Old Members Trust Travel Grant Report – Dora Amos, fifth year Medicine
I travelled to Mahe, in the Seychelles for a two week Obstetrics and Gynaecology placement as part of my fifth year of medical school. This was a fantastic opportunity to understand what medicine is like in a developing country.
My two weeks were spent at the Seychelles Hospital in Victoria, the capital of the Seychelles (and the smallest capital city in the world – it took about 25 minutes to walk across the whole city!). Obstetrics and Gynaecology is a very diverse specialty so no two days were the same. Each morning I would attend the team meeting, when the patients that had arrived overnight were discussed in a mixture of English, French and Creole. Luckily my knowledge of French meant out I could figure out most of what was going on in Secyhellois Creole. I would then spend the rest of the day going to the wards, the gynaecology and antenatal clinics, the theatres or the labour ward.
Ward rounds and clinics provided me with ample opportunity to practice clinical examinations, as there was a very high throughput of patients at each. Patients travelled from all over the Seychelles, often taking ferries between islands, to come to the only specialist centre in the country. I felt especially lucky to have so many opportunities to practice antenatal examinations; I can remember the excitement of the first time I felt a baby kick in its mothers’ womb and, feeling the legs, back and head of the baby, figured out its position in the womb.
The highlight of my placement was undoubtedly my time on the labour ward, where I was welcomed by both the midwives and the patients on the unit, and was lucky enough to be involved in the delivery of several babies. It is a real privilege to share in such a momentous occasion in a woman’s life and to witness their excitement and joy (and relief!). I was lucky that all of the babies that were born while I was there had simple births and were healthy and happy. As a medical student in the UK in a hospital obstetrics department one often only witnesses complicated, medicalised births, so it was good to be able to understand the physiological process of labour and delivery.
Sadly some of the greatest health inequalities in the world are in women’s health and the contrast with the UK is very noticeable, despite the Seychelles having one of the best healthcare systems of any African nation (for the first 10 years of its 30 years of independence the Seychelles was a socialist one party state and its development was heavily funded by the USSR. It continues to have a very left-wing government with lots of foreign investment). For example, I met several women whose babies had died in the womb (stillbirth), and were coming in to hospital to deliver these babies. The rate of late stillbirth is high in the Seychelles, mainly due to the prevalence of diabetes and poor education and access to healthcare leading to poorly controlled blood sugar levels in pregnancy. It struck me that the doctors in the Seychelles had become quite blasé about these late stillbirths; the women were given the news bluntly, given a bit of a telling off for not taking their diabetes medication and sent off to the labour ward where they would deliver their dead babies alongside women delivering their healthy babies. The intense grief and pain of these women, who were mourning the loss of a child, was barely acknowledged. Their helplessness also struck me; there was little that could be done for them in the Seychelles, but similar women in the UK would have been intensively monitored during their pregnancy and would likely have had their babies delivered earlier, giving them a greater chance of survival. This was one of many experiences in the Seychelles that reminded me how lucky we are to be in the UK and to have the NHS.
Published: 2 October 2016
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