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My Elective Exchange at The University of Zimbabwe College of Health Sciences

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Joy Kinya Kimathi

Post by Joy Kinya Kimathi, a 5th-year medical student at Jomo Kenyatta University of Agriculture and Technology in Kenya who has completed an elective exchange at the University of Zimbabwe College of Health Sciences.

I was granted an opportunity to participate in an elective program in the University of Zimbabwe at the Parirenyatwa Group of Hospitals in Zimbabwe, from the 20th of August to 30th September, 2018 by GEMx. I found this as a great opportunity to learn, a stupendous chance to mingle with new people, explore a new culture, food, and new places. It’s worth noting that Zimbabwe is a vibrant country whose occupants mainly speak Shona and Ndebele, and are amazingly hospitable.

 

Reception and Accommodation

On arrival at Zimbabwe, I was treated to a very warm reception by the University of Zimbabwe elective office. We were 2 students from Kenya at the time of my elective. Throughout my stay in Zimbabwe, I was accommodated at the Medical residence elective flat within Parirenyatwa hospital grounds. This was a very convenient spot to access the hospital, and I wish to pass my gratitude to the Accommodation office at the University of Zimbabwe for this consideration.

At the Medical and Dental Practitioners Council of Zimbabwe (MPCZ).

Academics

As a prerequisite to working in any clinical area within Zimbabwe, one needs to register with the Medical and Dental Practitioners Council of Zimbabwe (MPCZ). This was one of the first exercises that I embarked on just after settling down. The elective office was kind enough to offer transport to the Board’s premises to register with them.

Clinical Areas

Being a very adventurous person, I explored various departments within the hospital during my elective. These included: Medical Ward, Hematology Department, Urology Department, Oncology Department. I have to admit that I had an awesome learning experience within the institution. The consultants were very enthusiastic and more than ready to impart their knowledge and skills to me. Special thanks to Dr. Marejela (Consultant Physician), for his well-researched discussions crowned with a special sense of humor. Being in your ward round was something each of us looked forward to every single day.

Special thanks to Dr. Mberi (Hematologist Consultant) together with the whole Hematology team, for your dedication to teaching me. Lots of gratitude Dr. Chikore for teaching me how to administer Chemotherapy.

At the Hematology Laboratory

It was a great honor to work with Mr. Dube (Consultant Urologist). His austereness kept us on our toes bringing out the best in us. A shout out to the Oncology team for being one of the most amazing teams to ever work with. I was able to participate in cancer diagnosis, staging, planning of management, radiotherapy, brachytherapy and chemotherapy sessions. Above all the team got to include me in most of their social events making me feel at home.

The junior doctors (JrMOs) in all the departments I rotated in, occupy a special part in my heart. They were not only colleagues but also mentors and probably the greatest friends I’ll ever make within such a short period of time. They shared with me tips on how to navigate around Zimbabwe and were really great chaperones.

In a nutshell, the academic part of my elective was marked with new amazing and interesting exposures. Of special note is the fact that the whole experience sparked in me, a special interest in oncology, a field that I had never ever considered prior to my elective.

Interacting with local students ZiMSA dinner

Social

Over my stay in Zimbabwe, I got to visit many astounding places. It all began with a tour around the University of Zimbabwe main campus. The institution is located in a vast piece of land, in an exquisitely serene environment at Harare.

Some of my major highlights were: A visit to the agricultural showground, visiting the National Gallery of Zimbabwe, Grabbing lunch and dinner with the Zimbabwe Medical Students Associations (ZiMSA), and visiting the Bally Vaughn Animal Sanctuary

Challenges

Zimbabwe cash crises:

I found myself in the middle of a Zimbabwe Cash crisis right from the time I landed at the airport. The challenge was brought by the fact that I couldn’t withdraw any money from the banks due to acute cash shortage within the country. This was a very unique challenge that I had never anticipated at all. To add insult to injury, some of the swipe machines in the country were not compatible with my visa cards making it almost impossible to pay for accommodation as well as the Board fee. However, I would like to take this chance to thank the UZ elective office for being patient and resourceful in handling any new challenge that came up.

At this juncture, I would also like to pass my heartfelt gratitude to the Kenyan Embassy in Zimbabwe. They went out of their way to enable us to get Hard Cash when all our efforts had hit the wall. God bless you richly.

Photo at the Kenyan Embassy

Lesson Learnt

To any student planning to travel out of their country, make a habit of getting in touch with your embassy on the intended country of travel before leaving your country. Let your embassy advise you accordingly pertaining your travel expectations and expected challenges. This will help with your planning and cushion you from any unanticipated shock.

Conclusion

My trip was amazing. In the beginning, I faced a few strains, but I still got the best out of this elective both academically, socially, and culturally. I greatly appreciate the opportunity afforded to me by GEMx team. I wish to thank everyone who went out of their way to ensure that I had the time of my life. The GEMx initiative is a great one, and I take this opportunity to encourage more and more students to enroll and be part of it.

Orthopaedics and Traumatology at CES Universidad, Medellin, Colombia

Filed under: GEMx Student Ambassador Network GEMx Student Reflections

Post by Jack Dunne,  Student Ambassador at National University of Ireland (NUI), Galway who has completed an elective exchange at Universidad CES Escuela de Medicina.

Jack Dunne

Why Medellin, Colombia?

I wanted to explore my interests in trauma medicine. Ireland lacks trauma as a specialty, so an elective abroad offered me the only opportunity to experience it. I looked for a location that offered this practical experience but also one that offered cultural and travel opportunities. I read positive reports on Colombian hospital electives. The reports detailed a practical and intensive environment, where the standout point for students was that it had been very rewarding.

I chose Medellin simply based on the many positive touristy accounts I heard of it.

