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GEMx and American University in Beirut Making Dreams Come True One Robot at a Time

Filed under: GEMx Student Reflections

Blog By: Mostafa Sedky medical student from Ain Shams Univerity who has completed his elective at eye-caching American University in Beirut, Lebanon through GEMx

I went through an elective for one month at the eye-catching American University in Beirut. As it was one of my lifetime dreams to go there, GEMX provided great chance for me to apply for an elective and visit the place. Despite facing some difficulties to arrange for my travel, I used all my efforts and made it there. The amazing historical campus with the unique seafront view was fully equipped with a state-of-the-art entertainment, medical, surgical and educational equipment’s, which all added to the unforgettable learning experience.

One of my dreams that was also fulfilled was to learn more information about robotic surgery with the Da Vinci robot that was at the university and which is now the talk of the town in all the surgical fields. I had an opportunity to meet some kind and famous Lebanese professors and surgeons and learn from them about every single incision and suture while attending in the OR during my elective in the Department of General Surgery. I received a hands-on laparoscopy and suturing workshops on a simulator to add to the excitingly thrilling experience.

 

The administration has provided me with full access to the medical library which had a separate huge building with calm and encouraging weather and the latest medical news and information to indulge your knowledge with as well as a high-speed internet connection with subscriptions to open a lot of scientific databases and journals. I also had access to the student activity center which had a private beach, warm indoor swimming pool with an A/C surrounding as I was there during cold winter as well as an amazing Gym and an indoor basketball court. There were a lot of other courts like a stadium for football and tennis and volley courts but the basketball one was my favorite.

Regarding the exceedingly reputable and scrumptious Lebanese food, it was one of the best things in this country starting from the sizzling cheese of the street mankoosha to the mouth-watering ice cream of el Bachir, it was one of the best things in the country. When I wanted to be more healthy I resorted to the delicious Lebanese fruits especially apples which were unique than any other apples I have ever tried as well as the ambrosial honey from the cedars.

To add to the experience, l spent the weekends exploring this amazing country Lebanon from the far north in Tripoli visiting Faraya, Jetta, Junia, Byblos, Dora to Beirut then reaching to the south visiting EL Shouf, Beit el-Din, Deir El Kamar, Saida, Tyre to Baalbek. It was the first time in my life I built a snowman and went skiing then go to the beach on the same day. I spent some quality time talking to my new Lebanese friends and taking photos that make me perpetually happy whenever I remember them. It’s undeniable that this elective experience has called upon my untapped reservoir of tenacity, perseverance, fortitude, curiosity, and willingness to learn. It has opened the gates for me to believe more in my dreams and turned some of them into precious memories.

 

GEMx-SNO Exchange 2019: Refreshing My Passion for Medicine

Filed under: GEMx Sponsored Events, GEMx Student Reflections, GEMx-SNO

Blog By: Roxana Ramos, medical student from Faculated de Medicina UNAM who was selected as this year’s GEMx-SNO exchange winner, by GEMx and SNO TUFH and participated in a five week exchange at Flinders University NT in Darwin NT, Australia 

I am a Mexican 5th-year medical student that was selected to participate in the exchange to Flinders University in Darwin NT, Australia. It took me a while to believe the great news, and after I did, my excitement grew every minute until the day of departure.

Flinders University

I spent 4 weeks in the Pediatrics Department of the Royal Darwin Hospital, each week in a different ward: General Pediatrics and Adolescent Medicine, Pediatric Infectious Diseases and Malnutrition, Postnatal and Special Care Nursery, and the Outpatient Clinic. Every day started with the 8 am handover, where each patient was reviewed and after that everyone left with their teams to their ward. I liked this part because it was when I could hang out with the other med students for a little while. Each team was composed by a consultant, a registrar, a resident, an intern (or not), and a student. During the ward rounds it was like what I’m used to: follow the doctors, write some notes, answer questions, examine patients, get papers, and the most important job of a med student: awkwardly be in the way. Since I had already had my Pediatrics placement in Mexico, I felt confident about what I was seeing and listening, but the cool part is I got to experience different epidemiology and learn about diseases like Acute Rheumatic Fever and Rheumatic Heart Disease, that are very rare in Mexico. The two major differences I noticed from my home country to Australia are: – Doctors care for a good work-life balance and the system allows them to do it. The hours are reasonable, the pay is great and in general, the environment in the hospital is so nice and happy. Since the first day I was there I’ve been trying to think how to change the mindset of thousands of years and millions of doctors in Mexico, so that we can have a better quality of life. No clue until now, except lead by example. – Material resources are abundant, so they don’t struggle as much to give the best management and treatment to their patients. This also has to do with the Health System structure, which is very efficient in Australia. Although in Mexico we have a universal Health System, people still must pay (at least a symbolic amount) for consults, hospitalizations, and medicines. Meeting some of the doctors there gave me an idea of the way I want to be when I grow up, not just as a doctor, but as a person too. It refreshed my passion for medicine. We also had occasional teaching sessions, which were outstanding. Some of them included taking history and checking a patient by ourselves, others were to review a specific topic, etc. The Department also had other activities like the Journal Club, X-ray meetings, and Grand Rounds, which were great as well. Apart from the one-month rotation, I got to fly to a Health Clinic in a remote community called Warruwi in the South Goulburn Island. To prepare for this, I had to attend a Cultural Awareness Workshop. I enjoyed learning about the Larrakia people, mainly because I knew little about them before this exchange. I was surprised by some of their traditions, like their kin and family relationships, their traditional medicine history and their actual epidemiology.

Receiving my diploma from Justin Seeling (GEMx Manager) and Vishnupriya Vijayalekshmi (SNO President)

After those wonderful and enriching weeks, I got to assist the TUFH 2019 Conference, which was the cherry on top. I met med students from around the World, I was inspired by the talks and workshops, and pleased to know that there are good people everywhere who are trying to help others. I was excited to learn that next year’s conference will be held in Mexico City, and the best part: I’m the new Local Team Manager. I’m looking forward to the exchange and the whole event.

SNO International Executive Committee 2019-2020

It was a very enriching experience in all aspects of life. I feel blessed for this opportunity, and I think that it impacted me (in a good way) to see how Medicine is practiced in other places.

