We are proud to present the our Winner of the Adventure Medic Elective Competition 2015! Choosing our favourtite from the high quality entries we received was no easy feat, but we loved Madeleine’s colourful and reflective account of Saint Vincent life, both on and off the wards. Enjoy!
Madeleine Thomas / Final Year Medical Student / University of Edinburgh
Immersion
I landed in Saint Vincent after dark, and was immediately embraced by the vibrant Saturday night that was in full swing. I couldn’t suppress a grin despite my travel fatigue at seeing the throngs of people on the streets, dotted every couple of hundred yards with barbecue spots and infectious calypso music. I felt a million miles from home, alone in this new and curious place. But this feeling wouldn’t last for long.
There’s nothing you can do but get stuck in. The tidal wave of life here sweeps you along without time for question. Over the next few weeks I found new friends everywhere I went. The locals were bursting to show-off their island; whenever they spoke about ‘Vincy’ it was hard to miss the pride between their words. I would frequently be identified from the other side of the street as a medical student. Saint Vincent does not receive many tourists save for a small handful of fancy resorts and those en route to the Grenadine islands.
Everywhere to be seen was blue, yellow and green
During my first week in Saint Vincent, thirty-six years of independence was being celebrated. Everything was adorned in the colours of the Vincentian flag. In Kingstown, the capital, bunting draped across the streets and along the buildings. They like an excuse for a good party, and they certainly know how to throw one. The island spirit is palpable at such gatherings, and being a relatively small community of around 100,000 people where it seems almost everyone knows each other, get-togethers are certainly not small affairs. I had missed ‘Carnival’ season (a month-long celebration of culture known as Vincy Mas) but a benefit concert was held for Dominica in the national football stadium during my stay. I was able to get hold of some tickets for myself and some of the other students in a good old-fashioned scrum around a ticketing booth with a window the size of an A4 sheet of paper. This in itself was a lively experience! Dominica is a neighbouring island nation recovering from one of the worst floods in its history, and the draw of the concert was that it was bringing together some of the biggest Caribbean artists all on one stage – it was a wonderful opportunity to hear a multitude of different Caribbean music styles, from Soca to Reggae, Calypso, R&B and dancehall. The teaming grounds were dynamic with dancing and chatter. The night air was heavy with the smell of popcorn and the local grass. You could feel the energy right down to your bones.
Making do with so much to do without
The main hospital on the island is the Milton Cato Memorial Hospital, named after the late Prime Minister who guided the country through independence in 1979. This hospital, where I was placed for a month, offers the highest level of care available on the island. Medical care is heavily subsidised by the government, but there is an absence of some specialist equipment, drugs and personnel on the island, meaning that in many cases patients need to go abroad for diagnostic tests or procedures. This has to be self-funded, meaning unfortunately there are often times when patients go without. The medical team face logistical struggles and the frustrations of waiting for investigations and treatments on a daily basis. It was painful professionally to know exactly what a patient needed to receive, but being unable to provide it. The height of the ceiling of care at times was enough to give you back pain from the constant stooping! I have not appreciated until now the number and variety of obstacles that can occur to hold up even the simplest patient care.
In the face of this, the camaraderie amongst the medical staff and their unrelenting ambition to do their utmost for their patients was impressive. The senior doctors also fostered an inexhaustible culture of continued education, and consequently I learnt much about the spectrum of diseases seen here and refreshed my memory of many a common ailment seen back home as well. It was also interesting to speak to local medical students and those from other countries about their studies and experiences. The similarities were often comforting but I found some of the disparities in opportunities and resources hard to believe at first. It threw into sharp perspective my own experience of medical school, making me feel incredibly lucky.
On the road
The pace of life in Saint Vincent is both fast and slow at the same time, it was impossible not to go along with the ebb and flow of things. The most efficient way of getting about the island was on the merchant fleet of motley minibuses, although does involve placing your life in the hands of the drivers. There really is no other cost-effective way to travel – the island is so mountainous, riddled with towering ridges and dramatic inland reliefs, all covered in a thick layer of rainforest and jungle. The minibuses are all customised for full eye and ear-catching effect. The colourful and blisteringly loud reggae music emanating from them gave you advanced warning there would be one passing your way shortly. A host of graffiti-style stickers and paint jobs made them impossible to miss. These wild rides proceed at helter-skelter pace, taking you up the eye-watering inclines, and then hurtling down into each new bay along the knuckle-whitening dips and twists on the other side. No second was wasted in unloading and loading passengers in and out of the sliding door, no inch of room inside spared for comfort. I had to admire the efficiency.
