Jessica Moore reports on her experiences on a VSO placement in Kenya.
Having reached year 4 of SpR training in South Thames, I decided I needed a change of scene. I wanted to travel to a developing country and see a different kind of obstetrics and gynaecology. The RCOG/VSO Fellowship seemed the ideal way to do this. In years gone by it was very common for senior registrars to do a stint overseas in developing countries, but this trend seems to have disappeared. Among senior consultants I have yet to find one who regretted their decision to work abroad during their training and many have been hugely supportive to me during my time here.
VSO is an international development charity that operates through the work of volunteers like me. The ethos of VSO is not just to provide a service in the form of another doctor but to bring about some lasting change through training the local community. My placement started in June 2006 in a small mission hospital in the depths of Western Kenya. The rationale behind my job was to improve women’s reproductive health in the Catholic Diocese of Bungoma, a large area that provides health care through one hospital and five health centres. I am based at the hospital but visit the health centres once a month for clinics and teaching.
The hospital has only 100 beds and, before I arrived, was staffed by one doctor who did everything. He was more than happy to see me and relinquish responsibility of the maternity ward and any gynaecology patients. My job has evolved into a balance between service delivery (which has been the most amazing experience in my career) and training the staff in obstetrics and gynaecology. Although the number of deliveries is small, very often those that do come to the hospital have serious complications and present late. For example, it is not uncommon for a woman to attend with a retained second twin several hours after the first twin was delivered. The experience of seeing cases I had never seen before and learning to deal with them without a consultant on hand to advise has been a significant learning exercise!
Another challenge was adapting to very limited facilities – no ultrasound, no CTGs (sometimes a bonus!) – but on the whole a good stock of essential drugs and a reliable blood bank. Despite the poverty, patients have to pay for their treatment, a novel and distressing situation to someone used to free health care. Luckily, the hospital has donor funding to ensure that the cost of antenatal care and normal deliveries are kept low. However, even with a 300 Kenyan shilling cost (about £2.50) for a normal delivery, many patients still could not afford it. I particularly remember one pre-eclamptic patient begging me not to give her any more hydralazine as she was worried about the hospital bill – her BP was 200/140!
The nurses who work in the maternity department are extremely committed and very eager to learn – which has made my job of teaching and training easy. Due to a shortage of doctors in Kenya, many nurses are forced to act above the level to which they have been trained. Since I arrived in June, I have started a weekly teaching session for all hospital staff – every Wednesday evening at 8pm. It is very well attended, reflecting the desire of the staff to improve their knowledge. Having finished a very comprehensive obstetrics and gynaecology teaching programme, the teaching is now rotating through other specialties. I also teach the nursing staff in the rural health centres for one day every couple of months. They are even more grateful for teaching as they work without any medical help and the nearest hospital is often a considerable distance away.
From a gynaecology point of view there is a huge amount of pathology. I have a gynaecology clinic every week at the hospital and I travel out once a week for a clinic at various rural health centres in the diocese. These clinics are well attended, seeing anything from 12 patients to a record 65 patients. These clinics also provide an opportunity to train the nurses to deal with common gynaecology complaints. The potential for gynaecological surgery is huge – the only limiting factors being patients often do not have the money and for me to choose cases that I feel competent to deal with.
From a trainee’s point of view, I have gained excellent surgical experience and have done far more surgery in my time here than I ever would have done in a year back home. The fact that there is no consultant supervising means you really learn to take responsibility in a way that is very hard to do as trainees in the UK.
My contract with VSO is for a 40-hour week and I am not obliged to provide any out-of-hours cover. However, it would be pointless keeping to this so I am happy to work out of hours and some weekends. There are no bleeps or pagers here; instead, the ascari (the guard) comes to the house with a polite note from the nurse about the patient they want reviewed.
As for the living conditions, things are much more civilised – I have my own 3-bedroomed house in the hospital compound with running water and electricity (most of the time). I have the use of a car to drive to the rural clinics (the furthest is 100km away) and escape at weekends. Living in Kenya, with all it has to offer, has added to the experience – Christmas was spent climbing Mount Kenya; New Year in the Masai Mara followed by a trip to the coast!
I have now completed 9 months of my attachment and am due to return to the UK in June to resume my SpR training. I feel confident that my experience here in Kenya will be of benefit. I want to retain my interest in the developing world and hope to find myself working abroad at some time in the future. Having witnessed first-hand the inequalities in health care between countries like the UK and Kenya, I feel we are all obliged to do what we can to help. It is especially good to see the RCOG raising the profile of international issues through International News. While working in a developing country is not for every trainee, for those who think they may be tempted – waste no time and start looking into it.