Njera, castles, and compassion: just three of the wonderful things I experienced at Mekelle University

Filed under: GEMx Regional Exchanges, GEMx Student Reflections

By: DAPHNE KIBANDA , 5TH YEAR STUDENT (MBChB) at MBARARA UNIVERSITY OF SCIENCE AND TECHNOLOGY

Day out at Emperor Yohannes’ castle with Kidus(L) myself(C) and Henry(R)
The thought of an exchange study program away from my home university and country was as excitingas it was scary. With the GEMx website and with help from Ms. Faith Nawagi, the GEMx Africa representative, the application process went smoother than I expected. Within less than a month, my colleague and I were ready to travel to Mekelle University, College of Health Sciences, in Ethiopia. Ms. Sheila and Ms. Angela Nakato from the International Relations Office were also key in our travel preparations.

At about 5 a.m. on Saturday 13th July, we landed in Addis Ababa. Our flight to Mekelle was at 7.15a.m so we had some time to lounge. This was both our first time in Ethiopia and at Bole International Airport and so locating the different terminals took some bit of time. It can’t go without mention that every single person we interacted with at the airport, both passengers and employees, was very welcoming and helpful. Unfortunately, the flight was delayed for over 3 hours due to unfavourable weather at our destination and since we had no way of communicating with our hosts yet, we missed our transport from the airport. Nevertheless, we were very well received into Mekelle by the staff, students and even the locals.

With some of the C11 class members after a management session.

We joined the C11 group on the Internal medicine rotation as soon as we arrived and made very many friends. The students always readily helped with translation during clerkships as we were not conversant with the local language. I particularly remember an incident where I went to the ward to clerk a patient and all the members of my group were not around. I walked through the ward looking for a familiar face in vain. Later, I met a student from another group and when I explained myself to her, she was more than willing to help. They made the environment very comfortable and conducive for the one month we spent with them. Every day on the ward at Ayder Comprehensive Specialised Hospital was a new learning experience. Although the prevalent conditions didn’t differ much from those in Uganda, we were able to compare National treatment guidelines for common communicable conditions in both countries. We also participated in ward rounds, bedside teachings, and management sessions and were able to share and expand our knowledge further.

Outside of class, we appreciated the diverse culture of the people in Mekelle. We learned several words and phrases in Tigrinya, the native language, and by the end of one week, “Selam” which is a word for “hello” came much more easily to me. They have a unique taste in food, and I fell in love with “Njera”.

Njera and stew
I could not go an entire day without this traditional dish and to date, Ethiopian food is one of my favourites and Ethiopian restaurants in Uganda are a go-to. We also witnessed a traditional Ethiopian wedding and I must say the African culture is rich and full of diversity. We managed to visit Emperor Yohannes’ castle in Mekelle city, which serves as a museum currently and had some of our new friends show us around the rest of the city.

Our stay in Mekelle came to an end after exactly 4 weeks and on 9th August, we had to travel back home. We said a couple of emotional and even tearful goodbyes and promised to keep in touch with our friends. It was an educative, humbling, inspirational and fun experience for me, and I look forward to more of these opportunities with GEMx. Thank you so much for this amazing opportunity.

Camels and Cataracts: an Ophthalmology Elective at Lighthouse for Christ Eye Center

Filed under: GEMx Student Reflections

By: Denis KAMARA, Ophthalmology resident Mbarara University of Science and Technology for electives at Lighthouse for Christ eye center, Mombasa July 2019

Denis standing outside the hopital

 

With a lot of appreciation to GEMx, I am a Ugandan who just completed my elective and I will be starting my second year come August at Mbarara University of Science and Technology (MUST) where I joined in August 2018 from St. Joseph’s Hospital Kitgum, Northern Uganda. During my second semester a colleague, Dr. Naome Kyomugahso shared with me electives opportunity offered by GEMx which looked interesting, so I moved forward and applied. I must admit, it wasn’t all easy. In attempts of applying I had trying moments I gave up due to some technical and requirement challenges, but I was greatly encouraged and guided by Ms. Faith and Ms. Phiona to move step by step till I was accepted at Lighthouse.

Denis at the airport

My journey started from MUST on 28th of June, I arrived at Lighthouse at 7:30 pm Saturday for the flight from Nairobi had been rescheduled. Being weekend the facility was so quiet but Victor Indeche, staff welcomed me and showed me the accommodation. The next day, I requested to join him for the church at the satellite for Lighthouse churches. I got my first ride in a Tuktuk as they were so many of them as well as taxis called matatus (small minibuses). They were so different from the taxis in Uganda. They played loud music and were raised at the back like Pavilions. They move so fast even through inroads under construction, you find that they were moving in between two trailers whose containers look as if they will be falling off any second but to my surprise everyone else seemed fine, not bothered at all.

One thing that struck my sight was the architecture of most of the buildings which were connected and had blue-white colors as a symbol for the Mombasa County.

Denis with colleagues

On Monday 1st July, Lighthouse for Christ Eye Center became quite busy with many patients and staffs; I was warmly welcomed by Mrs. Gladys, she introduced me to the Medical Director, DR.Fredrick Korir who orientated me to all units. The facility has special clinics of cornea and pediatrics in addition to the private and general clinics of pediatrics and cornea. Operation in the theater is from Monday to Thursday; outreach teams carry out screening within the communities and there also satellite clinics. The facility provides a lot of services in eye care and spiritually nourishes the people from Mombasa and far beyond.

In my time at Lighthouse, I saw and managed patients from the general clinics most of the time when there was no theater so I learned and perfected my examination skills, did many investigations and learned basic refraction. I discussed several cases with Dr.  Fredrick Korir, Cornea specialist and Dr. Ibrahim Matende who taught me enormously. Learning continued during theater where I learned

Denis and team during cataract surgery
different surgical techniques in cataract, glaucoma and corneal surgeries. Thanks to Dr. Sawe David who provided me the opportunity to do 3 cataract surgeries under close supervision that challenged the energy and feeling within me so much so, that I now have the passion and desire to continue with that and be able to do them alone.

Thee second week was amazing and so fortunate for me because Lighthouse hosted a surgical camp with specialist in Cornea (Dr.Bowman Brad), Glaucoma, ( Dr.Tosin Smith) and oculoplastics ( Dr.Jorge Corona) all from Texas who taught me a lot after

Dennis and colleagues
knowing I was an ophthalmology resident on electives. We worked together in theater and I observed and assisted  in a number of procedures for my first time such as phacoemulsification,keratoplasty-DSAEK, blepharoplasty, Gonioscopy Assisted Transluminal Trabeculotomy, stent and tube insertion and so many others. Thanks to the elective, I am in touch with them for guidance greater inspiration in my ophthalmology career.

