June 12th, 2023

Firstly, I would like to thank the Guild, whose funding through the Barts Guild Elective Grant made this possible. My medical elective was in the emergency department of Tupua Tamasese Meaole Hospital in Apia, Samoa.

THE JOURNEY

On May 3rd, 2023, two friends and I began our long journey across the globe to reach Samoa, a beautiful, remote tropical island in the Pacific Ocean. We arrived on the main island, Upolu, and drove to Apia, Samoa’s capital city. Whilst our drive took us through a thunderstorm, all the villages were out playing rugby in their fields, enjoying the rare cool weather. We finally arrived at our accommodation after a total of 40 hours travelling; keen to sleep but excited to see what this elective would bring.

THE EXPERIENCE

I arrived at the hospital where I was introduced to the emergency team. The team was typically made up of five to six nurses and one consultant doctor. The department itself comprises of one waiting room, one triage room, and one main ward for admitted emergencies. After my introduction, I was immediately sent to triage to see patients.

My role varied from taking histories and examining patients to more practical procedures such as taking blood samples, inserting cannulas or catheters, or stitching up wounds. After seeing patients, I would present the case back to the consultant in charge along with my differential diagnoses and recommendations. Cases which commonly presented to the hospital included: pneumonia, complications of diabetes, sepsis, trauma, and cardiac arrests. A fantastic learning experience for me involved suturing the arm of man who had fallen on a machete. After washing and disinfecting the wound, I injected local anaesthetic before performing interrupted stitches to close the wound.

The wound was bandaged, and the patient was given antibiotics along with a tetanus booster to help prevent an infection. Injuries due to machinery and machetes are very common as villagers farm their own land to sustain themselves. Over the weeks, I learnt that the Samoan population has an obesity rate as high as 58.4% and the hospital sees many cases related to diabetes and cardiac conditions admitted every day. It was here that I experienced my first cardiac arrest call in real time. The staff were extremely efficient as a team, fulfilling each role well individually so they can help each other. Watching everyone work gave me a much better understanding of all the roles involved; from one person calling the times to the rotation of staff ready to perform CPR. It is an experience I will not forget and gives me a better insight into what to expect when I am involved with cardiac arrests in the UK.

There are many differences between Samoa and the UK but the most glaringly obvious is the lack of funding for the hospital. The department is extremely understaffed, and it is rare for there to be more than two doctors present on the emergency floor. Furthermore, there are only 4 surgical theatres and one CT scanner for the entire hospital. In addition, there is only one radiologist for the island and scan results can take several days to return. In comparison, the A&E in the Royal London Hospital alone has 4 different zones, and portable X-ray and ultrasound machines readily on hand to make a diagnosis. Working in Samoa highlighted how fortunate we are to have the UK NHS and the services it provides, especially in an emergency.

My experience in Samoa was extremely enriching for my clinical skills. Resources are scarce which results in clinicians only ordering the essentials and working closely with other teams to provide good care. This resourcefulness is something I hope to bring into my own practice as I challenge myself to pair up my knowledge with the true necessities to help prevent over testing/prescribing. In addition, I also experienced personal growth and a boost in confidence. As a final year medical student, the nurses and doctors treated me with respect and the expectation of a newly qualified doctor. This meant some nurses would come to consult me on a patient’s observations and what they should do next. This was the first time I had such an active role in the care of patients, and it helped me build confidence in my own abilities. I also learnt to acknowledge my own limits and when to ask for help from seniors. I will continue to work on my leadership skills throughout my career as I gain more confidence and experience in medicine.

EXPLORING THE ISLANDS

Outside of work I was fortunate enough to be able to explore Samoa. The country consists of multiple islands, the main island being Upolu and the largest island being Savai’i. On Upolu, there are beautiful beaches, ocean trenches, and fantastic mountain hikes to be done, whilst on Savai’i, there are breathtaking lava fields and ocean blowholes. The nature in Samoa is untouched and stunning to look at and, whilst I encourage tourists to go and visit, it is paramount that the land is treated with respect to maintain its unique beauty.

CONCLUSION

This has been a once-in-a-lifetime experience that has shaped my knowledge, skillset, and confidence. I miss the colleagues I worked with as they shaped my placement into the fantastic experience that it was. They were kind, patient and excited to help me learn whilst I was there. If I am fortunate enough to ever visit again, I would go back in a heartbeat. Now that I am back in England, I shall be working as a foundation doctor.

EMMA WELSH
Final year medical student
Barts and The London School of Medicine and Dentistry