There was time off to explore the island, and daytrip across to several of the Grenadines. The tropical thunderstorms that spring on the Caribbean at the end of the rainy season were liable to interrupt even the most well planned excursions; flexibility was key in order to experience as much as possible. Taking advantage of the more spontaneous opportunities often led to the liveliest of adventures. A tour of the windward coast and an exhausting but rewarding hike up the volcano (La Soufrière – “the one that sulphurs”) with a taxi driver I met on my first day and just kept bumping into, were some of the highlights of my stay. He became a firm friend over the weeks and, for me, embodied the real soul of Saint Vincent. He was incredibly knowledgeable and passionate and had so much to say about each little village, plantation and view we passed, all the while making anecdotes about his reggae career and back-story. It would not have been the same experience without him.
Close encounters of a tropical kind
There was one other person I met during my first few days in Saint Vincent who really defined my time there. A patient admitted during my first week on the ward, who was on the brink of discharge as I left a month later. We were both new to the hospital and over the weeks I was able to share with her in many a difficult moment. Her case initially caught my attention due to my interest in infectious disease and tropical medicine. It was likely that she had adult T-cell lymphoma/leukaemia, which turned out to be HTLV-1 associated. The reading I did around this group of infectious diseases peaked my interest in her case, but what really struck a chord with me was what unfolded over the following few weeks. The day-to-day transformation and deterioration of her condition was astonishing, lurching from hope to despair and back again, but her quiet resolve throughout was incredibly resilient and humbling.
As I left she was almost ready to be discharged after her first cycle of chemotherapy, pending the recovery of her blood count to a safe level. It is remarkable how much a patient has to learn during their stay in hospital and how much they pick up on of that which we don’t consciously teach. As I learned more about the way of life on Saint Vincent, she was learning more and more about her condition. We were in each other’s worlds, both a little ‘deer-in-headlights’ at first, towards the end talking each other’s language. It made me realise that the hospital environment is a foreign place to our patients, full of uncertainty, different languages and routines, and often loneliness. As the locals had made me feel at ease with their warmth and kindness during my month in their country, I am drawn to recognize it is the responsibility of medical professionals to do the same for our patients.
The tempo of the island changed as my time in Saint Vincent drew to a close. With the general election taking place in a few weeks time, the political campaigning was ramping up. During my last few days the atmosphere was throbbing with heated debate, you could easily get caught in the sparks of crossfire created by the friction between the different sides. The walls and streets were now splashed with the party colours, symbols and mottos – divisive and impassioned as opposed to the unity and goodwill expressed during the independence celebrations. Even as a visitor I could not escape the campaigning machine, my local friends boiling over with facts and reasoning and purpose. This was a reflection of just how passionate they are about their country and its future. Saint Vincent has made a lasting impression on me both personally and professionally, the experience was a true adventure – the stunning landscapes, the smells from the market, the hearty taste of the street food to the swamping 100% humidity, the conversations shared and the memories made. I have been given perspective, and have been made a lifelong fan of the Vincy way of life.
Further information
Where / Milton Cato Memorial Hospital, Saint Vincent and the Grenidines, Caribbean
When / Oct – Nov, but students do go all year round
Costs / $25 USD application charge & $25 USD elective charge per week.
Weather / Around 28 degrees Celcius, often with 100% humidity. Hours of sunlight are from roughly 6am to 6pm all year round, and it is useful to know that it gets very dark very quickly with very little evening dusk. The rainy season, where daily showers are more likely, is supposed to end at the start of December.
Vaccinations / All standard UK vaccinations, Hepatitis A and Tetanus/Diphtheria/Polio booster advised before visiting. I also obtained HIV PEP to take with me.
Accommodation / The hospital has a list of recommended landlords and their contact details, which comes as part of the application documents. It is advisable to stay with one of these. Be warned that electricity may have to be paid on top of rental prices.
Essential items / Copious amounts of DEET repellent (mosquitoes are day-biting so I did not use the mosquito net I brought with me), suncream, cool loose clothing and a good pair of trainers
Contact / Dr Charles Woods, Medical Director. Tel: +1 (784) 456-1185 Ext 162/163 Fax: +1 (784) 457-1014. Email: kghsvg@vincysurf.com