 

The Application Procedure

I Google searched Universities in Medellin and found various websites and email addresses. I came across CES Universidad and the organizer there was very prompt and helpful in her replies. I then noticed it was a GEMx University, so I made my application through the GEMx portal, rather than through the CES portal, and this saved me the cost of fees. Winning straight off the bat! Overall, the application procedure was very straightforward, I just needed the usual documents (letter of recommendation, grade transcripts etc).

View of Colombia PC: @baermannfelix

CES Universidad

CES Universidad is a small private university in Medellin, based in the leafy ‘El Poblado’ suburb. On the CES University application page on the GEMx website, you have 2 hospital options for each specialty available, CES Clinica or a General Hospital. I chose CES Clinica, just on the flip of a coin, and can only comment on that.

Streets of Colombia

I was very happy with CES Universidad. The programme was run professionally; I had an orientation before beginning and was also brought on a guided graffiti tour with other exchange students. The hospital knew I was coming was used to taking foreign students and had preassigned me to a doctor.

I initially assumed I would be placed in Clinica CES, a hospital close to the city centre of Medellin, however there all multiple ‘Clinica’s’ for medical students across the city and I ended up in a hospital called Clinica Del Norte. The hospital was actually in Bello, a suburb of Medellin. It’s a private hospital and has various different specialties and 4 theatres. It’s close to a busy commercial centre and the public metro station, Niquia.

Accommodation

Airbnb

It’s hard to judge an area you’ve never been to, halfway across the world, so I decided to figure out accommodation once I arrived, had spoken to people, and could ‘feel out’ the place. Don’t stay in a hostel if you’re doing clinical rotations (as I considered), that’s the 1st piece of advice. Colombians I asked said accommodation is advertised either on Facebook or through the grapevine. Hence, there’s only Airbnb available if you’re looking for a short-term rental. There’s tons of availability though. No tourists stay in Bello so every Airbnb was available for however long I wanted to stay. My advice would be to find accommodation for the 1st few days and then revaluate. I actually got lucky in that I had an Airbnb for 3 days, then met someone with a room to rent out and got a great deal, close to the hospital.
In Bello, Airbnb might set you back €12 a night, while finding local rent generally goes for $400,000-$500,000pesos (€115-€140) a month. Closer to Medellin city centre, however, the rent can be much higher: $600,000-$800,000pesos.

 

airbnb

Orthopaedics and Traumatology

Traumatology, in this case, was essentially an orthopaedic doctor based in the Emergency Department. In Ireland, orthopaedic doctors would be on call and required to come down to the Emergency Department. But there are so many orthopaedic cases in some hospitals, it’s far more efficient just to station an orthopaedic doctor there.

Clinica Del Norte is a private hospital for patients with good insurance, and this really dictates the patient cases that walk through the hospital doors. The vast majority of patients I saw were involved in low speed, minor trauma, motorcycle accidents. Know your bone anatomy of the upper and lower limbs as they’ll be your bread and butter for the 4 weeks. Though there were some polytrauma/major trauma cases, such as pelvic fractures and cranial fractures which I got to view/assist in. As I was based in the Emergency Department, I got to view/assist in many other cases, for example, a resuscitation case and a patient with a ventricular tachycardia. If you want to see big trauma, with gunshots and stab wounds, all the Hollywood gore of very sick patients, going to a public hospital is what you need to sign up to, according to the staff in CDN.  There is something to be said though for the less hectic, private hospital clinical rotation, especially when you don’t speak fluent Spanish.

I got a lot of practical experience from my time in CDN:

  • Doing various types of casts, splints
  • Suturing for various cuts/wounds
  • Intramuscular Injections
  • Digit ring blocks
  • Venous catheters
  • Urinary catheters
  • Taking blood from veins
  • Resuscitation procedures
  • Pelvic fracture stabilization
  • Shoulder relocation

 

The big piece of advice I’d give is don’t come over without knowing how to put on sterile gloves, wash your hands, and scrub in (your sterile techniques, essentially). I was most taken aback by the attitudes of the doctors and nurses towards medical students getting involved. I was never turned away from doing a procedure and was actively encouraged to try my hand wherever an opportunity presented itself. The staff was happy to teach the procedure and to patiently guide me through it.

Typical Day

7 am: starts and finishing at 6 pm most days, Monday to Friday. Weekends off for Orthopaedic students, not for emergency medicine students.

7 am: Reviewing the cases with students and doctors. Received teaching throughout the cases.

9 am: Go see the patients and do any of the tasks e.g. casts.

10 am: Teaching on a specific topic.

11 am: Go see patients on the wards/do any practical tasks/write up patient notes.

Lunch for an hour.

1pm-6pm: Based in the Emergency Department and seeing patients that came in/writing up notes.

CES Universidad

Orthopaedic Surgery

I expressed my interest to see orthopaedic surgery, and one of the students mentioned it to the doctor who then happily brought me along to theatre with him, making me feel very welcome. I got to scrub in, assist and close on all the operations they performed. The consultant would then struggle with his English to teach me what was happening in the surgery, which I really appreciated.

I got to see rotator cuff repairs, internal fixation of the tibia and LCA repairs.

Other Students

The Colombian students on the placement were lovely and helped me a great deal both with my medical knowledge and with my struggling Spanish.
I was also lucky in having another native English-speaking student from New Zealand there.

Colorful houses in Colombia

Spanish Requirement

CES Universidad doesn’t require a Spanish competency certificate, however, this may change after my stint there.  I would advise practicing your Spanish as soon as you make the decision to go to Colombia. It would take a high B1/B2 level in order to work competently and at least somewhat independently in the hospital.

Orthopaedics, however, is an ideal rotation for those with less Spanish ability. You need far less medical Spanish, and the nuances of a medical history aren’t as relevant.
Still, you should make a decent attempt at learning all the relevant vocabulary in order to get the most out of the elective

Things For Eager Students
Learn lots of medical Spanish and improve your all-round conversing Spanish.
How to type up a history in Spanish.