Weekdays were all spent at Light House and weekends were when I moved around with friends and spent much time at the beaches riding camels and swimming in the oceans. The last Saturday was well-spent thanks to Lighthouse where we went to Flamingo beach hotel for team building where a lot of lesson activities were provided. The weather was a bit cooler compared to another period although I felt it hotter compared to Ugandan weather. I also polished up my Swahili quite a bit as I interacted with patients and staff though English bailed me out most times.

Denis and friends after riding a camel

In general it was one of the best opportunities in my life though the time seemed short which was due to other university obligation that I was required to fulfill in the same time period limiting me to only one month, I call it the fruitful month of July for I gained a lot of knowledge, skills, and the uniqueness in how different the facility operates.

I am so grateful to GEMx for making a big difference in my life by offering me such a big opportunity to improve on my career, thanks a lot for those who were in contact with me to make it possible, Ms. Faith Nawagi, the GEMx Global Partnership Development Rep- Africa, Ms. Phionah Asaba Kinwa the GEMx Africa administrator, Ms. Hulda from COECSA finance, Dr. Simom Arunga from MUST is your GEMx manager, Dr. Frederick and Ms. Gladys of Light House in Mombasa. Thanks to Dr.Simon Arunga, senior lecturer and GEMx coordinator who confirmed my details and guided me accordingly.

Denis and colleagues on a computer

In the same spirit of thanks to Lighthouse family for hosting me as one of their own and each member contributing to my learning, Asante Sana to the entire team from management, administration, and everyone.

All things have a beginning where you start from and always return, great thanks to Mbarara University of Science and Technology for the collaboration and allowing me to come for electives. Be blessed for your good works in Jesus, name.

 

 

From Kampala to Rwinkwavu: Experiencing Rwanda and its Health Systems

Filed under: GEMx Regional Exchanges, GEMx Student Reflections

By: Tinka George William, Makerere University School of Medicine to University of Rwanda College of Medicine and Health Sciences 

Tinka and other cohorts at the bus park

At Nyabugogo Bus Park

On the 27th day of July, at about 7:15 pm, I left my room and headed to the Trinity bus parking lot. By 8:45 pm Marvin, Martin, Emmanuel, and Edward had come. Our other friend Reagan was not able to get to the bus by its departure time and he joined us the following day.

This began the longest bus trip I have taken to date. I went listening to George Carlin’s “When will Jesus bring the pork chops?’’ I have listened to it before, so the jokes were a little less funny since I already expected what he was going to say. At some points, I slept off, then woke up to the bus hitting a hump or something of the sort. By about 4 or 5 am the following morning, we were at the Uganda-Rwanda border of Katuna. The process of crossing over was a little fast yet, somehow, a little slow. It was so cold and my hands were freezing!

After the immigration bureaucracies, we sped off into the land of a thousand hills. For a moment we were confused about the actual time. The weather outside looked like 8 am (Ugandan time). My phone, however, was showing 7 am! We later found out that Rwanda is in a different time zone from Uganda. It was 7 am (Rwandan time).

Students at Rwinkawavu

Kigali, Rwanda was quite different from Uganda. It appeared, without a doubt, cleaner (I deliberately went on looking out for plastic bag litter but I hardly saw any). Their water channels weren’t clogged (like a good number of ours back home), we were being driven on the right side of the road (unlike the left for Uganda), there were indeed many hills, and their city looked relatively less busy than ours. The rest were the same Ugandan stuff. Same house architecture (especially in the urban areas), same people lifestyles: clothing, general activities, and the same weather. By 9 am we were in Nyabugogo parking station.

We took our first major bunch of snaps in Rwanda there. Those of us that hadn’t exchanged our Uganda shillings to Rwanda Francs also did so from there. I was surprised (and a little embarrassed) that the Rwandan currency has more weight than the Ugandan currency. Our Rwandan contact, Mr. Nepo found us shortly thereafter and took us for our very first Rwandan meal- breakfast. It was enjoyable. Mr. Nepo was a nice host. He told us of many interesting stories about Rwanda. We received a pleasant welcome.

Students on motorcycles

 

Another apparent difference between Uganda and Rwanda that I noticed as we broke our fast was that the ‘’boda-bodas’’ (motorcycle taxis) there seemed to much more strictly follow the rule of carrying only one passenger. They all had helmets for the passengers. This is unlike what takes place back home, and it is good as it reduces road accident-related trauma cases and deaths.

Next was the drive to Rwinkwavu in the Eastern province of the country. We were driven through Kigali. I must say that I had always imagined Kigali to be a small city (since it is in a small country!). Oh boy, I have always been wrong. Kigali is a relatively large city.

The drive to Rwinkwavu was rather long. We had been told it would take about two hours. I can’t say I am sure how long it took because I slept off along the way. You see, one other difference between Uganda and Rwanda was that the roads in Rwanda never seemed to have humps or potholes. It is no wonder therefore that the journey to Rwinkwavu was so smooth that we almost all slept off at some point. Not to mention that we were also tired by then.

All journeys come to an end, and so did this one. By 1 pm, we had arrived and settled into the secluded home of Partners in Health (Inshuti Mu Buzima), our hosts in Rwinkwavu. The place was a nice, quiet, and peaceful countryside settlement on one side of a hill overlooking a far way valley. It had most of the amenities to make our two weeks stay enjoyable.

 

The following two weeks: 

Students after University of Rwanda walk and talk session grouped outside building

The following day, we were joined by twenty students from the University of Rwanda. We were to study the Social and Community Medicine (SOCOMED) course with them. By the end of it all, they were to become our very tight lifelong friends.

The following two weeks saw us having lectures, presentations, community visits, a screening session, a trip around Kigali, and a mine visit. The lecturers always made the sessions fun. Our sitting arrangement in a U-shape setup with students facing each other made the lectures more of interactive sessions and less of the traditional boring classes. The different topics we had over the two week period included; an introduction to the SOCOMED program, the Rwanda Health system, the SWOT analysis technique, communication skills, the community health program in Rwanda, leadership, social determinants of health, palliative care, research, health equity, disease prevention & health promotion, traditional medicine, quality improvement and team building, etc. We got to listen from the Executive Director of PIH in Rwanda- Dr. Joel Mubiligi, the Chief Human resource officer of PIH, the Head of informatics, the head of medical education and training and many others. This ensured that we got to learn knowledge and experiences from more than the medical perspective. We got career guidance, leadership skills, and strategies and many other attributes.For presentations, we were divided into different groups. We were sometimes then given group and individual assignments to present to the class. My assignment was to present about SDG 9 using Sao Tome and Principe as a case study.

