Kathryn Hughes

I undertook my elective with Work the World in my final year of medical school and went to Kandy, Sri Lanka. I found the Work the World online ‘MyTrip’ planner very useful in planning my elective. MyTrip comprised a detailed timeline of the tasks I needed to complete before embarking on my trip. This meant that I could complete the necessary preparations relatively easily and nothing was missed out.

When I arrived in Colombo, I received the warmest of welcomes from three in-country representatives of Work the World. They welcomed me to Sri Lanka and immediately made me feel safe and at home. I was then provided with a comfortable hotel room in which to stay whilst I awaited my transport to Kandy. Upon arrival at the Work the World house in Kandy, I immediately felt welcome and had the chance to explore the bustling city. I found Kandy a great place to study for 3 weeks – it was a hive of constant activity which I found exhilarating.

During my stay in Kandy, I lived in the Work the World House. It was very comfortable, with three floors, lots of open living space, a balcony overlooking a school and mango trees and it housed around 25 people. The food was incredible; we had the chance to sample not only traditional Sri Lankan food (the chefs kindly reduced the amount of spice that was added to the food to save our delicate Western palates!) but also Chinese, Italian and, of course, the amazing weekly BBQ. I shared a room with three other girls; my housemate from the UK, an Australian and a Dutch girl. It was lovely to make friends with people from across the globe and learn about their countries. We had a great time getting to know each other and became good friends by the end of the trip – we were sad to leave each other!

When choosing which destination to undertake my placement in, I selected Kandy because of the wide range of activities that were available in and around the city. And it did not disappoint! Aside from undertaking my paediatric placement in a large, bustling teaching hospital where I saw a wide range of rare congenital and tropical diseases, I went white water rafting, visited an elephant sanctuary, took a stroll in Udawatakele Sanctuary accompanied by a troop of monkeys, glimpsed the Buddhist religion by visiting the Temple of the Tooth and the White Buddah and soaked up the culture at a traditional Kandyan dancing show. There was always time at the end of a busy day to peruse the vibrant stalls in the market place where you could find anything from red oil to saris being advertised by friendly locals who were always keen to chat!

Kandy is ideally situated in the centre of the country, meaning that all that Sri Lanka has to offer is within reach to explore at the weekends. Our weekend excursions included: a trip to Nuwara Eliya to visit the spectacular tea plantations; watching the sunset from Galle Fort in the South after a day of relaxing and paddle-boarding on the beach; cycling around temple ruins in Polonnaruwa; and surveying the beautiful views from the ruins atop Sigiria Rock. From waterfalls, mountains and tea plantations to cultural temple ruins and glorious white sand beaches, Sri Lanka is a beautifully diverse country offering a rich and wonderful experience that you will never forget.

Aside from the amazing time I had exploring the country, I gained an insight into a healthcare system in a developing country. Although the placement was mainly observational, I learnt about the tropical diseases that commonly present in children in Sri Lanka, particularly dengue fever, and congenital conditions that present later in life due to suboptimal neonatal screening, such as haemophilia A and thalassaemia. The healthcare system in Sri Lanka is funded by the state via the tourism industry, making healthcare free and accessible to Sri Lankan citizens. The Sri Lankan doctors were all fairly fluent in English and were friendly and willing to teach. Surprisingly, the management of the patients in my placement hospital was similar to the management of patients in the UK as the doctors followed NICE and Australian guidelines; however, infection control was not as rigorous as it is back home.

A case that resonated with me was a ten-year-old boy who had suffered an intraventricular bleed as a result of haemophilia A. One quiet afternoon on the ward this child entered status epilepticus, which lead to resuscitation by the paediatricians and eventual intubation. The aspect I found most difficult about the situation was the reaction of the grandmother, who was openly distraught at seeing her grandson’s suffering. However, it’s not common culturally speaking for healthcare staff to openly express empathy in Sri Lanka, which I found challenging when witnessing the reaction of the child’s relatives as it was my instinct to offer comfort.

I had the chance to experience traditional Sri Lankan Ayurvedic medicine for one week at the end of my placement. This was like nothing I have ever done before! I lived with a Sri Lankan family in Habarana in the north of Sri Lanka and we travelled to the Ayurvedic hospital each morning. Here, I assisted the Ayurvedic doctor in treating a plethora or orthopaedic complaints, including sciatica, prolapsed discs and fractures. The mainstay of treatment was to apply red oil to the affected area, cover this in shredded leaves and tree bark and then bandage and splint the limb with a roughly hewn, wooden splint. The most unusual thing the doctor told us was that in Ayurvedic surgery, fractured bone is usually removed completely and replaced with either monkey, iguana or goat bone, which is a stark contrast with Western medicine to say the least!

I had an amazing elective placement. It is impossible to choose just one highlight because there were so many! I loved experiencing a new and vibrant culture in a beautiful country that is so different to mine and meeting so many wonderful people – the students with whom I lived in the Work the World house, the Work the World staff and the local Sri Lankan people.

I would definitely recommend travelling abroad to do a medical placement if the opportunity arises – you will gain a valuable insight into medicine in a different culture and have a wonderful time exploring a country that you will surely grow to love.