Graffiti tour

Tourist Activities

I was fairly wrecked by the time the weekends rolled around, and I imagine you will be too. Probably best not to plan your weekends down to a T, to try and cram in as much culture as 48hours allows. I’d recommend allowing time to travel before or after for a couple of weeks. I arrived in Colombia early and did my traveling in the 4 weeks before I started in the hospital. There are tons to do, and it would be disappointing to leave without thinking you made a least a decent crack at ticking off the touristy stuff.
If somehow stuck with weekends, however, Medellin has lots to offer. The nightlife is great (I got to go out with the Colombian students which was a lot of fun).
The graffiti tour I’d recommend. Taking the cable cars around the city was cool. There’s a walking tour of the city which was OK (you might as well do it, but don’t rush to tick it off). Paragliding was by far the highlight of Medellin for me. Super cheap (130,000pesos) and you get to soar in the winds on Medellin, with a panoramic view of the city.

Safety of the city

I feel tourists love to downplay the safety of Medellin, based on their own well worn, insulated paths through the city. Medellin is still a city that can be dangerous in every zone, and there are places non-locals should never go. I’ve read often that if you ‘use common sense you’ll be fine.’ However, common sense in Medellin differs vastly from common sense in a European city. For example, you shouldn’t flaunt your wealth, or take out your phone in public, regardless of the time of day. No zones are safe to walk around in late at night, so take Uber where possible. Be very cautious of your drinks on nights out, and be very skeptical of anyone showing interest in you on a night out.
All in all, I never experienced any problems or frightening experiences, and I would have no hesitations about returning or encouraging my friends to visit.
It’s highly recommended though to read up on the do’s/don’ts, the common pitfalls, and dangers, and to have backup plans if an unfortunate situation arises.

Graffiti Tour

Costs

There were no hospital/university costs for the elective, and I got a free lunch every day, so technically I was making money!
My accommodation was €165 for a month.
Food per day was maybe €15, including breakfast, the free lunch at the hospital and a nice meal in a restaurant that night.
For food, transport, and accommodation, Colombia is cheap. However, any ‘western’ goods (electronics, clothes, food brands) will be far more expensive than in Europe.

Overall

I would highly recommend doing a traumatology rotation at CES Universidad. The practical experience amongst such warm and friendly people has been so memorable. I thoroughly enjoyed my time both at the hospital and around Medellin.

Jack Dunne standing in front of the street

Cardiology Electives in Uganda

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Lindokuhle DIamini

Post by Lindokuhle Dlamini MBChB 5 student UKZN Nelson Mandela School of Medicine, South Africa

Preparations and Travelling to Uganda

During the time I was preparing for my trip to Uganda for my Cardiology electives for three weeks. I was not sure whether it was going to be possible for me to go to Uganda or not due to the fact that this was my first time traveling to a place that is outside of my own country. Immediately after my online application through GEMx, everything was easy for me because I received the help I needed on time and hence it was easy to get Immunizations, Visa, and other useful information about the place I was traveling to on time. Many people intervened and assisted a lot, Prof. Mergan Naidoo who is the GEMx Manager at UKZN, Professor Ncoza Dlova the dean of clinical medicine at UKZN medical school, Faith Nawagi from GEMx and Sunga Chumia helped me a lot with the whole process.

During the day of my trip to Uganda, I missed my flight from South Africa to Entebbe in Uganda, and this was due to the fact that there was a very long immigration cue at the airport and very few consultants, this was the only challenge I faced, but I did rebook the flight and the following morning I then traveled to Uganda, it was a good experience indeed.

Arrival and General Impression about Uganda

I arrived at Entebbe, and I checked in in the country after that I went to the Mugalo Hospital guest house where I was staying for my electives, I met many people in Uganda, but the common thing I noticed about every individual I met is that they were so welcoming and respecting as well, even though sometime I would not feel well because I did not fully understand their culture during the few days of my arrival in Uganda, and my fear was that maybe I will do or say something that means something bad or rude according to their culture, but their respect always kept me feeling at home. Uganda is a very good country but very expensive. I went to Shoprite just to get a few items at Acacia Mall and while comparing prices with the South African Shoprite, it was a lot more expensive. Staying at Mulago Hospital guest house was very good I met few Medical students from other countries and it was very nice to meet them, listen, and observe them as well I learned a lot from them both academically and socially.

Lindokuhle posing for the camera

My first day of Cardiology at Uganda Heart Institute, as I was still battling with the one hour difference between South Africa and Uganda, one of the Medical Students from the College of Health Sciences was sent to come and give us a tour around the Mulago Hospital, it was so useful because from then I did not struggle with directions around the entire hospital. On my first day, I met Dr. Isaac Ssinabuyla who is the manager of the GEMx at Makerere University, who is also a Cardiologist at Uganda Heart Institute, I also met Phionah Kinwa who is the Associate Coordinator for International Programs at Makerere College of Health Sciences. Dr. Isaac Ssinabulya took us and we went to the Heart Institute, we arrived the ward round had already started and he introduced us to the team. The Cardiologist who was in charge was Dr. Lugero Charles.  I learned a lot, most of the patients we saw were mixed valvular disease patients. The team I was with at the Uganda Heart Institute were so keen to teach, I learned a lot from them, not only academics but even the conduct of a Medical Doctor, being part of the team equipped me, to such an extent that I now consider Cardiology my first choice specialty. On Tuesdays, I attended major ward rounds where I met Dr. Batambuze an old Cardiologist who received his training in the United States. He taught me Cardiology, most patients presented with the mixed Valvular disease, coronary artery disease, Aortic dissection mostly caused by hypertension, and congestive Cardiac failure.

