I'm currently working in Africa again.
For those who want to work in this continent here is my advice about the experience you should have before coming.
First and foremost
You'll often be the ONLY
western trained staff on site. So people will consider you as a doctor most of the time. They'll expect that you'll have an answer for almost anything, be able to perform surgery, deliver babies, cure about anything. That's particularily true in remote areas where the nearest hospital is over 1 or 2 days travel away
Quite often you won't have any support other than your knowledge, skills and books (don't dream too much about using Internet or your Ipad, electrical power is very often a luxury in remote settings.
This leads to the second point
You work in an underdeveloped country
That means that you'll be lucky to have microscope enabling you to perform or having performed very basic lab tests.
The KISS acronym is always
And by basic I mean that unless you work for a larger organisation, you won't have a lot of choice in terms of sutures, antibiotics and other medications, detergents and desinfectants (potassium hypochlorate works miracles and is easy to come by!). There'll be a shortage of about everything you might think of, medications are often past due date of use ( but they still work!), for instance ATBs past date for injection can be used directly on wounds...
Third point experience needed (this reflects my opinion from my practice)
You got to learn to diagnose diseases like liver cysts, GI problems, pneumonia, infections...
Best to get a degree in that, a REAL good one is the one from the Institut du roi Leopold in Anvers Belgium. Otherwise, try to get one online.
You'll have to be able to perform sutures, treat infected cysts. Sometimes amputations due to trauma, treat wounds due to bullets, knives, machete, burns (trauma is quite common in war riddled places). Remember that appendicitis kills (better be able to remove one). Spending some time in an O.R. IS
useful. Knowledge of basic dental surgery is good to have too ( you won't want to break the jaw while pulling teeth
: would be bad for your karma)
You got to be able to assist or to deliver babies, sometimes do a C-section if things turn bad.
Treat Gyne infections due to mutilation (excision are VERY
common in East Africa), AIDS, STMs (condoms are too expensive), rape and domestic violence.
Otitis are common, usually you'll see them when they're really infected (local treatment can use things like intra ductal tobacco..Seen in Burkina Faso). Knowledge of the use of an otoscope is good, how to use it to clear ear ducts, or perform paracentesis is better.
Infectious problems are common. You won't be able to treat ARMD (too expensive).
That'll help you to order your priorities. Learn to manage your stress.
PACU, ICU, CCU
They'll give a knowledge of the use and effects of useful drugs. Depending on the setting where you are, you can learn how local and locoregional anesthesias are performed. (lidocaine is cheap and really helps).
Examinating and treating a child is very different from an adult. Knowledge of their specific pathologies is a must have in remote settings.
Working in remote areas can go from difficult to really hard to
It's very demanding but really rewarding.
forget the cultural differences some things that are unimaginable in western countries are normal where you are.
The way people see death or diseases varies greatly from one place to another.
Be flexible and creative
, that will enable you to face the difficulties you'll have to face.
prepare for the worst and hope for the best. Knowledge is always
light to travel with but sometimes hard to get. Learn as much as you can, wherever and whenever you can (local treatments cure some illnesses)
Although you might be considered as somebody next to a God in some places, never forget that are only a human and not almighty.
Keep your mind open: you'll be surprised about how much one can learn from others.
, never forget that your cultural background is completely and often radically different from the one of the people you work with and treat. You better not go there as the one who knows everything better unless you want to be really disappointed (people can react in ways you and your body won't like...)
You were lucky to be born in a country that enabled you to go to school and learn a (really good) job. In remote places people are at the bottom of Maslow's and Henderson's pyramids.
You can do only as much as you can within the limits of the knowledge, the skills, the wits and your abilities you learned and got.
I hope my little post will be of some help to those who are interested in working in remote areas.
I tried to cover about all the topics I could think of, if I forgot some please forgive me: I'm not that young and Alzheimer is a