Barbados

Queen Elizabeth Hospital, Bridgetown

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A little about Barbados...
I decided to undertake my elective in the Caribbean, in particular Barbados, staying in a guesthouse on the south coast, about 15 minutes from the capital, Bridgetown.

Barbados is a beautiful island, where it is summer all year round. It started as a British colony, where sugar was its main source of income. Nowadays, tourism is its main focus, with only a single sugar factory on the island. With a population of almost 300, 000, Barbados boasts the highest number of churches per square mile. [As my consultant, a Barbadian, used to say, this means the population is excessively moral or highly immoral!]. The main language in Barbados is English, although the accent and the broken form spoken there is difficult to understand initially.

Barbados itself is a very expensive place: all things bought there (even most seafood) are imported, and the government levies a heavy tax on goods. This is in contrast to the neighbouring Trinidad, where although much is imported, governmental taxes are not so high. Trinidad, therefore, is the ideal place for the Barbadian to go on holiday, where he can do a vast amount of shopping at a fraction of the cost too.

Medical training & healthcare
Medical training in Barbados is similar to that in the UK. Students can start at The University of the West Indies as soon as they have finished their A-Levels. The course is divided into pre-clinical and clinical stages, the former lasting 2 years, and the latter 3. The pre-clinical years are undertaken outside of Barbados, at the Trinidad campus, or Jamaican campus. Students can come back home for clinical years to rejoin their year of about 80. After 5 years, graduands are awarded an MB BS degree.

The island prides itself with more than 11 doctors per 10 000 population; the UK has 17/10000, France- 33/10000, South Africa- 7/10000, Ghana- 9/10000. The main government hospital in Barbados is the 600-bedded Queen Elizabeth Hospital, Bridgetown. Here, care is given free at the point of delivery, funded by governmental taxes. This hospital also has a floor separated for private patients. There is also one main private hospital, the Bayview hospital, Bridgetown. Many private practitioners, however, convert a part of their home into a consultation suite, as this is more economically effective. Health insurance is fast becoming a big business in Barbados, as many of those taking advantage of private care have insurance. Consultants generally charge about US$40 for a consultation.

Further training is offered in most specialties at Queen Elizabeth Hospital. All consultants are invited to lecture on the programmes and if they take this opportunity up, are expected to undertake research in their field pertinent to disease in the population. In return, consultants are provided with a travel grant, three months sabbatical per year.

What did I see in the hospital?
The population demographics of Barbados are similar to developed nations, with an increasing elderly population. Disease burdens are also similar to those found in the Western nations: diabetes, hypertension, malignancy, and cerebrovascular disease are all extremely common. The prevalence of HIV/AIDS in the Caribbean, however, is second only to some Sub-Saharan African countries. This means that as an elective student there, I was able to see many late presentations of relatively rare diseases, including cerebral toxoplasmosis and pneumocystic carinii pneumonia. There were also cases of less common infectious diseases, such as leptospirosis.

What equipment and technology was available?
Many diagnostic tools are available on the island: computed tomography, ultrasound, and radionuclide imaging. Magnetic resonance imaging, however, is not. Barbados also boasts the only decompression chamber available for public use in the Caribbean.

I used my time in Barbados to study the uses of the decompression chamber. The Barbados Defence Force owns the only public decompression chamber in the West Indies. The experience of walking through the historic defence force alone is amazing: I was required to obtain a Visitors’ Pass, until the guards started to recognise me, when the almost gave me free reign to roam the grounds!

As an extremely popular tourist destination, with diving as one of its main attractions, I was able to see a number of diving accidents, along with (often diabetic) patients with chronic wounds being treated pre- and post-operatively to aid wound healing. The treatment of infective conditions such as necrotizing fasciitis, osteomyelitis, and gas gangrene may also include hyperbaric oxygen therapy in the decompression chamber. I also witnessed one case of carbon monoxide poisoning treated in the hyperbaric oxygen therapy.

Where did I stay/other students?
Barbados is also an extremely popular elective destination. While there, my accommodation was a fantastic guesthouse which was the temporary home for 8 other medical students from around Europe, and two English students from the Caribbean island of Martinique.

Did I enjoy it all?
In summary, my time in the Caribbean was a fulfilling experience. I learnt about how a different culture works, learnt new skills, refreshed old ones, and enjoyed my way through it. It is definitely an elective I would recommend to others.