 

Students huddled around community health worker

With the Community Health Worker, Mr. Emmanueri (2nd from the left)

 

 

We had several community visits. We visited community health workers first. We were surprised at how much the Rwanda Health Care system is relying on them. I realized they play a relatively bigger role in Rwanda than in my country (Uganda). They are provided with more resources also. For example, they must fill in the Health Information Management System (HMIS) Reports, they have clinical guidelines and treat malaria, pneumonia, diarrhea, cough & flu, and do health screening. They also seemed to have a relatively more advanced precision of clinical examination skills than their counterparts in my country.

students at screening sessions
  They could identify jaundice, anemia, cyanosis, edema, dehydration, the different signs of respiratory distress, etc. They also had the necessary tools like Mid-Upper arm circumference (MUAC) tapes,  thermometers, timers, drugs, etc. Another community visit we had was to a chronically ill patient. Here I learned that Rwanda, unlike my home country, has a working health insurance scheme called ‘Mutuelle de Santé,’ and people pay subscription fees according to their economic groupings (ubudehe) which ensures that the poor ones pay relatively less than the rich ones to ensure equity. During this community visit, we passed by Akagera national park. It was an amazing view.

We also appreciated that in rural Rwanda, people live together in distinct villages called umudugudu.’ This is unlike in Uganda where it is not uncommon to find people living in scattered homes away from everyone else. The umudugudus in Rwanda make it easier to get services closer to the people since they live in groups.

We had two non-communicable diseases screening sessions in Ndego. My role during the session was to measure random blood glucose levels using a glucometer.

Students in front of statue in kigali

 

Trip to Kigali. 

The first week ended earlier, on a public holiday called Umuganura (Friday).  It is a Thanksgiving Day. The day Rwandans celebrate their ever-bountiful harvest. We used the opportunity to have the following three days for ourselves in Kigali. In Kigali, we put up at the PIH house. We found Dr. Akiiki there with a good number of other people from different nationalities and career fields. We were nicely welcomed and had a good time there. By the time the three days of the long weekend were up, we had been to; the Kigali convention center, the genocide memorial center, Amahoro Stadium, Kigali airport, Kigali arena, Inema art gallery, downtown Kigali, etc.

The Rwinkwavu mines.

To appreciate different aspects of occupational health and safety, we on the second last day of our placement, went and visited the Rwinkwavu Wolfram mining site. We visited their offices where we were first told about the different health measures they have in place. We then proceeded to the mine itself and went a good number of meters down the mine tunnel. It was dark! I am kidding. There was light, but it was cold down there. Apart from appreciating the different health risks miners are exposed to, it was an exciting experience.

On the evening before the last day, PIH organized for us a farewell banquet. We had some good time with everyone and got our certificates. On the last day, the 9th day of August, we had the last presentations and sessions. We then prepared ourselves and were driven to Nyabugogo Bus Park where the whole story had started from. The bus we boarded departed at 5:45 pm and arrived in Kampala at 8 am. The story that had started with a long bus journey ended with an even longer bus journey.

 

 

 

 

Passion to Practice: Nzeeke Herbert’s Path to a Transformative Elective Exchange

Filed under: GEMx Regional Exchanges, GEMx Student Reflections

By: Nzeeke Herbert, fourth-year medical student from Kabale University School of Medicine, Uganda

Herbert Standing Outside
My name is Nzeeke Herbert, a fourth-year medical student from Kabale University School of Medicine found in south-west Uganda bordering Rwanda. It is one of the nine Universities in Uganda that offers a degree in Medicine and surgery. I am privileged to be one of the pioneers of this medical school and one of those who had the first chance to participate in this elective program through GEMX.

 Growing up, I used to admire health workers putting on white coats. I then started getting the passion for medicine seeing how the health workers were caring for the sick and especially whenever there would be an emergency with everyone running up and down in a bid to help. Watching my father and mother die before I achieved my passion was another painful moment for me, but this didn’t stop my hopes of pursuing a medical course.

I joined a clinical school for my diploma in clinical medicine and community health in 2002 to 2005. I developed a positive attitude of doing my best whenever I handled the sick/suffering without segregation. I had no hopes of joining the university for the degree because I was supposed to look after my siblings since I was the first-born child. However still with my passion for medicine, I didn’t lose hope and through Prayer God made a way in 2016 when I was finally admitted to Kabale University to pursue this noble course.

Pioneering

The GEMx program gave me another rare opportunity to have an experience in Kenya where I didn’t have any hopes of traveling during my undergraduate studies. It started with a simple announcement at the University notice board calling for students to apply and participate in the exchange program with a deadline. I thought it was not serious and kept busying myself until the deadline date when I finally submitted my application. To my surprise three of us, we were called to the office of the dean of the school of medicine where we were told that we were selected by the faculty among ten applications to participate in the GEMx program.

It was such a joy. I wondered how best I could handle this as to be one of the first people at my medical school and a pioneer of the program. However, I had to be with hope and wanted to experience how other countries carry out their training of medical students in their medical schools.

Safari to Kenya

We traveled by road from Kabale, Uganda to Nairobi Kenya via Busia border, a journey that took me twenty-one hours. This was the first time I had ever traveled such a long distance. But it was rather an adventurous journey as I viewed the beautiful scenery of Africa; the landscape, parks, different animals, and valleys provided such a good tourist view.

Acclimatizing to Kenya

I found that Kenyans were welcoming and friendly. Swahili was the main language of communication and initially, it was challenging but some locals tried English, which made me learn more Swahili so I would be able to communicate. Their main meal was “Ugali” (posho in the simplest terms) with greens (sukuma wiki). It was not easy to cope up with the diet as I was used to Matooke and Irish potatoes. I had to adjust to fit within the local dishes.

The Elective Begins!

At Kenyatta University the coordinator GEMx welcomed us and introduced us to the different head of departments including the dean School of Medicine. This made me feel at home. A time table was drawn that helped me go through the expected objectives smoothly. The teaching hospital-Kiambu level 5 Hospital in Kiambu county was located approximately 30Km away from the university. This called for waking up early morning to catch the bus that would transport students to and from the hospital daily. The University had a six-year degree program for medicine and surgery compared to our Ugandan program of five years.

