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Ray Williams Travelling Fellowship: Harry’s Story

Elective Report by Harry Farrer – Recipient of the Ray Williams Travelling Fellowship

My elective consisted of 4 weeks in Galle in the south of Sri Lanka. This time was divided as 1 week of community medicine followed by 3 weeks of general surgery including urology. I would’ve liked to take more photos of my elective, especially of the clinical areas, however it was a large cultural faux pas to take photos while at the hospital, a fact learned as I tried to take a photo of me outside the hospital on the first day.

The time on community medicine in Sri Lanka was a hugely eye-opening experience. Each day would consist of a different aspect of community medicine. Sites that were visited included (but were not limited to): Antenatal clinics, orphanage clinics, family health clinics, occupational health visits to farms/factories, Old age home visits and a visit to a traditional medicine hospital (ayurvedic).

This part of the placement was extremely useful for showing the differences between the Sri Lankan healthcare system and the NHS. Many of the areas have similar levels of care. I found that antenatal care although more basic in the clinic and with less imaging had a similar feel to the UK. This is backed up by Sri Lanka having the lowest maternal mortality from childbirth in Asia (a statistic that frequently told to us). One of the largest differences that I noticed were the clinical skills shown by the clinicians. Much more emphasis was placed on bedside diagnosis than the use of tests/imaging to diagnose a condition. This is something I will try to develop in my own practice despite a system where patients are heavily investigated with imaging techniques. Another difference I was surprised to see was the emphasis on occupational medicine. With far more of the population working as farmers and factory labourers there were concerns and screening programs for diseases common to a person’s occupation. An example of this would be monitoring clinics for workers in the local cement factory to assess for the effects of dust inhalation.

Lastly from this portion of the elective I noticed that there was a larger deficit in the support services in the Sri Lankan system than that of the UK. Many patients were expected to have their family look after them and the notion of state funded physio/occupational therapy was nearly non-existent. The system mainly focused on acute problems and those with more chronic conditions were less well looked after in my opinion. Patients with more chronic conditions often sought respite in the traditional medicine hospitals. Being the sceptic that I am I suspected that the benefit was largely due to the placebo as most treatments relied on rubbing oils onto a patient’s skin and the origin of these oils was lost in translation. However, many patients saw benefits of the use of leeches for their varicose veins so I’m not one to judge. It was however very interesting to see a state funded alternative medicine hospital.

The portion of my placement focused on general surgery with the team also covered the urological surgery of the hospital and the trauma services.

Due to having my license I decided to hire a motorbike in order to commute to the hospital. The first day also happened to be a Sri Lankan bank holiday the day after new year. As a result, I walked into the acute surgical unit to a male trauma ward of 30 beds with over 120 patients. Many of these had injuries from falling off their bikes the night before (no women as women are not allowed to drink in the culture). Many of these patients had open tibial/fibula fractures. As a result, I spent a long shift in the trauma theatre helping the team with neurovascular assessments, wash out and closing of the wounds. This was incredibly useful for my suturing abilities as it gave me lots of practice. I was also able to rest assured that the wounds would likely be opened by the orthopaedic teams that the patients were referred to. It did however make me confront my decision to drive a motorbike in Sri Lanka!

A photo included with this report is the aftermath of that day, asleep in my scrubs accompanied by some of the local wildlife. The rest of the placement was largely spent dealing with the trauma patients of the Sri Lankan New Year. I did also however get to assist in the open removal of kidney stones from a patient’s ureter and I assisted in some other general surgical procedures such as tumour removal, bowel resections and gall bladder removals (all done by the same surgeon).

The elective did allow me a week of down time towards the end of my stay which was cut short from 10 days due to the tragic bombings that occurred.

This was a cherished experience for me and one that would not have been possible without the financial aid of the Ray Williams Travelling fellowship I received. It has undoubtably made me more skilful in surgical aspects and has shown me the importance of bedside skills. During F1/F2 I will be looking to further develop these skills before applying for core surgical training.

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