It is good to write down your expectations and objectives – what you hope to achieve, to learn and share with others – before you go and then to update these things regularly in the light of the reality of the situation you find yourself in.
Healthcare in developing countries operates with very limited resources. This means that the priorities in health delivery and the standards attainable are very different from what you will be used to at home. Disease patterns and cultural attitudes to disease, suffering and death will also be unfamiliar. Poverty, ignorance, recourse to traditional remedies, poor transport and communications mean that patients will often present very late in their illness. Sometimes there is little that can be done. You will have to face death, both avoidable and unavoidable, much more frequently than in the UK. Be prepared for the wide range of emotions that this may generate in you including anger, fear, depression and guilt. Don't be afraid to get more experienced people to help you through the difficult period as you learn to cope.
From a missionary prayer letter in 2007
We had no power that night and as I examined the patient by torchlight, I could see that he was very close to death from severe dehydration. I had never seen a case of cholera before. After aggressive initial treatment, I went out to explore the store to see if we had any more IV fluids and the right antibiotic. His cramps suggested potassium deficiency and I remembered that lemons, bananas and oranges contain potassium. We didn't have any bananas or oranges but we did have a lemon tree in our garden so I added the juice and the cheapest form of antibiotic that we had to the oral rehydration fluid I had made up ... and he survived
Don't insist on your 'standards' at the expense of good relationships.
Time spent abroad is a tremendous learning experience. As a newcomer you may notice many things that you might think could be improved, things that you might think those who have been there longer have failed to notice, or alternatively lost the impetus to change. Note down your initial impressions but try to understand why things are done the way they are before you speak or take action. Things may be as they are for very good reasons (eg resource, financial or cultural constraint) and it may well take you a while to ascertain and understand these reasons (allow 6 months).
