September 16th, 2021

Although I wasn’t sure I’d actually make it to Barbados due to Covid-19 restrictions, writes Shikila Edwards, my elective experience was extremely useful and a great opportunity to gain insight into a foreign but known culture. A big thank you to the Barts Guild for supporting me financially in having an elective abroad, especially during the pandemic. Due to them, I was able to have a rare but valuable experience in 2021 of travelling to a new country to understand and reflect on the various ways in which Medicine can be carried out.

With a father who grew up in Barbados, I have had regular trips to the island from a young age, but was able to really experience the healthcare system this time around as the choice spot for my elective. I spent four weeks in a local polyclinic (similar to the GP clinics we have in the UK) and shadowed a public health GP. The GP practice itself was a large practice with around five or six doctors, several nurses and healthcare assistants. Not only did the practice provide GP services, there were also antenatal, psychiatry and podiatry clinics. I found it useful that these services were available in the local clinic which prevented patients from having to travel to the hospital unnecessarily. This also reduced the stigma around appointments for those with mental health diseases as they were able to visit their local clinic rather than attending the mental health hospital.

The first thing I noticed when seeing patients was the more laidback approach. Some consultations could take up to an hour and there was no major concern about meeting targets for the number of patients seen each day. I feel this allowed patients to not feel rushed in the consultation and to address any concerns they had come with.

The GP I shadowed allowed me to lead on the consultations with patients, providing me with guidance as we went along and this really strengthened my confidence in patient management and communication. It was interesting to see how the relationship between doctor and patient differed in Barbados in comparison to the UK. Patients came to seek advice and guidance from the GP and looked to their doctor to make decisions on their health, rather than allow them to make an informed decision for themselves.

Many patients came with a particular complaint for which they didn’t necessarily know or voice what their expectation of the doctor was but would allow the doctor to decide the best treatment or management for them. In comparison to my medical school experience in the UK where there is a heavy focus on providing patient-centred care and allowing patients to make decisions about their health, I found this extremely interesting and wondered if outcomes in Barbados would change if more autonomy was to be given to patients.

Another difference from my experiences in England was the more prominent use of herbal remedies by patients. Many patients would attend the clinic having already tried a herbal medicine at home such as herbal teas or commonly used natural medicines. As a medical student in the UK, I have rarely learnt about herbal or alternative medicines and it highlighted the importance for me to educate myself on these treatments. Living in London – a diverse and multicultural city, a knowledge of natural remedies may allow me to provide better treatment to patients and understand their cultural practices more. It also sparked an interest in natural remedies and their use and is now something I would like to do more research in to see how reliable and safe these medicines can be.

The aims of this elective were to experience the management of diabetes in Barbados in comparison to that of the UK and many things stood out to me. With little research, I was able to find that the incidence of diabetes in Barbados is around 10% more than that of the UK, despite the much smaller population. Particularly in Barbados, I noticed the younger age of incidence with some patients as young as 30 presenting with type two diabetes mellitus. This young presentation could lead to increased risk of diabetes complications with age and increased mortality and morbidity in Barbados which would be reflected in global health.

The management of diabetes medically is similar in Barbados to that of the UK. The same medications are readily available with many patients using Metformin. However, there seems to be an increased incidence of poly-pharmacy for diabetes with several patients having difficulty managing their blood sugar with just one drug. There is also a resistance to the use of insulin with many patients wanting to avoid injections and therefore being given sometimes three to four blood sugar lowering medications. This did bring the thought of adherence to my mind as from previous placement experiences, I have recognised that patients are less likely to take medication if they have multiple tablets to take.

Another issue I found extremely challenging was the rudimentary public healthcare system with some medical treatments and tests solely provided on a private basis. This meant that many patients who did not have the means to pay for particular tests or treatments would have poorer outcomes than those who did. In particular, a patient who seemed to have a rare genetic clotting disorder was unable to receive a test to investigate his blood flow as this would cost him around 350 bajan dollars – the equivalent of around £125. This highlighted to me the impact of private healthcare systems on those from a lower socio-economic background.

Overall, my elective was an excellent experience – I was able to experience patient management and consultations in a different country and see the differences as well as similarities with the management of diabetes and other common chronic conditions. The trip highlighted how important the provision of public healthcare is, particularly for those from a lower socio-economic background and made me proud of the NHS and the services it provides.

My trip allowed me to think about working abroad and demonstrated how similar the practice of Medicine can be and how small differences can make a big impact of morbidity and mortality.

SHIKILA EDWARDS