Lindokuhle and his colleagues

I clerked and presented patients to the doctors during ward rounds, and the most important thing Dr. Batambuze use to emphasize was the issue of being able to pick up clinical signs and being able to interpret them, as well as the importance of demonstrating how you elicited the clinical signs you mention. My Cardiology clinical attachment helped me a lot; it taught me to work with other people. Dr. Batambuze organized tutorials, and he uses to give both us medical students and MMed students tutorials, it is quite good to be involved in a clinical setting with many medical doctors, because you get different views and approaches as well which broadens your horizons. After the ward round, I used to study a lot, to try and cover as much work as possible. It was much discouraging to learn that Doctors are underpaid after so much hard work of their training, and the type of care they give to patients. It was also sad to see some of the patients in beds because nothing can be done but only palliation and some of them cannot afford to pay for the surgery procedures more especially the Type A Aortic dissection patients, because of limited resources at Uganda Heart Institute, and patients have to be transported to Kenya for such procedures only to find out that patients cannot afford, but I was glad because even though most patients could not afford, Doctors use to continue with medical treatment learned that there is a lot of communication in medicine, and to be a good doctor does not only require excellent academic record but it requires a lot of passion, patience, and commitment. I also learned to approach patients as a whole, not only to treat the disease but also to focus on other aspects of life, because they might be the precipitants and the cause of the disease. And now that I am at home I will make sure that I help other fellow students, and furnish them with all the information I received at Uganda Heart Institute. I really appreciate the experience I had at the Uganda Heart Institution.

Lindokuhle in his medical cap and stethoscope

Acknowledgments

I would like to thank GEMx for offering this exchange program, which made everything easy on my side as far as applications and other important information is concerned, thanking SAMA Scholarship for offering me funding. Prof Mergan Naidoo who is the manager of GEMx at the University of KwaZulu Natal(UKZN), Prof Ncoza Dlova who is the dean and head of the school of clinical medicine at UKZN who encouraged me to apply and further assisted me with finances where they were loopholes, Miss Sunga Chumia who assisted me with logistics. I would also like to thank Dr. Isaac Ssinabuyla who is the manager of GEMx at Makerere University in Uganda for the help and for hosting us as well as Phionah Kinwa.

Learning about the Healthcare System in Kenya

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Post by Frank Mayindi, a GEMx Medical Student from Makerere University College of Health Sciences [MEPI] taking an elective program at Kenyatta University

Frank Mayindi is my name, from Uganda, a Muganda by tribe, 24-year-old male currently pursuing a bachelor’s degree in medicine and surgery at Makerere University Uganda-Kampala College of Health Sciences currently in my fourth year of study, with a very strong passion for surgery, aspiring to be a neurosurgeon in future.

FRANK MAYINDI(1) EBELE GIFT ISAAC(2) MRS DOROTHY .W(3) AND KIKOYO JOACHIM(4) from the left side at the safari park in Kenya.

I undertook an elective placement at Kenyatta University Nairobi, Kenya through the period of 2nd June to 1st July under the Global Education in Medicine Exchange (GEMx) and I take this opportunity to extend my heartfelt gratitude to everyone that made this possible. ( Makerere University international office, Kenyatta University, and the GEMx co-ordinators).

My stay in Kenya was full of many experiences. While at Kenyatta University I rotated in the Department Of Surgery at the Kiambu level 5 hospital.

For the time I was in the hospital, I participated in ward rounds (major and grand), clerkship, and examination of patients, follow up of care of patients and bedside teachings. These activities enhanced my clinical skills especially in surgery and also served as a stepping stone to pursue my career in surgery.

I also attended CME’S (Continuous Medical Education sessions) and Morbidity and Mortality reports in which I got updated about some of the current medical practices and different approaches to patient care. I also appreciated the key leading causes of mortality and morbidity in the hospital’s catchment area.

Photo with the rest of the GEMx members at the postmodern library in Kenyatta University

Through my interaction with fellow students, I learned a lot about the Kenyan culture in terms of language, culture, and entertainment. I cannot withstand the temptation to mention about the wedding I attended at one of my friend’s place and the fact that most of the weddings were held on Saturdays and all vehicles attending a burial had to bear a red cloth tied to side mirrors or any available place as a mark.

I managed to attend a community outreach held at Brydges Home Center in Kajiado County, it was a place away from Nairobi and I managed to have an experience of Kenya outside the main capital city. While at the outreach I stationed in the pharmacy department where I managed to dispense different medications to the different patients, it gave the opportunity to interact with the pharmacy students and also learn briefly about the common drugs used in Kenya.

Group Photo was taken at the community outreach

Through my stay in Kenya, I realized that it was a cold country compared to my home country, however, I managed to maneuver through the weather through the use of jumpers and very thick sweaters. However, there were no unexpected outcomes through my stay in Kenya.

I was warmly welcomed by the student community especially the students I was to rotate with, at a moment I didn’t feel I was in a different country, they played a major role in my stay in Kenya. They taught me a lot of Kiswahili and Kikuyu, allowed me to join them in their co-curricular activities like football matches plus tennis and also I participated in their discussions as early as the 4th day of my stay. Still, through the guidance of my fellow students I managed to visit the national hospital of Kenya-Kenyatta National Hospital-and this broadened my picture of the health care system in Kenya. All in all my interaction with the students was far-reaching and up to now I still maintain communication with them and there was no moment I felt unsafe and not welcomed by them. Through interaction with the lecturers, I managed to meet with surgeons practicing in Kenya and the chairman of the department of surgery at the hospital, these greatly natured me in the field and encouraged me to pursue my career further.

The picture was taken at one of the clinical teaching sessions in Kiambu

To any student out there planning to partake a GEMx elective in a country away from home, I strongly encourage you not to hesitate to pursue such an elective. Learn about the language of the host country especially the basic words for basic community survival and also while in the host country make as many contacts as possible to further grow your carriers and to enhance your international relations and let every day that you spend for your elective count.

