Benefits

Today was a bad day.  I noticed her out of the corner of my eye as I walked into the resus room, her back was arched, lifting her torso almost off the bed and her young face was in spasm.  A concerned nurse and house officer stood next to her administering oxygen and blood, watching her heart racing on the cardiac monitor.  She was only 14 years old and desperately sick.  My first thought was that this may be tetanus but on closer inspection, I could find no wound and a blood test had indicated a high concentration of malaria parasites.  Her story of headache, fever and her pale conjunctiva pointed towards the diagnosis of severe malaria and she was now unconscious.  She had been catheterised and a small trickle of black urine had collected in the bottom of the bag.  I looked at the others standing around the bed and their faces said it all, we knew she was in trouble.  Within hours she was gone.

Working in the medical profession, you become accustomed to patients dying and in a country where the average life expectancy is in the 40s, it tends to be a frequent occurrence unfortunately.  It is never easy, however, to watch a child die especially when the cause is potentially preventable.  There is some consolation in the fact that you know you have done your best but there are still days when you question whether what you are doing makes any difference.  So why do we do this?  Many of my colleagues at home were a little bemused when I told them I was heading to Sierra Leone and I am sure that some friends and family thought I was a little off the wall.  I am not entirely certain myself.  In truth, I think it is a combination of factors; the desire to make a contribution and do something worthwhile, to learn and challenge yourself in a new environment; to develop new skills and perhaps a spirit of adventure that urges travel into the unknown.  It is also fair to say that I felt a little burnt out after a decade of working emergency medicine junior doctor rotas and needed a change. 

    

It does involve sacrifice; there are days when I feel exhausted, being away from friends and family is hard at times and I have just missed the birth of my niece.  Some may see it as selfless and others as selfish, I’m sure that I have tested the patience of my fiancé on occasions and I look forward to being reunited soon and meeting my new niece in person .  I have gained a lot from the last year in Sierra Leone and there are many more positives than negatives.  Just last week, for example, supported by several colleagues, we delivered a 5-day course on emergency medicine to the final year medical students.  Spending time with a group of young people that are enthusiastic to learn and eager to develop their skills is immensely rewarding and will hopefully equip them with tips that they can use in their future careers.  Some even expressed the desire to become emergency physicians which is fantastic as the specialty is currently not formally recognised in Sierra Leone; the only way it will develop is through local doctors driving it forward with appropriate support.  I actually spend more time here undertaking service development and conducting training than clinical work but that is not necessarily a bad thing.

The All-Parliamentary Group on Global Health report in 2013 set out the benefits of UK volunteering to low and middle income countries; namely strengthening the capacity of health systems, institutions and professionals.  The caveat is that it must be appropriate, coordinated and geared to the needs of the country or institution in question, with an eye towards sustainable work.  Development work done badly can actually cause more harm through misaligned priorities, time wasting and utilising resources that would be more appropriately directed elsewhere.  This may foster resentment and worsen morale.

The Tropical Health and Education Trust (THET) identifies the key to success as working in partnership.  A successful partnership involves the UK partner being responsive to the overseas country’s needs, establishing a two-way relationship that is mutually beneficial and utilising a multi-disciplinary approach.  The All-Parliamentary Group also described the benefits to UK individuals and organisations in terms of leadership development, sharing innovation whereby UK institutions can learn novel approaches to solutions where resources are limited and improving international relations.

There are many other benefits to health partnerships and global health volunteering, such as improved cultural competence, education and research opportunities and a greater understanding of social and ethnic diversity amongst staff that volunteer.  This certainly echoes my experiences over the last year.  Engaging in global health is government policy and a framework document was published in 2014 which states that development work “should be seen as the norm, not the exception for every health worker’s career.” 

In the last decade, global health has increasingly been a priority to governments around the world following outbreaks such as SARS and H1N1.  This was brought to the fore during the Ebola epidemic and Public Health England’s Global Health Strategy involves improving global health security, responding to outbreaks of international concern, capacity building and strengthening UK global health partnerships.  Since then, the Zika virus has emerged unexpectedly as a new global threat and who knows what is around the corner. 

In conclusion, when done well, working in global health can have many benefits and I would encourage anyone who is keen to learn more and consider getting involved.  Global health is everyone’s concern and in my experience, there are more good days than bad.