Forensic Medicine   

In forensic medicine, I was able to attend a few lectures and five autopsies with lots of learning and getting expertise from the experienced government pathologists. The pathologists were such good people who made me learn when, why, and how to do an autopsy. I had the chance to visit the biggest government chemists’ laboratory where samples are taken for analysis concerning forensics and the law. This improved my knowledge in forensic medicine and skills in carrying out autopsies which will help me become a good medical officer in the future.

Mental Health

In mental health at Mathari Hospital, I gained skills in clerking mental cases and attended rehabilitation sessions in a private rehabilitation center for substance abuse clients at Blessed Talbot. This gave me great experience in understanding the relationship between drug addiction and mental health and the team approach in handling such clients.

Surgery

The experience in surgery rotation was such an amazing one especially the radiological investigations in managing surgical cases for example; MRI, MRCP, CT scan in addition to other routine investigations were readily available within reach and patients would go for them when requested. The surgeons were such good people as they made me learn a lot with their good advice and teaching.

This was such an interesting experience as it contributed to my knowledge that will help me go through medical school smoothly and use it in the future during my practice so I can become a good professional medical worker with the relevant skills. On the social aspect, I made friends, interacted with many students and visited many malls around Nairobi and markets. It was very interesting staying in Nairobi. Would wish given another opportunity to go back. Traveled back Kabale-Uganda by road and had a safe journey. All my travels and welfare were fully facilitated by GEMx. LONG LIVE GEMx LONG LIVE KABALE UNIVERSITY.

 

Group Reflections on a GEMx Family Medicine Exchange from University of Zimbabwe to University of Kwazulu-Natal

Filed under: GEMx Regional Exchanges, GEMx Student Reflections

Post by Nyasha Manyeruke, Leslie Mashayahanya, and Talent Munjombi, medical students at University of Zimbabwe College of Health Sciences who completed a elective exchange at University of Kwazulu-Natal School of Nursing and Public Health (South Africa) through the GEMx-AFREHealth Regional Exchange Partnership.

 

Students selfie in Durban

INTRODUCTION

When we signed up for the GEMx Elective experience in South Africa, we hoped to experience and gain better understanding of the clinical setup in a neighbouring African country and improve our overall clinical skills in preparation for our final year of medical school. We happily report, that the experience exceeded our expectation and broadened our knowledge overally.
Under the supervised guidance of Proffessor Mergan Naidoo, we had an opportunity to rotate in different wards at the hospital, that is- High Care Unit, Out Patients Department, HIV clinic and Accident And Emergency Department. We had multiple opportunities throughout our elective to interact with Family Medicine constultants and Registrars for “one on one” tutorials as well as group tutorials. We also interacted with other members of the clinical team including interns, counsellors and nurses, who taught us and encouraged us to perform certain procedures, such as, drawing blood for investigations, inserting urinary catheters, suturing and so forth. Outside clinical activities at the hospital, we also explored Durban –visiting the beach, shopping malls, indulging in local delicacies, and interacting with fellow Zimbabweans living in South Africa, as well as the other locals we encountered in our day to day activities. We gained a greater appreciation of the multicultural and diverse society that makes up South Africa, Durban in particular, and how this correlates to patient management in the hospital setup.
In this report, we have summarized our elective experience into experiential sections and attached pictures accordingly.

Hospital Clinical Experience
1. Out-Patients Department
We each spent a week attached to the outpatients department, participating in local procedures and guidelines. In our logbooks we had clear learning objectives and subjective measures to assess our progress throughout our elective. We enjoyed ourselves thoroughly, and below in Figure 1.1, the picture illustrates Leslie clerking patients seated on the bench waiting to be served at the Out-patients Department.

MD student looking at papers

2. High Care Unit
We each spent a week attached to the high care unit. We mainly learnt ward management of patients and ward conduct as well as protocol. Besides knowledge learnt on commn ailments in our setting, such as, HIV, TB and Myorcadial infarctions, from the various ward rounds and tutorials,we also assisted the interns in performing their daily ward duties, such as, taking blood, performing lumbar punctures, inserting chest drains and so on, as well as interpreting lab results for investigations. Figure 1.2 below illustrates Talent taking blood from a newly admitted patient, with the assistance of one the nurses.

Students taking care of patient

3.HIV clinic
We each were attached to the HIV clinic for one week, and we mainly participated in patient adherence counselling, reviews, as well as initiation of patients on Antiretroviral medication. We learnt about the importance of the multi disciplinary team and we often assisted the nurses at nearby clinic( gateway clinic) in using the referral system tool effectively in ensuring patients receive the best care. Figure 1.3, is a picture showing Nyasha, standing at the entrance for Gateway clinic.
Student in front of hospital sign

4.Accident and Emergency
We each spent one week at this department. This was a very busy department, it was very interesting learning about the triage system at this hospital and the acute management of patients. We learnt about the importance of time and sharing tasks amongst members of the clinical team in order to manage patients adequately. In figure 1.4, the picture below illustrates Leslie, preparing bloods to be sent to the laboratory for investigation.

5. Other Hospital Related Activities

Talent and Leslie reviewing clinical magazines for updates on recent research findings, new additions to clinical guidelines and for Continuing Medical learning(CME) in the doctor’s tea lounge during some of our lunch breaks.

Students Reviewing Journals

Talent(female) and Leslie, standing in front of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marveled at the architecture

Talent(female) and Leslie, standing infront of college of health sciences building for the University of Kwazulu-Natal. We visited the medical school a few times during our stay and we marvelled at the architecture

A selfie taken after our GEMx end of elective exercise and discussion with us and Professor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

A selfie taken after our GEMx end of elective exercise and discussion with us and Proffessor Ross( one of the consultants at the hospital. We enjoyed our interactions with him during ward rounds and our various tutorial sessions.

As we come to the conclusion of our elective experience, we would like to thank all the people who made this elective experience possible, we thank you for impacting our careers in our fruitful and adventure filled manner. We hope you continue your great work.

