My elective involved a 6 week clinical placement at the Northern District Hospital on the island of Espiritu Santo, Vanuatu. This was a unique opportunity to observe and involve myself in another culture, quite removed from my own.
The hospital serves 66% of the nation of Vanuatu and is one of only two secondary care centres. There are five wards (medicine, surgery, obstetrics and gynaecology, paediatrics and tuberculosis), an outpatient department and a small Accident and Emergency Department. I was impressed by the standard of care provided given the resource limitations, particularly the theatres, where the sterile techniques and equipment were not too dissimilar from the UK. The doctors were all excellent generalists, but what was really lacking was specialist expertise.
My day would begin with an early ward round, followed by observing surgery or going to outpatients clinics. The doctors were quite keen for us to help, and once I had learnt the local language (Bislama, a simple yet vibrant pigeon English) I was able to run my own clinics.
The medicine itself was mixed in pathology. Communicable disease are still problematic, notably TB and osteomyelitis, but have declined significantly in recent years. The new, evolving challenge to the pacific island communities is the burden of non-communicable diseases, particularly diabetes. Preventive health care was almost non-existent due to the distances that people had to travel, such that it was not uncommon for people to present with end stage complications of diabetes. Therefore I undertook an audit to assess the incidence of diabetic amputations at the hospital. I also encountered tropical medicine I am unlikely to experience in the UK, ranging from a girl who had been concussed by a coconut to cerebral malaria and ciguatera poisoning.
Although there was no Jewish presence on the island, my elective was not without a Jewish component. I visited the Jewish museum in Sydney en route to Vanuatu, and I made an effort to compare the traditional values within Vanuatu to my own Jewish ones. Of particular interest was religion within Vanuatua. The traditional practices are very superstitious and mystical but have been largely replaced by Christianity due to foreign missionaries. The missionaries’ activities were evident throughout the town, and even in the hospital there were posters they had put up. However superstition was still a large part of the local outlook, with anything good being attributed to ‘papa G-d’ whereas anything bad blamed on ‘black magic’. Other traditions, such as the ceremonial drinking of kava (a slightly narcotic drink) are still part of the daily life and remain largely unchanged. I thought that this was comparable to the challenges we as Jews have experienced to our religion and culture in the face of modernity and religious intolerance throughout the centuries.
Overall I thoroughly enjoyed my elective and I would recommend Vanuatu to other students. I would like to thank the Jewish Medical Association (UK) for their financial contribution and I will be happy to speak to any members who wish to undertake a similar elective.
Aaron Hughes
UCL