Volunteers

David Song

As part of our medical degree in final year medicine, students are required to undertake a 6 week elective period in a clinical setting of their choosing in a country of their choosing. This criteria gave us a wide variety of choice as it meant we could go almost anywhere in the world. Upon choosing our elective destination and setting, we had a few factors we took into account which would allow us to fufil our aims and objectives to give us the best possible experience.

1)       To travel to a developing country where our skills were fully utilised under the appropriate supervision

2)       To work with an organisation who incorporated a large amount of rural medicine through outreaches to people unable to easily access healthcare

3)       To have access to public health information and figures which highlighted the main issues and challenges facing the country

We found MSP through the World Health Organisation (WHO) website and were immediately struck by the wide range of services that the charity provides and the good work that came along with it. Upon confirmation of the elective period, we were able to set out more specific aims and objectives when working with the charity. This included:

1)       To learn specifically how MSP delivers its services

2)       To travel to as many outreaches as possible in combination with the desire to see more rural medicine

3)       To contribute and assist within our means

Upon coming to the office on the first day, we were warmly greeted by Nazura and the team. A meeting in the morning highlighted our role within the charity and allowed us an insight into what we would be doing in the next few weeks. We were going to be rotated between three departments, the STI clinic, the general medical clinic and outreaches to the smaller villages; all of which would provide a different insight and opportunites. We would be equally spread out amongst the three departments giving us an equal opportunity to experience everything. We would also be partaking for a week in the Hibiscus festival, a festival every year in Suva with a particular emphasis on a world issue.

Immediately going on outreach, it was clear that people in rural villages had much less knowledge and access to healthcare, especially with contraception and family planning. It is not uncommon in Fiji to see parents with children of 5+; sometimes simply due to a lack of family planning. This further highlights the importance of the work that MSP does and also emphasises the need . Whilst on outreach, I also had opportunities for education in high blood pressure and diabetes. Again, with the decreased access to healthcare, I felt this was important for people, especially with dangerous readings to seek the help of medical professionals in hospitals.

Whilst not on outreach, I had the opportunity to sit in with the doctors in clinic and the sexual health centre, both of which gave me the opportunity to see patients with a vareity of medical needs. With the correct supervision, I was able to see a variety of sexual health and general medical cases, further allowing me to improve my consultation and examination skills. It was incredible to see that although Fiji is still a developing country, there is still an emphasis on healthcare and it is great to see that it is free.

Another great experience was working for MSP at the Hibscus booth, I was involved in speaking to people regarding any medical issues or questions they may have and promoting safe sex through giving out condoms. It was particularly inspiring to see MSP being involved in such a large festival which will only boost their platform and spread the good work that the charity is doing.

Working with MSP has been a fantastic opportunity and is an experience I will cherish. Working with MSP especially on outreach highlights the sheer importance of the work that they do and the services that they provide. I can see MSP expanding in the future and it is clear that there is greater need for their services highlighted by the new branches in Nadi and Labasa. Working with MSP has aided me in my clinical development and will surely make me a better doctor in the future. I have treasured my time here and am extremely grateful to all the staff for the opportunity to work with the charity along with their time and enthusiasm to make the placement so enjoyable.

Caroline Apsey

I came to MSP as part of the elective period for my medical degree from the University of Leeds. A medical elective is an opportunity to experience medicine in a different setting and gain an increased understanding of healthcare around the world. I chose to work with MSP because I was interested in observing the challenges faced by an NGO and to help provide healthcare and education to women and children in. MSP provides reproductive healthcare for women and adolescents as well as providing support for women and children who are victims of sexual assault. It is a small but growing charity that was established in 2010.

The charity is based in Suva, the capital of Fiji, and conducts outreach programmes to nearby towns and villages. The charity work I was involved in included working at the general clinic in the MSP offices, the STI hub connected to the local hospital, outreach to local villages/factories/schools and helping at the hibiscus festival (a week long festival in Suva). I was able to clerk patients, help construct management plans and counsel patients. On outreach trips I had the opportunity to educate women on topics such as breast examination, STI screening and Pap smears. I was able to use my clinical skills to help provide smear tests and take bloods.

Aims

1. To understand the challenges faced in providing reproductive healthcare in Fiji.

2. To support the provision of healthcare in remote areas by working with the clinical team of MSP.

3. To improve my confidence in clinical histories, examination and management.

Objective

To learn about the healthcare in a different health system and to provide healthcare support within my clinical capability.

While working on outreach to local areas it was inspiring to see the work of the nurses and counsellors educating women on the importance of family planning and screening for non communicable diseases. Breast and cervical cancer are currently amongst the highest causes of mortality amongst women in Fiji, a lot of these deaths are preventable by promoting effective screening and thus identifying the cancer at a more manageable stage. MSP educates about how women can check their own breasts for lumps and makes it easier for women living in rural environments to access Pap smears. I attended a garment factory with MSP and helped to conduct Pap smears and provide family planning, I thought this was a particularly effective way of targeting a population in need of healthcare.

