By: Adriana Cappelletti (Meds 2018)
1) Read up: Find out as much as you can ahead of time about the place you’re visiting.
Learn about the country’s history, current political situation, and local customs. Find out what people wear to work and around town to make sure you pack appropriate clothing. Some countries have more conservative styles. For example, where we stayed in Uganda, women almost exclusively wear skirts (usually to the knee or lower), while men wear button-down shirts and full pants, even in the heat.
2) Medical supplies: Bring your own masks, gloves and hand sanitizer. In low resource settings, you do not want to put a dent in their supply.
Also, try to snag any surgical gloves or sterile sutures you can get your hands on. You can ask surgeons, residents or scrub nurses you have worked with about any slightly expired, unopened sutures they’d be willing to donate.
3) Little Pharma: Stock up on your own mini drug supply and plan all vaccinations well in advance.
This takes up more time than you’d expect! You’ll need prescriptions for both drugs and travel vaccinations. Useful prescription drugs can include antimalarials, HIV post-exposure prophylaxis, and ciprofloxacin (or alternatively azithromycin) in case of bacterial gastroenteritis.
Travel vaccinations you might need include yellow fever, typhoid, and hepatitis A/B. Yellow fever is in limited supply in Canada and is necessary for entry to many countries in Africa and South America, so don’t leave this to the last minute. Do not expect to get travel prescriptions filled by a walk-in clinic. You can either pay $80 for an appointment at a travel clinic, or if you have a family physician, they may provide you with these prescriptions and save you eighty bucks. Over-the-counter drugs for your mini pharmaceutical kit might include polysporin, ibuprofen, acetaminophen, bismuth salicylate, PEG, and immodium.
4) Moula: Seek out any funding opportunities for global health initiatives.
If you look for it, there’s plenty of money out there to help fund your global health elective. Check out this link for the opportunities available to students at Schulich.
5) Safe living quarters: Don’t skimp on accommodations and compromise safety for savings.
When going somewhere unfamiliar to you, it’s best to err on the side of caution and choose trusted accommodations. We connected with a Guest House owned and operated by Massachusetts General Hospital for medical trainees and staff. For $25 USD per day, we had a private bedroom and bath, 24/7 on site security, and we were walking distance from the hospital. We felt safe and at home, and we met other Global Health aficionados.
6) Expectations: Establish mutual goals with your supervisor abroad.
Either ahead of time online or in person on your first day, try to establish a sort of contract of expectations with your supervisor. Let them know what you’re hoping to get out of your elective. Find out from them what they’re expecting of you and what is actually possible at their site. This can prevent disappointment or misunderstanding on either end.
7) Dive in: Embrace the culture, food, and local language(s).
Get to know locals, either from the hospital or through your accommodations. Ask them about their lives: how did they grow up, what is medical school or residency like for them, and what do they like to do for fun in their spare time? Immerse yourself in daily living by going to market and visiting shops. Find out if there is a nearby cultural centre. When we went to the Igongo cultural centre for the Ankole district of Uganda, we learnt about how farming, construction and traditions evolved in the area.
Try traditional foods. Avoid street meat, which can be undercooked, or raw vegetables, which may be washed with unfiltered water. Learn some basics of the local language. In Western Uganda, the academic language is English, but many people speak only Runyankole, the regional dialect. Knowing simple phrases like, “How are you?” or “How was your night?” can go a long way in building patient trust. If you show interest in the country’s culture and language, people will notice and be appreciative that you are making an effort to understand their way of life.
8) Ethical tourism: Support local businesses when buying groceries or gifts and planning weekend getaways.
As a visitor to a developing country, you have the opportunity to contribute to that nation’s economy and be a responsible traveler. When grocery shopping, hit up local markets. At supermarkets, try to buy food items manufactured within that country. If you’re planning something tourist-y (we went on safaris), book transportation and accommodations that are operated by and employ local people.
Gifts for your friends and family back home (or, let’s be real, for yourself) are also an opportunity to contribute to the economy. In Uganda and many other developing countries, tailors can be commissioned to make custom clothing at low cost. We bought fabrics in traditional African patterns from the market and had one-of-a-kind clothing made for $30 or less per item.
9) Emotional support: Know who you can talk to about your experience.
Global Health electives can be extremely enriching, but they can also be emotionally draining. Your clinical experience in a low resource setting might raise moral and ethical dilemmas you didn’t anticipate.
Let’s use an example: a young man gets in a bota-bota (motorcycle) accident and needs an emergent head CT. The cost isn’t covered by the government, and he and his relatives cannot afford the $200 CT that is needed to save his life. Everything is stalled while he is dying. Do you pay the $200 out of your own pocket? If you do, what happens when other patients’ families find out that the international student (you) can pay for imaging or drugs?
Don’t keep this inner turmoil to yourself. Rely on physicians with experience in Global Health. Share your thoughts with them, and have a discussion around the complexity of these situations. Back in Canada, debrief with the Office of International & Health Equity Learning (IHEL) and a physician mentor. It’s also really helpful to complete this type of elective with another medical student, for both safety reasons and to have someone who understands what you’re going through abroad and back home. For moral and ethical cases to work through in preparation for your elective, check out this link .
10) Share: Make use of the new insight you’ve gained by publishing or presenting about your elective.
You’ve had a life-changing experience! Take advantage of your unique perspective and the learning you’ve had to contribute to medical journals, blogs and conferences. You can write reflections or poems for the UWOMJ Blog or the CMAJ Humanities Blog. You can partner with your supervisor abroad to publish a case study. You can prepare a poster presentation on your experience and attend a Global Health conference in Canada or internationally.
Author: Andriana Capelletti
Adriana Cappelletti (Meds 2018) completed a Global Health elective in Obstetrics & Gynecology in Uganda in November 2017, alongside Rachel Loebach (Meds 2018). Adriana is pursuing a career in Family Medicine and intends to incorporate Women’s Health and Global Health within her practice. Adriana’s clinical experience in Uganda was cut short by an unfortunate physician strike, which left countless patients without care. Witnessing the repercussions of political turmoil on population health has only heightened her sense of social accountability and motivation to engage in international partnerships.