For my elective I spent six weeks in a rural district hospital in the Western Province of Rwanda. The hospital had around 250 beds and had maternity, neonatology, paediatrics, emergency, internal medicine and surgery departments. There were 13 doctors, mainly Congolese and Rwandan, for the hospital who were split between the different specialties, although none of the doctors were specialists apart from an American surgeon.

Each day began with morning devotions and prayers with all of the hospital staff, which was a great way to start the day. I spent most of my time working in neonatology and paediatrics which involved doing the ward round with a doctor. I was given lots of opportunities to see patients by myself and make clinical decisions under the supervision of the doctor. It was an excellent experience, particularly as I am interested in paediatrics but previously had not had much opportunity to work in neonatology. In general the reasons for admission were similar to the UK except for the malaria cases in the paediatric ward. This was a good learning experience as I was previously unfamiliar with the treatment of malaria and now have a reasonable idea.

During my time I also worked in the Emergency Department. Due to the unpredictable nature of this I was sometimes very busy and sometimes had no patients to see, but it was very interesting as patients often had to walk or be carried for several hours to attend the department. Again I was able to see patients by myself and suggest initial management plans. One thing that was a problem was the language barrier. I was unable to communicate with the patients directly and usually asked a nurse to translate from English or French to Kinyarwanda. It was strange getting used to taking a history and giving information via an interpreter as I was sometimes unsure whether information had been interpreted correctly, and obviously it takes a lot longer! Some of the nurses and doctors spoke English but in general I had to use my slightly rusty French, and most of the notes and handovers were also in French.

While at the hospital I also did approximately 70 consultations with members of the hospital staff as part of the newly established Occupational Health program. This was good experience as I am interested in General Practice and I got to see a wide range of complaints, some trivial and some very serious. It was also an excellent opportunity to practice my clinical skills as I was required to perform examinations on all of the patients.

We also went to visit a mental health patient who was part of the hospital's pioneering social affairs program, made possible by donations from churches in the UK and USA. It was great to see someone who would normally be marginalised given housing and hope for the future, and his faith despite his circumstances was amazing.There were several differences between working in the UK and working in Rwanda. The staff very rarely, if ever, washed their hands between patients and I also noticed that the medicine practiced was very paternalistic. One example of this that doctors rarely prescribed adequate pain relief; they would prescribe one analgesic and assume that would suffice. It was strange working in such a different environment and in general I thought the doctors and nurses did a good job. I was made to feel very welcome and gained very valuable experience which I may not have had the opportunity to get in a developed country.