Daisy Tudball

I wanted to travel for my elective as I’d heard from a lot of other doctors talking about their experiences overseas and how much they valued it. They talked about how it prompted them to take certain directions further along in their careers, helped them choose their speciality, and even sought opportunities with organisations like MSF.

I chose to travel to Sri Lanka in particular, as I’d always wanted to visit the country and I knew that the healthcare system would be totally different from what I’d experienced in the NHS.

I was quite nervous in the run up to the placement. Mostly because I was going into a new hospital environment and didn’t know what to expect. Work the World’s team in the UK had briefed me on things I might see, like a lack of pain relief on the labour ward, but you don’t truly understand until you see it for yourself, so there were definitely nerves.

Saying that, as soon you get onto the flight the nerves go, because at that point there’s no turning back.

I landed at the airport and travelled to the private accommodation with a member of Work the World’s in-country team. It was the first time I’d been anywhere like this and so it was a relief to see someone in a blue Work the World t-shirt waiting for me.

I think it was during the drive to the house that I realised how different Sri Lanka was going to be. There were other students who arrived at a similar time to me, so we travelled to the house together. We all agreed that the roads were a bit like Mario Kart with cars and bikes weaving in and out of traffic, seemingly with no adherence to the rules. In spite of that, we still felt very safe and comfortable as their system worked regardless of the apparent chaos.

The following day, we went to our placement hospital for the first time. The placement itself wasn’t starting until the day after, but it was a chance for us to take in the new surroundings and meet the hospital staff we’d be spending the next few weeks with.

The hospital was incredibly busy. It wasn’t as hot as I thought it was going to be, which was a relief. One thing that struck me was that there were areas of the hospital that were surprisingly modern. There was a lecture theatre with a fancy projector and what I’d consider to be more or less state of the art technology.

But then when you visit the wards themselves, it’s a different picture — patients crammed in, sharing beds, very little privacy and a lack of sterilisation protocol.

I spent two weeks in OBG and one in general medicine. The latter I chose because I wanted to get a broad understanding of the spectrum of conditions that doctors have to manage in Sri Lanka. And OBG is the speciality I’m choosing, so it only made sense to get more focused experience in this area.

Something I might not necessarily have expected was that surgeries, procedures and the medicine in general was quite similar to what you’d see in the UK. The big difference was in the equipment, or lack thereof, and in the attitude towards patients and their care.

Doctors barely spoke to patients at all. I think it was probably similar to how we used to do things in the UK, where now things are more collaborative between doctor and patient. In Sri Lanka it was very much that the doctor comes to a decision and tells the patient what’s going to happen without explanation or patient input.

This extended out to there being a lack of privacy and dignity for women in OBG. I’ve no doubt it would be the same in other areas of the hospital, but in women’s health this difference is more pronounced. A woman might be giving birth and there would be all these people, who she may or may not know, able to watch her.

When I spoke to people about this, the consensus was that doctors are so revered in Sri Lankan culture that patients rarely speak against them or challenge them.

I experienced some quite confronting situations while I was on placement. There were instances where young women, as young as 13, had been raped and fallen pregnant as a result. But because termination of pregnancy is illegal, regardless of the circumstances, they had to go on to have these babies.

There were clear links between both culture and religion affecting clinical practice.

There were also cases where women who were in early pregnancy had ‘fallen over’ and started bleeding shortly thereafter, but the consultant’s suspicions were that these patients had undergone illegal terminations. It was very difficult to see, but enlightening all the same from a medical point of view.

Another incredibly interesting insight was that one of the consultants was a Buddhist, and it was his view that terminating a pregnancy would give him bad karma going into the next life. So there were clear links between both culture and religion affecting clinical practice.

My time in general medicine was just as fascinating. There were lots of end-stage conditions where patients had left it up until the last possible minute to seek treatment. It was also the case that conditions we would normally see in older men were occurring in much younger men. Men in their 50s with severe COPD, diabetes, asthma… In the UK it would be rare for a condition to get to such a late stage in men of that age.

It was an utterly fascinating experience and one I’ll carry with me throughout my career.

Sri Lanka itself is a beautiful country. We got the chance to see some of it during our down time in the evenings and at weekends. On one of the weekends we travelled to Sigiriya, which was amazing, and on the second weekend we went down to Ella, which was incredibly beautiful. The Sri Lankan people were all so lovely and welcoming, and they couldn’t do enough for you.

I booked this trip quite sporadically. I’m not usually the kind of person who does these things, but I thought I’d throw caution to the wind and go for it. I almost regretted my decision in the two weeks leading up to the placement because I was so nervous. But I am so glad that I did it. It really was the experience of a lifetime and I can’t recommend it enough.