Abstract
The life of a trainee doctor in the UK can feel like you are on conveyor belt, you start at one end and finish at the other a few years later with a Certificate of Completion of Training in your chosen speciality. One way of taking a step away from this feeling is to spend some time on an out-of-programme project. The available options and the process of arranging this experience have been presented previously (Dholakia, Lydall, & Kiernan, 2011; Ladbrook, 2010). My experience consisted of 4 months in Belize, Central America, just prior to starting my GP training ST3 year. Having time to reflect on the experience since my return has given me a greater appreciation of the skills that I developed in Belize. I hope that by outlining these skills I may encourage other trainees to step-off the conveyor belt and try something different.
I worked as a volunteer at the Hillside Health Care Center in the Toledo district of southern Belize (Fig. 1). The clinic here is run by a combination of local staff and volunteers and provides free healthcare to the local people. It is funded by donors from around the world, and in addition to delivering healthcare to the local population it also provides global health education to volunteers and students serving at the clinic. The clinic’s motto ‘Learning while serving’ perfectly describes the experience.
Outside the Hillside Health Care Center, southern Belize.
As well as running a clinic on-site, we also delivered mobile clinics to the rural villages of southern Belize. This often involved long drives out into the jungle; we travelled as a team of doctors, students, pharmacists and physiotherapists supported by local staff. For the longest journeys we stayed overnight in the village returning to base the next day. We also offered dental education and fluoride-varnishing programmes to the local school children and the visits to the schools to carry out these tasks were always fun and enjoyable. Education was a fundamental part of everyday life at the clinic, and elective students were essential to the day-to-day running of the clinic. The students were all from the USA, so it was interesting to compare their education and experience to my own.
Most of the patients presenting to us had surprisingly similar complaints to those encountered in the UK. Many presented with viral illnesses, musculoskeletal problems, rashes and other common minor ailments. We also provided contraception and family planning advice. Diabetes, hypertension and stroke were all common, so health promotion was an important, but challenging, aspect of the role. There were also more exotic conditions that presented fairly regularly. I saw patients with leishmaniasis and there were plenty of patients presenting with other interesting skin conditions: scabies, impetigo and fungal infections were all common.
The most enjoyable aspects of the experience were feeling part of the local community, as well as having the chance to form new friendships with other like-minded people. Living on the edge of the jungle was an incredible experience and a unique location to practice medicine. The educational aspects of the clinic were fantastic, and the emphasis on teaching the students and volunteers about global health was inspirational. The challenges I experienced included supervising the students to a much greater degree than I was used to back in the UK, although this was an educational experience in itself. The lack of investigations meant that patients with more serious or complex issues could not always be managed at the clinic and had to go elsewhere, which could be sad and frustrating.
My basic clinical skills improved as a result of my experience in Belize, as I had to rely on them so much, due to the lack of investigations available. I also found myself becoming more able to handle uncertainty; clinical decisions had to be made quickly on the information gathered at the time. On the mobile clinics you were many miles from a hospital and the villagers were unlikely to see another doctor until the next time we visited, so decisions had to be committed to. Looking back, I can see these experiences were invaluable for training me in the habit of making decisions based on limited information, similar to undertaking home visits or out-of-hours work in the UK, where decisions often have to be made on the spot.
Dealing with sometimes challenging clinical situations in hot and humid conditions could be hard work and the lack of resources was at times frustrating, however, these challenges promoted a form of resilience and encouraged a sense of teamwork that is as good as any I have experienced. Supervising the students and encouraging them to take responsibility for aspects of patient care was rewarding and instilled me with confidence delegating clinical tasks to others. I had previously struggled with this particular skill; however, there was no choice in Belize, as it was essential to ensure all the patients received attention. I quickly developed the skill of making decisions based on information received from a student’s assessment. I found this incredibly beneficial once back in the UK, as I felt much more comfortable acting on information received from other professionals who had seen a patient and were asking me for advice. I was also more relaxed about trusting other healthcare professionals to handle clinical tasks I delegated to them after my Belize experience.
Belize also provided experience in carrying out important aspects of public health. The dental fluoride programme we delivered to the local school children combined with ensuring they all had a toothbrush and knew how to use it was a perfect example of preventative care on a larger scale to that I was used to. The simple interventions were often the best in Belize, and a creative approach was encouraged. For example, we often used adapted Coke™ bottles as spacers (see Fig. 2) and this kind of lateral-thinking is similar to that often required when facing complex clinical situations in the UK.
An improvised Coke™ bottle spacer.
I hope this brief report of my experience in Belize will encourage others to take time out-of-programme and undertake adventures that will benefit them in many diverse ways. By volunteering abroad you not only gain satisfaction from helping disadvantaged people, but also develop and enhance your clinical skills while making new friends along the way. On returning to practice in the UK, you will, overtime, realise that the skills you learnt are still with you and likely will have become embedded in your day-to-day practice of medicine, thus making you a better doctor.