 

Sharing Experiences That Changed My Life

Filed under: GEMx Student Ambassador Network GEMx Student Reflections

Post by Fuensanta Guerrero del Cueto,  Student Ambassador at Universidad Nacional Autónoma de México (UNAM) guest speaker at the Manipal Teaching Hospital in Pokhara,  Nepal.

I believe in the importance of understanding and embracing diversity as a fundamental part of the medical profession.

When I was elected to be a Student Ambassador at UNAM, my main aim was to share my love for medicine, education and cultural exchange with fellow students who would later become my colleagues. If we can see ourselves in our patients, their families, other students, and doctors, no matter how different they may seem at the beginning, empathy will drive us to provide the best care that we can. An international experience is a great element to encourage it, and this is what I tried to transmit at the Leadership in Medicine lecture on 17 November 2016 during CICOM.

I was invited as a guest speaker to share my GEMx exchange experience at Manipal Teaching Hospital in Pokhara, Nepal in 2015. I was very excited until I knew that it would take place at the main auditorium of my school, which has room for 965 people, in front of all the UNAM and visiting students that were present at the contest. This certainly posed a challenge, since as a teaching assistant I had only given lectures to 40 or 50 students maximum. I felt that this great audience deserved to hear not only my story, but those of all UNAM students who had gone to Nepal before me, so I decided to compile pictures and quotes to show them why this elective had changed all our lives.

Embracing traditions: the celebration of Teej women’s festival with nurses from the Hospital

I told them that I had chosen Nepal because there was no place further away from Mexico that I could have traveled to (it is almost our geographical antipode). However, this turned out to be even more challenging because I arrived right after the 2015 earthquake and during a fuel crisis period. What shocked me at first was the difficulty to communicate with patients whose language I did not speak or understand. However, language barriers encouraged my reflection, since they are always present, not only with Nepali but even with Mexican indigenous languages or when caring for people without formal education.

Additionally, the importance of traditions and family structure is shared between my country and Nepal, and this is something that must not be overlooked by the medical professionals. Lastly, the strength of our people to “do more with less,” overcoming hardships and getting the best out of what they have is one of the most admirable qualities that we share with Nepal.

An elderly woman carrying wood during the fuel crisis. In the background, you can see Manipal Teaching Hospital and the Himalayan range

Community Medicine elective allowed me to approach marginalized populations in Tibetan refugee camps or in the mountains, where medical attention is difficult to access. The similarities between this country and my own were very meaningful for me. I became more aware of social and environmental determinants of health, and how patient education and empowerment are fundamental in these settings. This supported my decision to choose Global health and One health pathways for my medical career.

The opportunity to tell my story and try to inspire others was one of the best experiences as a member of the Student Ambassador Network, which I tried to continue during my outreach activities. I believe that medical students who dare to go out of their comfort zone will discover that “the others” are very similar to themselves. We need to become less isolated from one another in an increasingly globalized world where developmental and health challenges transcend national boundaries.

Team for outreach clinic with British nurses and Nepali doctor

 

Get to know Businge Alinaitwe

Filed under: GEMx Student Reflections

Businge Alinaitwe

Post by Businge Alinaitwe a student on an elective exchange from Makerere University College of Health Sciences [NEPI] to Lusaka School of Nursing and Midwifery [NEPI]

Hello,

Briefly about myself,

I am a Ugandan male, self-driven, motivated and interested in personal growth and development in all aspects of life including social, economic, interpersonal and professional growth. I love my family so much as well as engaging in business. Professionally, I am interested in delivering quality healthcare and I believe in the future I will be able to establish a quality ensuring health facility. I like soccer so much, being a Bayern Munich and German National team fan. I love engaging in athletics as well as adventuring. My Facebook name is Busi Mohbyl and on Twitter, I can be found at @busimohbyl.

As of now, I am really enjoying Lusaka for the people here are hospitable and loving. The weather is cool. The learning is good as the clinical instructors at the University Teaching Hospital (UTH) are so much willing to teach and guide us. I am really so much privileged to have such an opportunity, thank you GEMx.

Businge Alinaitwe.

Smiling with colleagues

 

The 4 Amazing Weeks in Nairobi, Kenya

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Joachim Nsubuga Kikoyo

Post by Joachim Nsubuga Kikoyo, final year medical student from Makerere University Medical School.

I wake up, time check 7:46 AM, I know it’s a different morning, one that is starting the day that I am going to have the longest and funniest journey of my life. Deep into my heart, I sing, “I am going to have the most amazing time for the next month.” My name is Joachim Nsubuga Kikoyo, a final year medical student from Makerere University Medical School and this is my four-week experience in Nairobi.

 

TRAVELS

Well anticipated, me and my colleagues including; Bitira Lyness, Wassajja John Bosco, Akanyijuka Abel, Mayindi Frank and Ebele Isaac Gift had already paid our bus tickets two days prior; so we are already at the bus station at 6:25 PM. Our luggage is packed and there we are, setting off at 7:09 PM.

Taking selfies on the bus

4 hours later, we are at the Uganda-Kenya border, cleared everything normally, but then one thing is messed up. Our bus has broken down. We are stuck for almost one and a half hours until we get back to the road. One good thing was that we got to have a wonderful view en route including the Naivasha Game Park, and Savanna Vegetation! It was some sort of a blessing. We however arrived and settled in Solomon plaza, in Kahawa Wendani in Nairobi.

FIRST DAY

I can’t completely describe the feeling, the wonderful environment, friendly people, the food, the glamorous weather, etc. To make this interesting, I will split this into parts.

a) Food

The food is not so much different from our food.  Just what we eat at home as snacks are what they actually eat as lunch, and supper. For example one can have a Chapatti (Chapo) with any sauce, beans, meat, etc. well they have lots of new foods I’ve never eaten, seen or even heard before, say for example; Ndegu, Mutura, and Mukimo

Ndengu;

I always call these ‘tiny peas’. They almost have the same taste. They are greatly delicious especially when served with rice.