THANK YOU
Siyabonga

Report on GEMx Postgraduate Ophthalmology Elective in Mombasa, Kenya

Filed under: GEMx Post-Graduate Exchanges, GEMx Regional Exchanges

Post by W’mosi Brenda Achieng, an Ophthalmology resident at University of Nairobi Faculty of Medicine (Kenya) who completed a elective exchange at Lighthouse for Christ Eye Centre through the GEMx-COESCA Regional Exchange Partnership 

 Ophthalmology Elective Experience

Residents standing in front of hospital

Me with colleagues, I am the on the extreme left. Dr. Basha in the middle, was winding up his elective term and I had just begun.

In my second year as an ophthalmology resident I had the opportunity to do my first elective term. I chose to do it at Lighthouse for Christ Eye Centre and applied through GEMx.

Traveling:

I flew to Mombasa early in the morning. The airplane ride was short and comfortable. I had booked the ticket two weeks in advance so I bought the ticket at a good rate. I would advice anyone who wants to fly there to buy the tickets online way in advance as they are a lot cheaper as compared to purchasing them a few days to the journey. I took an uber from the airport to the hospital.

 Weather:

The weather there is generally hot and humid. It is advisable to carry lots of light clothes and some sunscreen. There were occasional rainy periods during my stay but the rainfall was quite light.

Arrival and stay:

I arrived and went to report at the hospital. I met the Medical Director who is also a Cornea specialist.

He gave me a quick orientation and introduced me to all the staff. He gave me an overview of the values and mission of the hospital and communicated what was expected of me during my elective period.

I was informed on work attire and would put on my white coat on top of my clothes or wear scrubs. I would advise on putting on scrubs to work as they were comfortable and easy to work in the hot weather.

Everyone was very welcoming and friendly. I had no doubt that I would feel at home away from home. He gave me the afternoon off to go and settle myself at my accommodation as I was to stay at a nearby flat outside the hospital for the first 3 weeks.

After 3 weeks I moved into the hospital accommodation. It was a quite a big room, with a bed, fan, fast Wi-Fi and a set of sofas. It was self-contained with a shower and toilet. The kitchen was however adjacent to it with its own key. The kitchen was clean and had a table top cooker and gas. Utensils were also provided in the kitchen.

Work experience:

Photo of the hospital

The hospital

My first day was in the general clinic which runs every day. The clinic is usually very busy. There was a visiting consultant from Japan who is an anterior segment specialist. Together with him and the medical director, we were able to see about 100 patients on day 1. Some of the other clinic staff were on an outreach in another county doing free cataract surgeries in the community.

I was able to attend the other clinics which run concurrently with the other clinics on specific days. I attended some of the cornea clinics which would run on Tuesdays. I also attended some of the Wednesday clinics which were paediatric ophthalmology clinics. Main theatre days are on Mondays, Wednesdays and Thursdays. I was able to review challenging and interesting cases with the medical director who was always available for consultation. I also managed to review interesting paediatric ophthalmology cases with the paediatric ophthalmologist. I also learnt a lot from the other cadres at the hospital. Apart from the ophthalmologists, there are also two ophthalmic clinical officers two ophthalmic nurses, and other cadres. Everyone was willing to teach and also learn something from the other.

At Lighthouse for Christ Eye Centre, there are visiting ophthalmologists from time to time. They are from various countries and different sub specialties. Apart from getting to work with the Anterior segment consultant from Japan for a week, I also got to meet and work with a visiting Cornea specialist from India. Together with the medical director and the visiting cornea specialist, I was able to review patients with them and learn a lot over the few days.

I also managed to learn a lot surgically. I did my first complete cataract surgery and managed to do 13 cataract surgeries. I was also able to learn and do other procedures like 3 excisions of pterygiums and conjunctival masses. I learnt how to excise chalazions and also how to do punctum repair when doing a lid laceration repair, and also learnt how to do YAG-capsulotomy. There are also Continuous Medical Education seminars every last Friday of the month. I was able to attend 3 seminars during my stay at the hospital which were very informative.

Day to day living:

I would cook most of my meals in the kitchen. However, at lunchtime, I sometimes would buy meals at an affordable price at the hospital canteen. The meals sold there are balanced and healthy with fresh ingredients. Price range was about ksh50-100 for a full meal. For fresh vegetables, there is a market not too far away in town where one can access fresh raw ingredients. The hospital and the central business district are very close to each other. About 5-10 minutes away from each other. I had access to the supermarkets, ATMs and banks as they were just a few minutes away. My main means of getting around were ‘Tuk-tuks’ and ‘matatus’ for nearby places as well as Uber taxis for the places that were far. Most means of transport were affordable and convenient.

For some of the cultural dishes, there are many hotels that serve the authentic coastal dishes that were affordable and a walking distance from the hospital

I did my own laundry and there is a good outdoor hanging line.

Security within the hospital was very good and it is round the clock. Both the room and kitchen had padlocks. In case of emergencies, there was an alarm within the room as well as an indoor phone which you could contact the other residences within the hospital or the main hospital block. The security officers were always courteous and willing to help in case of anything.

There are also many tourist sites that one may visit over weekends when free. For example, there are some tourist sites not too far from the hospital for example Fort Jesus. There are many beaches as well as the marine park just to mention a few.

Religion:

Lighthouse for Christ Eye Centre is very tolerant of all religions despite being a Christian institution.

It serves a community which has Christians, Muslims, Buddhists among others. All patients are treated equally and with respect regardless of religion, race and socio-economic status.

There was devotion twice a week, on Tuesday mornings and Friday mornings at 7.15 am -8 am which I attended. All staff were welcome and the sessions were always spiritually uplifting.

Overall:

My overall experience was great. The work experience was different and very interesting. I got to work with different people and cadres. The staff at Lighthouse were hardworking and professional as well as very warm. Learning was both ways and I learnt a lot from everyone. I was exposed to so many different conditions from which I learnt a lot in terms of management and surgeries. I was able to perform surgeries under supervision and my teachers were patient.

I am grateful to GEMx for granting me this great opportunity. It was invaluable in my training in ophthalmology. I would not trade that experience for anything.

My GEMx Elective Placement At Kiambu Leavel 5 Hospital Under Kenyatta University

Filed under: Uncategorized

Post by WAMUBIRIGWE EMMANUEL MAKERERE, a medical student at Makerere University College of Health Sciences (Uganda) who completed a elective exchange at Kenyatta University School of Health Sciences (Kenya)

Acknowledgement

Meeting the GEMx students of Kenyatta University

Meeting with GEMx students of Kenyatta University

I am grateful to the Global Educational Exchange in Medicine and Health Professions (GEMx) for this opportunity to participate in the exchange program at Kenyatta University and facilitating my electives period and stay in Kenya.

