Electives: Africa vs America

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As mentioned in a previous article, electives are becoming a fundamental part of medical education especially in European and North American medical schools. The experience is invaluable no matter where you choose to go, but have you ever wondered what the differences are between doing an elective in an underdeveloped or developing country, as opposed to a developed country could be?

Here a few points for comparison: 

Different structures to healthcare systems 

The healthcare systems in a continent like Africa differ greatly from that of Europe or the USA. Even within continents, disparities between country-specific healthcare structures exist. This is possibly due to differences in culture, disease burdens, health budgets, population, availability of healthcare professionals, and so much more. According to the World Bank, the UK has 2.8 physicians to 1000 patients, while Senegal has 0.1 physicians to 1000 patients. So the set up will be considerably different.

Electives will afford you the opportunity to experience and study a variety of health care structures and how they impact health outcomes for the general population. You might also find yourself figuring out possible solutions to the issues you come across, and who knows you might actually bring those solutions to life one day!

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Resources available to healthcare professionals 

Many underdeveloped or developing countries are burdened by limited health care resources and infrastructure unlike developed countries, so it’s a no brainer that healthcare practices would differ. It could be as simple as clean running water, adequate power supply, availability of diagnostic equipment, and even efficient waste management systems. These have a key role to play in healthcare practices in different regions of the world.

Doing electives will give you some insight as to how these issues are managed on a day to day basis by the physicians and patients. 

World Bank

Physician responsibilities 

The responsibilities of physicians vary significantly in different parts of the world. Drawing from my observations of both sides, physician responsibilities are considerably more in underdeveloped and developing countries. With a lot of these countries experiencing infrastructural limitations and physician shortage amongst other things, physicians are expected to do more, beyond the scope of what their usual responsibilities should entail. For instance, you might sometimes find family medics, emergency medics and internal medics performing cesarean sections, and emergency medics carrying out family medic duties. It is also not unheard of for physicians to individually or collectively offer financial aid to low-income patients, as well as free medical care.

Although this isn’t ideal, it comes in handy during electives if you’re looking for hands-on clinical experience.

During one of my electives in ‘developing country’, as a second-year medical student, I found myself delivering babies all by myself, sometimes at odd hours of the night. This is a good example of something you won’t get the opportunity to do as a second-year medical student in Ireland or Chicago.

Ethical issues

Ethical practices in medicine vary by region and can be influenced heavily by culture. Some ethical issues that might be considered absurd in Sweden, could actually be viewed as normal in Cameroon, and vice versa. An example is a teenager having the free will to decide whether or not to have his/her parents in the consulting room during a visit to the doctor. Being Nigerian, this wasn’t an option when I was in my teens. My mother was there whether or not I consented to her presence, and it wasn’t regarded as abnormal.

It’ll be interesting to compare and contrast what ethical issues come up during your electives and how these issues are managed. 

Electives are invaluable wherever you choose to do them but it might be worth leaving your comfort zone on occasions to give your mind and clinical knowledge a chance to explore beyond what you already know. 

Dr Wendy Evans-Uhegbu

The author Dr Wendy Evans-Uhegbu

Dr. Wendy Evans-Uhegbu is a graduate of The Royal College of Surgeons in Ireland, with experience in Connected Health, Medical Technology, Clinical Research, Medical Education, Medical Communications, and Web Design/Development. She is a part of the Medics Abroad team with the role of Chief Communications Officer. She is also a Medical Writer at 3D4 Medical and runs a Medical Communications and Children's books company (ODR Integrated Services/ ODR Books).  She is the author of the newly published children's book series "The Things Around Me".

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