Ndengu “Tiny Peas”

Mutura:

Mutura dish

My favorite; I almost ate it every day. It consists of offal’s packed with minced meat and usually some fats. It is either fried or grilled and then served with salad or chili. The taste is confusing between offal’s and meat if you have ever tasted both separately.

 

 

Mukimo:

Mukimo dish

A mixture of Irish potatoes, maize and pumpkin leaves that gives it the green color, all mashed together to form one solid chunk. The taste too is combinational, though the Irish potato taste is prevailing.

 

b) The people and the language

I can possibly say, Kenyans are the friendliest people I’ve ever met. Not that I haven’t met all of them, but it gave me that ill feeling that I don’t usually act in the same way when other visiting international students come at Makerere. I mean, who stops and asks if you are lost; and then after directs you, where you desired to go.

One only challenge though is the language. Kenyans speak, mostly Swahili, English and some speak some Kikuyu and other native languages. It’s funny that I don’t speak Swahili yet I come from the great East African region that is thought to be speaking Swahili as a joint language. But anyway I labored to learn how to speak some including: How you would inquire about a price, Ordering some food, Asking for directions and of course How to greet I still got many friends though, including; Punam Raval Ajay, Brian M Mbogo, Vugutsa Magada, Daudi E Musokyi, Dennis Mukabati, Juliet Wanjiri N .

Joachim taking pictures with his colleagues

An interesting thing though is that people who speak English are often thought to have more money, “a rich kid.” When you are negotiating prices you will always be charged extra despite your resemblance to the natives if you can speak English.

On Sundays, I took off some morning hours to attend mass. The mass was amazing attending one in a new community. Everything was however normal since it’s the same procedure like one at home, just the language though.

 

c) Transportation

Well if you are from Kampala and you are used to the boda-boda guys; in Nairobi they are rare, if you are to get one, which is possible, they are a bit high at cost and usually not allowed in the city center. So you will probably enjoy their great matatus (taxis). One funny thing with them is that, if you are to board one of them (that is if you are lucky) it will feel like you are entering a club. The matatus have loud booming music, flickering lights, and a large TV set in the front. The ride is inexpensive as a 2 km distance can cost you as low as 10KSHS.

d) Prices

The standards of living in Nairobi are kind of higher than that in Kampala. It’s worse if you don’t know where to buy the cheaper stuff if you can’t speak Swahili and worse if you are bargaining in English. So if you have a Kenyan friend, stick to that one, he/she will probably save you.

e) The Weather and Climate.

Not so much from the one in Kampala, its rainy season in June and so in Nairobi. It’s too cold, you will probably consider coming with winter clothes to be on a safe side.

f) Sports and Leisure.

A lot of sports activities exist at Kenyatta University; Soccer, Hockey, Basketball, Handball, etc. The sport I am interested in is soccer. It is fun to play around with my Kenyan brothers, even when communication skills are poor. At least you can use sign language or even struggle to shout Swahili words, but anyway, the major thing is I enjoyed playing soccer.

HOSPITAL WORK

Kenya organizes their health system in a stepwise manner so as complicated cases are referred to a higher level i.e. from level 1 (Community Level) to level 6 (National Referral Hospital).

I was stationed at Kiambu Hospital, a level 5 facility, with almost all facilities to manage most of the conditions in Kiambu County of Kenya. I was rotating in Pediatrics and it consisted of three wards; Newborn unit (NBU), Ward, 1 and Out-patient Department. I decided to rotate in each of these wards weekly.

a) NBU

NBU Facilities

Not so much different from the one in Mulago, with nearly all facilities, with a good sense of organization and yeah the crying cute little ones who I loved to be around with. One other thing though, it’s kind of too hot in there, so it was usually my safe haven for the freezing cold weather during that week. At NBU, that’s where I got to be taught by Dr. Mugane a neonatologist, who took me through the common conditions managed at their unit and how and they are handled.

 

 

b) Ward 1

Doctors from Ward 1

The ward consists of the resuscitation area, the acute respiratory emergency management, and others. One specific thing, however, is that I was lucky to be taught by the pediatrician, Dr. Grace Akech Ochieng, a consultant pediatric cardiologist, who took me through the echocardiography. I learned how it is taken, read, and interpreted. It was my first time seeing one be done.

 The Medical Camp

This involved boarding buses to Isinya in Kijiado County, South of Kenya at a children’s center (Brydges center). It involved examining the kids, providing them with prophylactic treatment and distributing hygienic supplies. It was fun to hang around small kids even when I know we can barely communicate.

THE TOUR OF THE NAIROBI SAFARI WALK

My colleagues and I got to visit the only game park in the capital of the nation.  This involved sight and sound of different animals, trees, the river and the people. Though it is not my first time to see animals like the ostrich, hippopotamus, hyena, buffalo, crocodiles, and many others, it was however too long since I last saw any of them. I guess my last time was when I was 8 or 9 years old. The best part of all of the tour was being able to hang out with the newly acquired friends and enjoying every moment of it.

THE LAST DAY

I hate goodbyes, but unfortunately, that’s life! Everything has a beginning and an end. It was the end of the four weeks; I knew this would be hurting to leave. So I had to say the hard words. Even though I know I will see them again.

The picture with the GEMx team

 

Get to know: Imelda Namatovu

Filed under: GEMx Regional Exchanges GEMx Student Reflections

Imelda standing in front of the airplane.