I would also like to appreciate Ms. Faith Nawagi the African GEMx representative, Dr.Ssinabulya Isaac GEMx coordinator at Makerere University and Ms. Phiona the assistant coordinator for international programs at MakCHS. Dr.Kahiga Titus, GEMx coordinator at Kenyatta University and Madam Dorothy for the good reception at Kenyatta University.

Dr.Ngatia Justus the chairman obstetrics and gynecology department Kenyatta University. Dr. Were Francis, my supervisor at Kenyatta University and the fourth year students I was rotating with, thank you for making my rotation wonderful.

Travels

At KICC, Nairobi town view.

At KICC, Nairobi town view.

It was on 25th May when we boarded the modern coast bus heading to Nairobi. We set off at around 10:45pm. All my colleagues Muhumuza Mark, Agaba Kenneth,Turyamureba William and Isingoma Simon were all on board on the same bus.

However, it being night, we all slept off and woke up at the Busia boarder for the check up and we cleared everything. Our first stop over was in Nakuru town where I bought some breakfast. The price of the coffee was 100ksh and I felt it was so cheap but when I tried converting to Uganda shillings, it’s when I felt it was quite expensive.

We arrived in Nairobi safe and luckily enough, Madam Dorothy didn’t take long to come pick us up and she took us to Destiny park hostel in Kahawa Wendani, which would become our new home for the next four weeks.

First day

I did my clinical rotation at Kiambu level 5 Hospital

I did my clinical rotation at Kiambu level 5 Hospital

At the hostel we found some people there and these would be our first friends in Kenya, the likes of Derrick. Madam Dorothy got us lunch served in the dining room; we had rice and meat on our first day in Kenya. Later on, Derrick showed us around that day, there was a pool table and we started by spending part of the evening playing pool.

We moved around the place Kahawa while we were going for our supper with Derrick.

Food

Food seemed to be a shock at first because what seemed to be snacks back in Uganda was main food in Kenya. There was a variety of food in Kenya, chapatti, beans, meat, dengu, matumbo, ugali etc.

Their matooke wasn’t made like in Uganda. It was a little different and people eat one type of food at ago, they don’t mix all varieties at ago. Most people were eating chapo(chapatti) with beans which looked weird because back home, such food was eaten when someone ran out of options that day and was completely broke.

They have very good fish; my best meal I ate was ugali with fish plus some greens. I ate that meal every Sunday supper. It was my best. However normal days at hospital I used to eat rice, beans, dengu, ugali, matumbo, chapo depending what I wanted that particular day.

I also had a chance to eat the local food ‘mukimo’ it’s a mixture of smashed irish potatoes, maize, pumpkin leaves. It appeared greenish and it had a very good taste. I liked it most with meat. Also had a chance to eat githeri, amixture of beans and maize fried together. I didn’t enjoy it that much though.

People and the language

One particular thing I liked was the fact that these people have one common language they all speak, Swahili. It makes communication so easy. Of course I found it a challenge because I didn’t know the language. However, by the end of my stay, I had learnt some few words and phrases. How to greet, asking for price of something, asking for food. I had friends who always told me which word to use.

The people are so friendly and welcoming and always willing to help in case your lost or don’t know where to go. They were always willing to teach me a few Swahili words for survival around.

I made some good friends in Kenya, Ivy Reni, Onsare, Gibs, Felix, Bonniface and we have always kept in touch with them. They all promise to come to Uganda very soon.

In terms of transport, I was used to boda boda in Kampala but in Nairobi they are very rare. However the matatu are similar to ours in Uganda. But the matatus are not allowed within the city center so I used the bus mostly when going to the city center then matatu when going to campus, going to other places outside the city center.

There were the taku taku, I got a chance to board one while going from the by-pass to go and have chama choma. I had never sat in any of them, they are comfortable but so scaring, I always had a feeling they were going to knock it because it’s very small and sharing the road with big vehicles. But it was very safe.

Weather and climate

We were in Nairobi around the rainy season, it was really cold both day and night. I wasn’t used to wearing sweater whole day but Nairobi made me get used.

Hospital work

Fellow students rotating in obstetrics and Gynecology at Kiambu Hospital

Fellow students rotating in
obstetrics and Gynecology at
Kiambu Hospital

I was doing my rotation from Kiambu hospital level 5. It’s a county referral hospital of Kiambu county. I used to go to hospital in the University bus together with other medical students in the morning. We had different buses going at different times so you had a chance to board a bus that is convenient for the timing.

I was rotating in the obstetrics and gynecology department. I was oriented by the class representative, Onsare together with Ivy Reni. There were different wards, the gynecology ward, antenatal ward, postnatal ward, outpatient clinics and the theatre.

I decided to rotate in all these departments at least to have a feel of everything. I used to clerk patients with the help of my friends from Kenyatta University because of the language barrier. Presented to the doctors and discussed different conditions and their management. I had a chance to attend all the lectures organized in that period.

I also attended the labor suite where I mainly assisted the nurses in delivering mothers, went to theatre during obstetrics days and gynecological days. I had a chance to witness procedures that I had not seen in Mulago hospital especially the gynecological procedures. I also witnessed ward procedures like the manual vacuum aspiration.

The doctors were willing to teach and they demonstrated to us different skills we needed to learn. They were good and explained every question you asked during the teaching. I enjoyed mostly the bed side teachings where we had to clerk the patient, present to the doctor then we discuss the patient and management with the doctor. I had a very good experience with my rotation.

Social life

At the Biennial Infectious Disease Conference Nairobi Hospital

At the Biennial Infectious Disease Conference Nairobi Hospital

Socially Kenyans were nice people. The people we were staying with were very good, we became friends and used to watch television together, we used to play pool together especially in the evenings back from hospital. We used to prepare our own food on some days but we mostly used to buy from the nearby restaurants.

On weekends, we used to go out to some good places around. We got one of our friends from Kenyatta university and we used to tour with him around Nairobi town. We went to the parliament, the railway station, KICC, Uhuru Park, where we had some ice cream, horse riding.

One of the things valued a lot in Kenya is nyama choma. So we had a chance to go and have a taste of this nyama choma, we boarded and went in the evening with our friends and it was really nice. We also had a chance to visit Thika and Ruiru towns. We went to Thika road mall and had some good time there.

