Why do an elective?

It made me want to go back home and become a good doctor so that I could come out here again.' 'It was quite simply the best part of my training as a doctor.' These quotations from recent elective reports sound incongruous in the context of a nation where one in four doctors is leaving the profession within four years of qualifying and many older ones are looking to retire as early as they have earned an adequate pension.

What is so special about a medical elective in a Christian mission hospital when medicine in this country is so full of disillusionment? Maybe it is that it makes sense when so much else in our post-modern society does not. Whatever your reasons for starting a medical career there is only one that can last. Intellectual challenge can fade after qualifying unless it can be prolonged by post-graduate study and research. Money has a way of failing to satisfy. Helping other people loses its appeal when so many of them along with the media and regulatory bodies are constantly finding fault with what you or your colleagues do. Working long hours at a job you enjoy is counter culture. But if you realise that you are primarily appointed by your Creator and that he will make all that is done in his name count for eternity that gives real satisfaction.

On your elective you will discover that God has a heart for the poor, be they sick, hungry, cold, homeless, friendless or defenceless. In fact they are strategic in his plan to rescue the world. You will work with colleagues of other cultures who care about their patients and about you. You can work and live with them, pray and study the Bible with them. They may experience more overt opposition to their faith than you do but defend it by demonstrating the love of God. Back home you have seen secular society steadily erode the opportunities to express your Christian faith in your work. You are being driven to a spiritual schizophrenia because it is increasingly difficult to be both a Christian and a doctor at the same time. But 'out there' they practise whole-person medicine and they live whole lives.

Essential preparation

CMF and MMA HealthServe (formerly the Medical Missionary Association) produce booklets on where to go (Medical Elective Opportunities) for your elective and how to plan it (Preparing for your Medical Elective Overseas). Start 18 months ahead if you want to explore the options and find a situation with which you feel at home. If you will be applying for grants you need to have your plans ready to present to the grant making trusts in plenty of time.

Most but not all of the opportunities are with traditional mission societies. When you apply, the society has to correspond with its partners overseas. Some societies will want you to attend an orientation day. In asking a mission society to organise a place for your elective, you may be asking to join a community of nationals and expatriates in a remote situation. Orientation will enable you to know how you can best fit in and be of help to your hosts as well as further your own learning and experience.

In addition to books there are CMF/ MMA HealthServe Electives Days held each year in Scotland, Leeds and London that explore some of the options and ideas with those who have been hosts and students themselves. Elective reports can be found on the CMF and MMA HealthServe websites and in their magazines (see Further Information at the end). MMA HealthServe has other elective reports on file; they may be able to send you a copy of one relating to the hospital to which you plan to go and put you in touch with its author.

There are various practical preparations that also need to be made. The journey from the destination airport may need planning. Most mission societies will have experience of how you should get to the hospital. Often it is best to travel with a colleague. Unless you are an experienced traveller finding yourself in a strange culture and entering parts of it where there is much poverty can be a lonely experience. You will want to decide what to take with you for your own use and/or for those you will be leaving behind at the end of your elective.

You can write to those with whom you will be working and ask if there is something you can bring, but be sure you know what to do about importing equipment and especially any medical drugs. You may decide to plan a project or you may find that the clinical workload and reading up about the conditions you see is likely to provide you with enough to do. Ask about any reading you can do in advance relating to the healthcare problems, the culture and the languages used. Your medical school may have requirements about where you are allowed to go and what you may do. They and any grant giving body will probably want written reports on your return.

You need to find out what the entry requirements to the country are, what health regulations there are such as immunisations, antimalarials and HIV precautions. You need some kind of insurance against health problems and property loss, eg passport, tickets, money or camera.

Counting the cost

You will want to know how much the elective is going to cost and plan how to find the money.

There will be other costs of comfort and convenience such as differences in culture, food, weather, travel, languages, housing, worship and company. You may find loneliness a problem but this can be a learning experience and a challenge to rely more on the Lord. There will probably be some greater risks to be taken especially in relation to health, travel (particularly on the roads) and property.

There are also the longer term costs of searching for God's calling on your life. All costs are budgeted against gains, be they financial, material, intellectual, or spiritual. You could draw up a budget to show expected gains and losses for yourself and for the kingdom of God. An elective is an opportunity to discover what your gifts are and how you can best use them for the kingdom. You are taking steps of faith that in human terms are calculated risks or sacrifices but which under God will become doorways to fulfilment - not self-fulfilment, but his fulfilment for you. 'Well done, good and faithful servant come and share your master's happiness' (Mt 25:21) is the greatest reward in life and in eternity.

Making decisions

• Where do you plan to go and with which organisation?
• What are your objectives - medical, spiritual and probably also for a holiday?
• Draw up a plan of action with dates;
  Preparation - what needs to be done and by when
  Projected elective - all you plan to do while there
  Post elective - what you will do with the experience

Where you go and with whom you go are likely to be inter-related decisions. You may go with a UK-based sending agency and ask them to suggest where you go. Or you may choose a place such as the hospital where a doctor from your medical school who is now supported by your CU works. An elective is an opportunity to get to know a mission organisation with whom you might return one day, with whom you feel comfortable and whom you feel able to support. Many of the traditional mission societies have rather run down their medical departments and don't have a clear medical strategy. This needs to change or new methods of sending and supporting medical mission partners need to be found if Christians in the West are to respond to the biblical challenge to care for our global neighbours in a world that is becoming increasingly hostile to the poor. An elective is an opportunity to decide how to respond to that challenge.

If you choose a host who does not have a UK office or representative such as a Christian hospital or a Christian mentor in a secular hospital overseas you will need to research more carefully the conditions to which you are going and whether the hosts are aware of the requirements of your training.

Return to this country should not be so much the end of an elective as the beginning of the next stage in your contribution to global medical mission. Pressure of exams or jobs may make it easy to write a report and put the experience on a back burner. Instead, keep in touch with those to whom you went or with the mission society that sent you. Receive a prayer letter and/or a magazine. Attend a conference. Keep the vision alive. I heard today of a student who once she was qualified returned to the place of her elective to prove to herself that her time there had not been as good as she remembered and that the surgery with which she had been assisting was not for her. She was unable to convince herself of either and is now enjoying a surgical rotation in the UK with a view to going back!

If you are thinking of returning to work in a developing country you have to decide how to prepare. Most traditional mission or church hospitals are district level institutions and the doctors in them are general practitioners in the local sense. They are often the only doctors available to rural people. Their work includes outpatient general practice and inpatient hospital work of all specialties as well as administration and community care. Unless your gifts point you to a specific specialty you may well decide to train in the UK in general practice or public health and then insist that you start overseas mentored by experienced doctors who can teach you the necessary surgery and obstetrics. The MRCS could be a useful surgical training for overseas work but hospital doctors in the UK are likely to become so specialised that they will be increasingly unable to work outside the wealthy West. Unless or until there is a College of Appropriate Medicine you may need to commit yourself to long-term overseas service or practice in such a way that you can maintain your UK validation. Taking a year out in a Bible college might no longer be an option. You will need to be able to feed yourself spiritually.