Post by Imelda Namatovu, a student from Makerere University College of Health Sciences [NEPI]  on an elective exchange to Lusaka School of Nursing and Midwifery [NEPI] 

The cyclical patterns of audacious curiosity and dogged determination have constituted the last two decades of this maze, I call my life. For an African girl who has been raised in deprivation of opportunities to dream big as well as bring her dreams to life, it is my pleasure to confidently say it is never about society but arduous nature of the person in you. This get-up-and-go has further driven me to ends many never thought I could stretch. Pursuing the Nursing profession has unbolted all doors to my career goals. My interest in Nursing research and teaching is growing untamable as well.  I enjoy watching soccer, teaching and singing is my most treasured hobby. Coming from a relatively smaller highly populated country (Uganda), my experience in Lusaka (Zambia) has been a totally different one. Being a large country with a relatively smaller population, I have met a number of very warm and welcoming people who are willing to spare time to teach us as well as make us feel at home. Despite the comparatively cold weather, Lusaka has been a wonderful discovery in my life. It has been wonderful experiencing a different culture while learning from another health care system as well as expanding my career network and professional aptitude.

Imelda standing with her colleagues

The Beautiful Art that is Medicine

Filed under: GEMx Student Ambassador Network GEMx Student Reflections

Josefa Santa Maria

Post by Josefa Santa Maria, a student ambassador from Pontificia Universidad Católica de Chile Escuela de Medicina who has completed an exchange at Universidad Pontificia Bolivariana Facultad de Medicina.

My GEMx Ambassador Experience: Exchange in Medellin

During the period that I worked as an ambassador for GEMx, I had the opportunity to participate in many activities, from virtual meetings to lunch with the dean of the faculty. However, probably the one that I will remember the most will be my Emergency Medicine elective in Medellin, Colombia.

One of the reasons why I applied to be an Ambassador for GEMx, is that I consider the values in medical education as something that transcends the geographical barrier, and the exercise of this in other countries (even in another city) is an enriching experience both academically and humanly speaking.

My personal experience doing the elective of Emergency Medicine at the Pontificia Bolivarian University in Medellin, Colombia, is something that I will definitely turn into one of my most precious memory. It was a great challenge (and I have to admit that I was even a little scared) to leave my comfort zone and to do part of my internship in a foreign country: everything was different: the schedule, the food, the academic requirement, the way of teaching, the responsibilities with patients, the shifts, and even though the language was Spanish all the same there were local words and expressions that took me a long time to understand, but none of that was an obstacle to get to the hospital every day with a big smile and my maximum enthusiasm to learn.

Posing in front of buildings

One of the things that I liked the most was the warm reception I received from my intern colleagues, the doctors and especially the patients, who always asked me where I came from, and how did I feel living in Colombia, on many occasions I had very interesting conversations with them. They were always very happy and grateful for the attention I gave them, that was something that definitely left my heart full. In addition to having theoretical seminars every day and all the learning I got from each clinical case in the emergency service, my elective in Colombia allowed me to experience the diversity of the gastronomic culture of the area, to do tours around the city, in which I learned from the history and tradition of the neighborhoods of Medellin, and visit the nearby towns, where I  could enjoy wonderful landscapes.

Standing next to art mural

All in all, the 4 weeks I spent in Colombia helped me grow in different dimensions, both personally and academically. They helped me to be more independent, to improve my ability to adapt, to relate to different types of patients, and last but not least, to learn more about the beautiful art that is Medicine.

Eric and Aline’s Elective Exchange to Uganda

Filed under: GEMx Student Reflections

NIZEYIMANA Eric and AKAYEZU Aline, 5th Year Medical Student from University of Rwanda. We completed GEMx Exchange on Family Medicine at Makerere University 

INTRODUCTION

Eric and Aline on the way toward Makarere University for Elective

Our hearts were very full the first time we received an email confirming that we were chosen to be a part of this amazing elective. The Family Medicine is not yet initiated in Rwanda health system. This was a golden opportunity to learn more and bring back a package of knowledge to share with our colleagues.

It is the dream of every Medical student to do an exchange outside of their usual setting so that they work in another healthcare system to learn and have a different experience that’s why I can’t hesitate to say this was our turn to realize our own.

 WELCOME TO MAKERERE UNIVERSITY  

Eric, Ms. Phionah and Aline at Makerere University

 

 

 

 

 

 

 

 

Our journey took 718 km2 from Kigali-Rwanda to Tororo-Uganda training center in Uganda, where the training about family medicine took place.  Arriving at MAKERERE University, we met  Ms. Phionah, the international students’ coordinator at this university. With warm welcomes, she gave an explanation about the exchange and introduced us to the rest of the team.

It was a great experience to travel the long distance on a bus. It was the first time, we took the time to observe the Uganda country, environment, and appreciate how well it is.

ACCOMMODATION

During our elective, we stayed at the Crystal Hotel. The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

 

Eric and Aline at Crystal Hotel

The hotel was close to the hospital. It was safe, comfortable and calm when you were studying. They had all kind of foods and it was delicious.

ORIENTATION AT TORORO DISTRICT HOSPITAL   

Our 2nd day in Uganda was for the introduction to family medicine and orientation at training center, Tororo district hospital. We met with Dr. George Welishe and Dr. Okuuny Vincent, the senior consultants in Family Medicine who greeted us with warm welcomes. We had a  tour of whole hospital, introducing us to all departments of the hospital. We visited patient hospitalization wards, general theater, labor and administration offices &staff, emergency ward, HIV patients department and antenatal and family planning services. Everyone was happy to host us and we were also happy to be among them and excited to be in different healthcare settings. It is a large district hospital, which has many departments.

Eric, Aline, Dr.Okuuny and Dr.Maria (intern from Italy)

The daily schedule was made by morning staff meeting which was followed by ward round, theater, or labor or other department visit in the hospital.

1.Morning staff meeting

Every morning we have presentations on the topics that we were given on schedule. The topics that was chosen by trainers according to two conditions: 1.The most common cases in medical career related to the family medicine in which they think that will be useful to us along our internship and medical career. The second condition is the cases that are mostly found in Uganda healthcare setting especially in Tororo district hospital.  . Under consultant supervision, we had discussions in which they taught us on both our presented topic and presentation skills.