All in all, my experience in Kenya was a wonderful one. Had never thought I would get a chance to experience a life outside my home country, but Kenya gave me that experience. Will live to remember my days I spent in Kenya.

Internal Medicine Elective at Queen Elizabeth Central Hospital (Malawi)

Filed under: GEMx Regional Exchanges

Post by Tebogo Bolani, a medical student at University of Witswatersrand (South Africa), who recently completed a GEMx elective at the University Of Malawi College Of Medicine (Malawi).

Umuntu ngumuntu ngabantu. This a Zulu proverb that I have never fully appreciated until I arrived in Malawi. My first experience of Malawi was the airport – it was certainly not what I expected. We were welcomed by a small group of local children standing behind a fence waving at us stepping off the plane. It was humbling and exciting at the same time. I completed my elective at the Queen Elizabeth Central Hospital (QECH) in Malawi. We arrived on the 26 of November and stayed until 23 December 2017.

When we arrived at our temporary home at Kabula lodge, we were greeted with no electricity and no food and no means to get food. The food situation certainly improved throughout our stay, the electricity not so much. Power outages and load shedding occur regularly in Malawi. The country is reliant on hydro energy, but there has been a drought of late resulting in electricity shortages. All in all, the next month looked like it was going to be a challenge. We made it work though, we started cooking outside on a coal stove, locally called a Mbalula. Funnily enough the president came to town and for the entire duration of his stay we had continuous power.

villagers sitting around a tent
Monday morning, we woke up bright and early to go to the hospital. What struck me first was the bright colours from the chitenje that the locals wear. Malawians take pride in their culture. The chitenjes are used as clothing, bedding, to carry babies and many other uses that I have never encountered. I spent a significant amount of my time collecting different patterns and colours as gifts and to wear myself.

We were allocated to the internal medicine department, at our request. When I first walked into the ward I was shocked. It was nothing like I imagined. I expected a similar setting to South Africa, instead I found poverty and overcrowding but also the spirit of Ubuntu – which translates as “a person is a person through other people”. Malawians have a true sense of community. We joined the ward round and soon found out that resources are severely limited and that receiving something as basic as an ECG can be near impossible for the low-income patient. They do not have a Blood Gas machine or CT scanner. An MRI machine is available, provided the proper procedures are followed.

There are no barriers between patients resulting in no privacy, there are inadequate beds resulting in patients sleeping on mattresses on the floor and some even in the corridors.
One of the things that impressed me most about QECH is their ability to improvise. No chest drain is available, so they use a catheter, no hand sanitizer is available so they poke a hole in a bottle of spirit and use it as disinfectant. Also, they have what they call guardians. I am used to a system whereby nurses bear the brunt of the responsibility. In Malawi patients are always accompanied by their guardians. Guardians are family members that stay with the patient at all times, they do a lot of work that would ordinarily be considered the nurses’ job. Guardians empty catheters, give patients bed pans, feed patients and provide some of the medical history. They have no medical training and sometimes, they are a hazard (force feeding a patient with a reduced GCS), but I still consider them invaluable. Guardians sleep on the floor next to their relative without a blanket or pillow or mattress. I honestly believe they keep the hospital running. They exemplify the spirit of Ubuntu.

selfie of four african medical students
I have this memory in my head. It is the image of an elderly gentleman who was very ill. He was visibly wasted, weak and confused. His son was his guardian. Every day I would watch his son position himself behind his father on the bed and allow the father’s upper body to rest on his chest as he fed him. It was heart-breaking to watch. Partly because the father was very sick and had a poor prognosis, but also because his last moments where spent in a hot hospital, with flies everywhere that he did not even have the energy to swat off himself. It just seemed like a very unpleasant way to die, my only consolation is knowing that he was never alone, and his son was by his side.

Patients in Malawi seem to have a very high tolerance for pain. I was shocked when I assisted in performing a lumber puncture and no local anaesthetic was given. This is the norm here. Of all the patients that received a lumber puncture, not one screamed in pain. At home in South Africa local anaesthetic is used, and the majority of patients scream at the top of their lungs, so much so that the nurses come and check what is wrong. One of the senior doctors was asked why patients here never complain. He claimed that in the patient’s eyes, doctors can do no wrong and they are too polite to complain. The only response patients seem to have is to reach towards the hand causing the pain. But they never make a sound.

On a more positive note, the academic teaching in the internal medicine department is excellent. They have daily case presentations prepared by the students and everything from history, management and microbiology is thoroughly discussed. I learnt most during these early morning sessions. My Chest X-ray interpretation skills have improved. I loved that it is a platform for active learning. The consultants would sit in a line in the front row and the students and registrars behind them. After the presentation the consultants would ask questions about the case. It did not come across as an interrogation at all. It was academic discussion amongst academics.

The ward rounds where similar. Students are part of the work force. They clerk all the patients with the assistance of the intern and registrar and on Mondays and Thursdays present their patients on the consultant ward round. They ordered their own investigations and drugs as well. They are very independent when managing patients. Sometimes they would even come in on Sunday to prepare for Monday’s consultant ward round.

Four African Medical Students
The ward round was another platform for teaching. I am accustomed to passive ward rounds where students do not really participate. But QECH certainly does not conform. The ward round is run by the students with help from the junior doctor. The students, which soon included us, would present most patients and then have a discussion with the consultant. It is probably what I enjoyed doing most. It was the perfect combination of theory, clinical skills and fun. Granted it was exceedingly stressful, because of the pressure and fear of doing something wrong, but it always worked out in the end.Once we got the hang of how things worked we started seeing our own patients. I found it very satisfying to be managing my own patients from admission to discharge. I was certainly grateful for the help that the students and registrar provided. It was probably the first time I have ever felt like I am really becoming a doctor. It was stressful at the best of times and writing a discharge summary in the health passport is time consuming, but the joy of doing something right outweighs it all.

Looking back now, my experience at the hospital is not what I expected at all. We were necessary labour and I appreciated that. We became part of the team. We made friends with the students so much so that even though they have left, we still chat with them on WhatsApp group. My independence has definitely been put to the test. Being away from the comforts of home was difficult but bearable. I got used to the new normal. I think I gained more completing my elective internationally than I could have at home. I developed my ability to communicate with people that don’t speak the same language and my ability to adapt to a new community and culture. I also succeeded at performing procedures that I have repeatedly failed at, at home (lumber punctures). Additionally, I have proved to myself that I can live in another country and still be happy.

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