk properly again! There were a group of Masai men (and women, but we did not see them so often) who were in Zanzibar for the high season, trying to sell curios to make money to take back to their boma’s. They were all very friendly and often came to chat to us on the beach, and we also met them in the evening and played pool or something equally western! They seemed to be a very happy people, and we had fascinating conversations about their way of life and their views on life. We were aware that it must be very strange for them coming to this place with girls in bikinis, people playing sports on the beach, sailing in fancy boats, drinking plenty alcohol etc, when compared to their life back home. We had asked one of them how he liked it and he told us it was far too busy here and he loved going back to the boma where he could spend all day sitting and listening to his radio! Another man, when we asked him if he was married, told us he was saving up – he had 2 cows and he needed 25! He had a long way to go! They did performances of their famous ‘jumping’ dance in the evenings at hotels, and we figured this must be how they made their money as they rarely tried to actually sell us their curios, instead just wanting to chat!

New years eve was spent first with an amazing buffet of sea food spread which was delicious and then we headed for the beach bar called Cholo’s. We had coincidentally met with a South African guy that Jose had befriended in Malawi and so we spent the evening with him Tshepo and Tsabi his south African friend, and Patrick a Namibian dude we picked up along the way. The banter was great – lots of dancing, including round a fire..and on top of boats and tables. It will definitely be a new year to remember!

Unfortunately, our holiday was then coming to an end. Farewells were said to Lyndsey, and we started the long bus journey back to Malawi. I think what will stick in our minds the most, is the friendliness and liveliness of the Tanzanian people. I am sure one day we will be back, and maybe if they opportunity arises, me and Jose I think would be happy to settle their for a few years…lets see! For us, it was also so nice to spend some good quality time together on our first proper holiday!