 2. Hospitalization Patients, Internal Medicine wards round

Aline, Eric, with Family Medicine Post-graduates Dr.francais and Dr.Christine on right and word round team on right

We had a daily attendance of ward round with the rest of the team which was made by family medicine consultants, family medicine postgraduates, nurses, and other medical doctors. I gained more experience in patient clerking and presenting during this activity and from this I understood that medicine is the same all over the world because it was very exciting to be able to make a diagnosis for a patient from another setting and participate in patient management by the same knowledge.

This ward round also emphasized on bedside teaching according to the case as long as also that most of the attendants were students. This was occupying a big part of our exchange where we learned much as found more cases that we didn’t see in our healthcare setting. Here I can list sickle cell diseases associated with malaria which is more common in the pediatric setting here, sepsis secondary to septic abortion, HIV and TB were more frequent in general wards especially in young people. We have seen some special cases like Asthma attack, dog bite, and pregnancy on sickle cell disease.

We learned from all the cases and were involved in their management process. We can confirm without hesitation that we are confident in managing patients.

3. Gynecology and obstetrics department

Eric using fetoscope

This was another interesting and productive service that we rotated in. The main objective was to know what services they deliver and get experiences in them as a future clinician and the objective was achieved. The major services that we provided were TORCH screening (toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex/HIV)  and counseling on results, Prevention of Mother to child transmission of HIV, Family planning, Immunization, Examination of pregnant mothers to assess for any complications that might arise during pregnancy.

We experienced also on the procedures done included vaginal examination, head to toe examination focusing on the abdomen for the pregnant mothers to check for the fetal heart rate through the use of the fetoscope. The LEOPOLD Maneuver like palpation of the abdomen to check for the lie, presentation, and engagement of the fetus. Not only this but also in labor they taught us, conducting spontaneous vaginal delivery, neonatal examination, and resuscitation for the newborn with fetal distress and other complications.

We enjoyed the rotation since we could learn more from each other through discussion of patient’s condition and be sharing an idea with the rest of the team which was mostly made by midwives.

4. HIV patients clinic

Eric (left) and Aline *right in HIV clinic consultation

In all the time we work at Tororo district hospital, we rotated also in HIV clinic. The services provided were history taking and physical examination for HIV patients to access drugs adherence, new HIV diagnosed patients counseling, viral load monitoring and shifting of patients from drugs line to another.

Of course, as a referral hospital, the number of attendants was big, At the time we helped around 80 patients and surprisingly the 2/3 was women and reason was that of the polygamy culture in Tororo community which makes the prevalence of  the HIV infection to rise in women than in men

BENEFITS

We met friends and we made friendships, we learned much from each other and we made strong networks. Finally, we had fun.

SKILLS AND KNOWLEDGE GAINED

Together with family Medicine post-graduates having fun

Four weeks at the Tororo district hospital for family medicine was productive beyond our expectations. Along all time, rotating in different departments we gain many skills in Family Medicine, the way it works and the services it provides. As long this specialty is not yet initiated in Rwanda health system, I hope to share with my colleague medical students, and other health professionals this skills or others who will be interested in family medicine. In addition to this, we gained also more about presentation skills.

The knowledge gained includes patient history taking and physical exams to list differential diagnosis, appropriate patients management, conducting a normal lobar and c/section delivery. Antenatal care includes Leopard maneuver and use of fetoscope and management and follows up of HIV patients.

CHALLENGES

All the time we spent in this amazing elective, the main challenge we meet is the languages. After arriving in the Tororo town, we have found that they are more local different languages spoken in the community which account more than 5 which also is related to different tribes with a different culture. This has brought some limitation during patients caring especially in history taking and management, explanation on medication taking and patient diseases education.  So to handle this, we used to organize a team during ward round such that there is one health care provider who speaks both English and one of the local languages so that he/she will translate.

The other challenge we met was to work in low facilities hospital where some materials were not available especially medications and septic environment, which was a barrier in patients treated and also we thought it could be a source of spreading diseases among hospitalized patients. To handle this will need multidisciplinary involvement including Minister of Health in Uganda and other health institutes but we did some advocacy about the problems.

LESSON I LEARNT

Dr. Cecilia and Enrica (left)

Of course, learning is a continuous process, but in this elective, the first thing I learned is that every healthcare professional can deliver the health services to the community according to his or her level.

The 2nd lesson is that working in limited health facilities can be challenging in the medical career while you were delivering health services but it’s good and important to adapt and use the few we have effectively to help the patients

The 3rd lesson, learning from each other and sharing information and respecting each other is most important in terms of both helping patients and teaching during health care services delivered.

The 4th lesson is As a student I got a lot about professionalism at work during this elective at Tororo district Hospitals. The healthcare professionals were having a positive attitude of medics towards students and their work made me enjoy my stay and practice as a student there.

ACKNOWLEDGE

We want to express my sincere gratitude thanks to the executive committee of GEMx represented by Carol Noel Russo, GEMx Regional representative in Africa Faith Nawagi, the host coordinator at MAKERERE UNIVESITY Mrs. Phionah and my university of Rwanda GEMx coordinator, Dr. UWINEZA Annette and everyone who contributed to making this elective happen

It great pleasure to thank all confident you hard toward us and offer this opportunity in which we learned much skills and experience and all your commitment and effort you made to create a way so that the elective on Family Medicine at Makerere university lead to success.

Special are destined to our trainers, senior consultants in Family Medicine at TORORO District hospital, Dr. Welishe George and Dr. Okuuny Vicent with the rest of the team who showed strong commitment to teach us as much they can, we really highly appreciate their motivation and strategies they use during training  health professionals and I wish they could spread that attitude among the rest healthcare professional trainers around the world.

 

 

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