Working with the STI clinic gave me an opportunity to help in consultations with patients with HIV. Although the HIV rates in Fiji are relatively low, there is still a significant stigma against people with STI. It was encouraging to see there are suitable resources available for treatment and monitoring. The main obstacle to HIV care is poor compliance to care provided, this highlights the importance of patient education and patient support groups. We also went on outreach to locations such as the women’s prison and USP to provide screening for HIV amongst high risk groups.

The one stop clinic is a clinic below the MSP offices in Suva which has doctors, nurses and counsellors working Monday to Saturday. It is a particularly useful service as it provides free general healthcare and support for women and children who have been victim of sexual assault. The doctor supports patients through reporting assault and MSP provides legal support for court dates if necessary. There is also a service that provides long term support for people after assault, it provides meetings with counsellors and support finding work and housing if necessary.

I thoroughly enjoyed this opportunity to work with MSP and provide healthcare to women. I am particularly interested in working in women’s healthcare in a developing country during my career and so this was an invaluable experience for me. The main difficulty facing reproductive healthcare in Fiji is poor education and poor access to healthcare. Women are not taught about the importance of family planning and the many options available to them, this is partially due to the difficulties of accessing health services for women in rural areas. This is why MSP are working hard to increase awareness of their services by visiting areas with high female populations (such as garment factories). It is hoped that women who access services from MSP will be able to educate other women they know about what healthcare options are available via word of mouth and sharing of health information booklets such as MSP’s own ‘Girl Empowered’.

Thank you to all the staff at MSP for providing me with the opportunity to help with all your hard work. I have had an amazing six weeks and am already looking forward to returning to Fiji!

Rebecca Haddow

Introduction

The medical elective period provides the opportunity for future doctors to experience a healthcare system in another country, and in an invaluable experience. When organizing the elective there were many aspects that I needed to consider in order to gain the most from the experience. Firstly I wanted to take my medical skills and knowledge to an area of the world where I would be of use, i.e. a middle or lower income country. Secondly, it was important that the country I ventured to spoke English as a main language as I feel that it is essential to be able to communicate with patients in a mutual language. Lastly, I aimed to find a specialty that interested me and that I was able to put my all into, and women and child health fitted this.

Medical Services Pacific (MSP) was found on the World Health Organization website, and is a non-governmental organization whose primary aim is to provide access to reproductive health care to women and young people across Fiji. Along with this MSP supports many vulnerable communities including providing a nationwide child line to aid children going through abuse and hardship.

Aim and objectives

Upon securing a place at MSP, thanks to the help of Nazura, I was able to configure my own aims and objectives for the 6 weeks period.

Aim:

To gain an overall understanding of how the health system in Fiji runs, and how NGOs contribute to this system, along with providing medical aid and advice where able.

Objectives:

1. To partake in outreach programs, allowing smaller settlements and communities access to essential reproductive healthcare
2. To assist the clinic doctor in carrying out consultations, examinations and procedures
3. To gain further knowledge of reproductive and child health, and bring this back to the UK

My experiences and feedback

Medical Services Pacific is a wonderful organization focused on providing care to those in need. I have great admiration for the staff at MSP for their dedication to providing counseling and medical services.

During the 6 weeks at MSP we had the opportunity to partake in three different areas within the organization. First I was based in the MSP clinic, and immediately I was able to discuss with the doctor and nurse how the ‘one-stop-shop’ clinic runs. It became obvious very quickly that the clinic has much more potential that is currently utilized. Most days the clinic was very quiet, indicating that many people do not know about the facility. Having a free, NGO-run clinic is a blessing to Suva, and so more emphasis could be put into promoting the clinic facilities. I was able to fulfill an objective and take full histories and perform examinations, along with dispensing medications where necessary.

During my time in clinic I was saddened to hear of the high number of sexual assault cases that MSP have to deal with, highlighting the issue within Fiji as a whole. MSP have a system where they are contacted by the police when there is a case of sexual assault, and they are able to provide a full medical check for the victim, also useful as evidence in court, along with counseling to support the victim through the ordeal. This aspect of MSP is extremely important, and I believe that they are doing an amazing job providing counseling to those in need.

The second area I was based in was the STI hub, a separate organization to MSP, in which we were able to take sexual histories, and provide advice. What was striking about this facility was that a diagnosis was made based on a history, rather than using swabbing and testing. This highlighted the need for more resources here in Fiji to enable more accurate diagnosis to be made.

Lastly, partaking in the outreach services was extremely interesting. Having the opportunity to take health information to communities and corporations outside Suva is one that I will treasure. During the outreach services I was able to give talks to the local communities, and advice about breast self-examination which had a good response, and provided breast examinations to those who had concerns. The outreach projects are MSP’s biggest asset, and it is rare to find an organization with such a passion for bringing healthcare to the people of Fiji.

Whilst on outreach it became clear that many people do not have a basic understanding of family planning methods, the importance of PAP smears, or indeed a general understanding of how to lead a healthy life.

If there were more organizations like MSP, Fiji’s health system would be a much better place. More funding is needed for MSP to reach its full potential, and I hope this is achieved in the near future

Many thanks to all staff members at MSP for making us feel so welcome, and we hope to visit at some point in our careers.