My last two weeks in Iloilo were as enjoyable as the first two, and perhaps even more so because they were significantly less sweaty.
I couldn’t work out whether this was because the weather had gotten cooler or because I had acclimatised following the many hours I had spent on the infectious wards (the odd thing about these wards is that they are so much muggier than the rest of the hospital that you are left continually worrying that you must have actually caught something from one of the patients on them). Some of the realities about medicine in this sort of setting were really starting to hit home though and – despite the excellent preparation I had received from my medical school and Work the World – I still wasn’t really ready for the impact it was going to make.
For example, I knew that it was going to be hard to come to terms with the fact that so many of the patients are simply not able to afford the treatment they required. But when you have interacted with a patient (and their family) over the course of a week, seen them rapidly deteriorating, and then witnessed the doctor – someone you consider to be your friend – having to inform them all about the inevitable consequences if they do not pay for dialysis “now”, and the subsequent helpless expressions that everyone shares…well, it suddenly drives it home in a way nobody can prepare you for. And then you get a second wave of emotion as you start to feel guilty for getting so upset about it because just imagine how the other people in this scenario are feeling!
Sorry for that less-than-cheerful start. I thought it was important to mention it though, because I don’t doubt there will be similar tricky moments for just about everyone who comes away to the Philippines – as well as to the other Work the World destinations no doubt - and I’ve come to realise that this is an important part of the elective process. Have I mentioned before how glad I am that I am going to be working in the NHS? Because I have no idea how I could cope with telling people they need medications or surgery that they cannot afford…
Week 3 saw the arrival of the third elective student to the Work the World house. Despite being happy that we were going to have a new person to hang out with I couldn’t help feel aggrieved that MY room was going to have to be the one shared. I tried a variety of petty tactics at first to try to oust my intruder: hissing at him whenever I passed him around the house, turning off his fan in the middle of the night, and leaving frogs in his shoes, but all to no avail as it became apparent he was actually a very nice chap, and the fact he was working in the Paediatrics department meant the friendship group of local staff and Work the World students expanded that much further. I imagine that when they are up to full capacity a placement here must be like going to work with a big extended family. Kind of like the mafia but without the threat of maiming. Unless your placement is in the surgery department of course.
There was so much variety in the cases that came through the door during these weeks, and I know that I tend to glaze over when people start listing medical conditions (a talent that has always gone down well with my consultants) but I’m going to throw a few out there anyway. As the end of the dry season was fast approaching the numbers of patients with schistosomiasis and dengue fever started to steadily increase. I had never seen these conditions before and was full of questions for the doctors, to the extent that a number of them were probably regretting ever having admitted to being able to speak English. Then a patient was brought in with tetanus which just dialled the excitement up to eleven. I explained to the doctor who had been lumbered with me that day that I HAD seen a person with tetanus before, but that it was Shane from Home & Away and he sadly didn’t make it past the end of the episode, so I was very keen to know where the doctors in Yabby Creek hospital had gone wrong. The doctor shot me back an expression I couldn’t quite identify, but I’m sure it was somewhere between respect and admiration.
I could probably go on and on about my elective experience in Iloilo, and my past blogs are proof that you can take me at my word on that. But I suppose there is not much point when probably all you really want to know are the answers to two simple questions:
1) Is Work the World Philippines a good choice for my elective?
I honestly don’t think I could ever have organised anything a tenth as good as the experience I have had here. And I’m not someone who is completely green to travelling to foreign destinations. I am very impressed with the “Work the World” way of doing things: the big, beautiful, shared house which seems to be a theme in all of their destinations; friendly local staff who take immense pride in the work they do; hospital placements which have about as much structure and effort put into them as it is possible to imagine (and certainly far more than you will ever experience with a university placement), and a general feeling that they are a safe pair of hands who are looking out for you for the entirety of your trip.
And when you combine this with the hospitality and general friendliness of the Filipino people and all the things that the city of Iloilo and the surrounding area have to offer, then you have got an elective which is seriously good value for money. And I say this fully in the knowledge that students often tend to baulk at the price of these placements (because a few of my friends did before I went). I think it MAY be possible to organise an elective for less than Work the World charge, but you wouldn’t be staying in accommodation anything like as pleasant, safe and secure as a Work the World house; you wouldn’t be able to enjoy anything like the variety of food that Gerry the chef prepares (you would presumably be eating out and choosing the budget option every meal!); you wouldn’t have the support and camaraderie that comes from living and working with a bunch of people doing a similar sort of thing to you; you wouldn’t have a team of staff looking out for you at all times, willing to sort out your problems and prepared to listen as you ask them progressively sillier questions; and you certainly wouldn’t be able to walk into a hospital placement where all the background work has already been done for you, and where the local staff are actually excited and willing to take you under their wing because of the successful placements the organisation has provided in the past.
2) Are the Philippines a good tourist destination?
Unfortunately I was not able to get the time to get away and explore a great deal of the country, but I did get to spend some time in Boracay, which truly is an excellent destination for beach-lovers. And I also came into contact with a lot of people who WERE able to make the most of the country, and I can honestly say that I intend to go back there someday because, by all accounts, it just about has it all! If you are into diving, surfing, or sitting on a beach then it has some of the best locations in the world for all three. It has huge schools of whalesharks that you can swim with, volcanoes you can trek across, beautiful rice terraces to visit, excellent mountain biking trails and a vast network of caves you can explore. Plus it is a cheap flight away from a number of other south-east Asian destinations.
Okay so I’m starting to sound a bit like Judith Chalmers now. I’m honestly nowhere near this enthusiastic normally but I had such a good time on my elective in the Philippines, really appreciate the role that Work the World played in it and recommend it to anyone thinking of coming here in the future.
Rob is a 5th year medical student from Barts & The London, Queen Mary's School of Medicine & Dentistry.