Which country did you visit: Zimbabwe
Year of visit: 2018
Which region/city were you in: Harare
Name of hospital/clinic: Harare Central Hospital
Urban
Private run (Abalon Trust, https://www.abalontrust.org/ )
How long was your placement for: 2 months
Planning the elective
Why did you decide to go there?
I wanted to put the elective in God's hands and felt that this was where He was calling me to go.
How did you come across this opportunity?
Through a contact of a friend whose charity were wanting to trial running elective placements.
Was accommodation arranged for you?
The President of the Charity (Abalon Trust) arranged for us to stay with a family he knew there as the intended accommodation was not ready, however this turned out to be much better than having our own place as it allowed us to integrate into the culture more and get to know people.
Were there any unforeseen difficulties?
Some of the patients struggled with English making it trickier to communicate and be able to take histories off them. However, the working language was English in the hospitals so you could still get by without the language, and there were still some patients who spoke English, it was probably 50/50. In general, you'd find English was the language of the rich and urban areas, and those who came from the nearby rural areas spoke local languages.
Placement experience
Did you undertake a clinical elective? If so, please describe your experiences:
I did a split post between psychiatry and internal medicine. I really enjoyed the placement and people were generally very welcoming. I would say the psychiatric hospital and clinics in the medical hospital were generally the more useful and education places to go. You could get a bit lost on the ward rounds when it was a big team and it was tricky to go and take histories of patients yourself afterwards due to the language barrier.
Both placements were very eye opening, and I have to say it made me very grateful to have the NHS despite all our complaints of various issues and underfunding. It was a good opportunity to see late signs of certain illnesses, both physically and mentally, that you would not see often in the UK. In the psychiatric hospital you'd tend to find patients presenting very actively psychotic, usually because they'd either presented late, likely related to the ongoing stigma around mental health, or because they couldn't afford the psychiatric medications. You also saw a lot of side effects to medications as older medications with high side effects tender to be cheaper and what people could afford. It was very strange to be in a healthcare system where money would influence and limit the investigations and treatment you could have.
It's also probably worth mentioning that a lot of the medical patients were infectious diseases patients, so if you've got an interest in ID and want to see the diseases that are rarer in the UK or the late signs that we do not often see, then it's a good place to go.
Describe the support and supervision at the placement:
People were generally welcoming, and the hours you did were pretty flexible. You weren't really given much independence in assessing or managing patients, but if you went to clinics you generally got some teaching and I found these were more useful to go to than staying on the ward.
Describe any particular or difficult ethical issues you came across:
There were a lot of ethical issues encountered on the placement. Mainly in regards to professionalism and patient dignity, and this was mainly witnessed in the medical hospital rather than the psychiatric one. Things could still be very hierarchical, and often it was felt that patients were talked down to and their dignity wasn't respected. There were many things that would be highly unacceptable in the UK, yet seemed to be the norm there and patients would just accept being treated like that.
Wider community
I spent a lot of my time in the wider community and this was probably the highlight of the trip. We got to experience family life there by staying with a family and then the president of Abalon trust who organised our trip came over for a time and took us for dinner at his family's and to visit some of his relatives in the rural areas of Zimbabwe to see what life was like there. There was such kindness and generosity displayed by the local people which really touched my heart and felt very undeserved.
I also attended a local Church there called Borrowdale Community Church (http://www.borrowdalecommunitychurch.org/), this was another highlight to me. I got involved with a homegroup early on which enable me to make friends who I'd meet up with socially as well as at Church events. I even went on a lady's weekend with them, which definitely challenged me on my openness to the Holy Spirit and my willingness to let Him touch me no matter the manifestation. The people, the teaching and the worship were all amazing and I was very sad to leave at the end of my placement. The people at the Church again were so generous and kind, and they had such good knowledge of scripture and a real openness and awareness to the Spirit.
The third main part of the wider community I was able to get involved with was a local orphanage and the school which was linked to it. This was because the president of Abalon's relative ran the orphanage. It was amazing to spend time with both the younger children and the teenagers in the school. I spent some time running biology revisions classes for teenagers facing exams and wanting extra support, as well as time playing and supervising the younger children. It was such a privilege to get to know both the children and teenagers, and also great to see them being looked after in such a God centred and loving environment. God's hand was so on the orphanage and I was blown away by the faith they had for God to provide. They had so many testimonies of how God has faithfully provided for the children.
Value
What have you gained from this elective? How has this experience shaped your thoughts about your future location/specialism in medicine? What has God taught you?
I honestly gained so much from this experience and found myself not wanting to leave at the end. God had moved so much in me and I found I had managed to settle into the community so well. I truly felt comfortable and at home there, even when my friend who I had initially gone with had left as she split her elective between 2 posts. Not once did I feel alone and it also gave me plenty of time to press into God and process things that the busyness of med school had hindered. I know God grew my character a lot in that time.
I'm not sure it's massively shaped my thoughts on specialist training; however, it did really open my eyes up to the world outside of Europe and changed my attitude towards international working & mission. I was surprised how quickly I was able to adapt and feel at home in a completely foreign environment and I am definitely a lot more open to mission abroad should that be where God calls.
I think one thing God really taught me was to step out of my comfort zone, and to trust him when I do. Something I've always been terrified of doing is public speaking, yet I ended up speaking at a formal event for the Charity we'd gone over with where important government officials were present such as Zimbabwe's Foreign Ambassador. I had been asked to talk about why I'd chosen to go to Zimbabwe and really felt God wanting me to share how it was Him that led me there and how He has a real heart for their country. This further terrified me, yet I didn't want to be disobedient to God. After some wrestling I decided to do it, and amazingly when I went up to speak all the nerves disappeared and found myself speaking with a boldness and confidence that was not my own. I was then later put in another public speaking situation where I thought I was going to teach a small class but once I arrived it turned out they'd got the whole school in the assembly hall for me to teach, and it was far too late for me to back out. Again, this was a situation that I would normally avoid at all costs, yet I was filled with such peace and confidence, and also thankfully with wisdom on how to answer some of the typical teenage questions such as 'Is masturbation normal?'. God really showed me that He is more than capable for making up for my perceived weaknesses, it is in them that His power and glory are displayed. Often God will call us to things that we feel incapable of doing, however with Him nothing is impossible, He is more than able to come through for us when we take those steps of faith. We must not let our own perceived weaknesses limit the ways in which He wants to use us.
What advice would you give to anyone else considering an elective in this setting?
The main piece of advice I'd give to anyone considering this placement would be to get plugged in. Be proactive in engaging with the wider community and developing friendships. Get stuck into the Church and involved in home groups. Be open to what God wants to do and give this elective over to Him.
