by Work the World

Lots of students tell us that working on our programmes has given them the chance to work with diseases and illnesses that they never come across at University. We asked our students this week if working overseas has given them the opportunity to work with diseases and illnesses that are rare at home?

In Arusha the students were all keen to expand on the differences between what is common at home and how it differs in Tanzania. Candace is from America, where “we don’t see a lot of malaria patients ....and that is quite common here. Malnutrition isn’t really an issue back home either where it is rather prevalent here. Having that opportunity to work with patents suffering from those illnesses has been an eye opening experience. Learning the disease process and treatment options first hand is invaluable to me and could never be replaced by reading about them in a textbook” . Laura has found the same - "on the paediatric ward many of the children are admitted with malaria and some of them here been admitted with TB. With malaria we have learnt what medication to give them, for example Quinine and all tablets. It’s has been really interesting to see tropical diseases that I have never come across". For British student Louise, it is the very fact that tropical disease is prevalent here that drew her to Tanzania. "I have come here to learn about tropical and infectious diseases. I have seen several cases of malaria already in my first week, which I have never seen in the UK. However, what has also surprised me is that a large prophetic of the patients in the medical ward are suffering from poorly controlled diabetes, also a major problem in the UK.  Severe malnutrition also seems very common here, but whilst this is only really seen in the old at home, both young and old suffer here”.

Depending on the department you are working in, the experiences can be quite different. In Obs and Gynae, Annie has found an increase in complications, whereas Jessica has found that in surgery "pressure sores are common in Mt Meru hospital, generally due to the fact that patient’s lie down all day everyday for the duration of their stay. One lady had the most horrific sacrum pressure sore I had ever seen in my clinical experience, but they didn’t have the correct dressing available to dress the wound so it was basically left open. Other illnesses being on surgical wards are mainly wound infections, generally to poisonous insect bites. One gentleman had his small toe and bad toe missing due to the bite and it had stated to attack the bones in his foot, this gentleman in now due for an amputation" and Angie has found similar. "At home, amputate septic wounds and laparoptomys are not as common as they are here in Arusha, Africa. Thus the treatment of these cases/operates are also way more common than they are at home".

In Dar most of our students are working in the referral hospital. Although you do see common ailments, you also see more specialist treatments - many of which can differ to treatment at home - and advanced pathologies. In the dentistry department, Farah has been " able to see lots of advanced oral pathology, including observing the excision of a parotid tumor. The patient had had this tumor for 6 years and it was the size of the head and it was ulcerated. I have also been able to observe lots of ameloblastoma removals, which often involves the removal of the whole mandible. These patients usually present to the hospital 20 - 30 yrs after they first noticed a lump due to various social factors". Delayed treatment due to social problems is not only a problem in dentistry. Victoria has helped treat patients following "backstreet abortions" and has worked with "HIV and cancer - both of which were far more advanced compared to what we normally see at the home - it is caught earlier in the UK and there are less complications".  Dar has one of our only psychiatric placements in Africa, and Emma has found that although "the prevelence of psychiatric conditions is similar worldwide, what is different here is that  alot of people with mental illness attribute it to bewitchment which is not the case in UK".

Our other African country Ghana has similar problems with tropical diseases and a relatively poor economy. It means students on programmes will be just as likely to come across medical cases rarely seen in an advanced country like the UK or Canada. Joe spoke to his students about the rare cases they have come across. "Even the commons ones seen in the UK like diabetes, stroke etc can turn out to be very different to home, largely because the symptoms are worse as a result of late detection". Predictably Malaria was on top of the list of most students, "Malaria in pregnancy is a condition rarely found in the UK" according to Margaret "but is very common here on the obs and gynae department". Ella has found the same in the Paeds department, with malnourishment joining malaria as the main culprits.  "I have only read about "Kwashioko" (malnourishment) in text books until now, I had never seen it in the UK.  But due to economic constraints over here  I suppose it is no surprise that it is common here on the children's ward".

As with Arusha, depending on the department the students witness differences elsewhere too. On the surgical ward, Julie and Heidi have come across"genital hernias, priaprism and neurofibroma - none of which we have seen or heard about in the UK apart from in photo books and through lectures. We have learnt so much about all these conditions within just three days of our stay in Ghana". Tania, from Canada, highlighted a common concern "I have never come across TB in Canada, but it is common in Effia Nkwanta. I was initially scared of possible contraction, but now I am looking forward to telling my colleagues back home about what it is like to work with it. The text books have come to life in Ghana!"

Our two Asia destinations do not come across malaria, but there are other frequent recurrences of diseases that are not common at home. In Nepal, Sally has been working in a leprosy hospital - this has been a huge learning curve for her and although she could only observe, she joined ward rounds and outpatients which really helped her understanding of the disease. Now in the second part of her split placement at the large regional hospital, she has also found that "rheumatic fever, scepticemia and HIV are common". Adrian has found similar, but is has been interesting to him that his status as a male has not affected his placement "I have spent 4 weeks in Emergency and during that time I have seen lots of gynae problems which would never be handled by a male nurse in the UK"

In India the students have the option of working in a variety of different hospitals - some of which are of much higher standard than Nepal. Gillian, a physiotherapy placement student has found one case particularly interesting "I have been observing and  treating a patient with no sensitivity on the left side of their face. This is a very rare case and I haven't even read about it before. They have given different muscle exercise treatment for that patient and asked the patient to come to the physiotherapy dept every day". The dental students have also come across unusual cases "I have seen a person with swollen cheek due to severe tooth decay. The swollen part was so big that it almost closed his right eye. This sort of case wouldn’t occur in UK - we would treat it much earlier". They have also seen firsthand the effects of excess tobacco stains that have been left untreated. What has fascinated Rhiannon though is not the unusual symptoms of some patients, but in a similar way to Africa there are patients that seem to attribute their sufferings to witchcraft or a god "I have seen a few people who claim to have seen a god and that is why they are in the hospital".

Next week we are going to ask our student's "how does the role of physio / nurse / dentist / medic or midwife differ overseas?" Watch this space for the revealing answers!

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