St Kitts and Nevis

Joseph N France General Hospital, Basseterre

• Destination contact(email): None available
• Destination website: None available

My learning objectives

• To learn more about health care in a poorer setting
• To develop practical clinical skills
• To gain more experience in medicine

Learning more about health care in a poorer setting
St Kitts and Nevis is a developing Caribbean nation. With a population of approximately 42 000 and an area of 261 km2, it is the smallest nation in the Americas. The landscape is dominated by extinct volcanoes, surrounded by rainforest and former sugar plantations. After decades of losses from the sugar-cane industry, tourism is now the main contributor to the country's economy.

I spent eight weeks working in the A&E department of the main hospital on the island. Unlike the well-staffed hospitals we are used to, there was only one doctor working during each shift.

In addition to lack of doctors, lack of resources often posed a difficulty: for weeks, there would be no urine dipsticks, pregnancy tests, specula or otoscopes. I frequently had to make diagnoses based solely on clinical suspicion without basic investigations to back this up. Although routine blood investigations are available, more complex investigations may need to be sent to Martinique for processing and occasionally France.

Money is also a problem for patients. Citizens must pay for private doctors, so everyone comes to A&E for the most trivial complaints because this incurs no consultation fee (though subsequent care must be paid for), often overwhelming the system. Over recent decades, St Kitts has seen an epidemic in obesity, due to an increasingly poor diet and sedentary lifestyle. Hence, it is common to see conditions such as type II diabetes mellitus and hypertension; either de novo presentations or the complications of these conditions. Lack of education means that patients may be non-compliant with their medications. A deep-rooted history of herbalism sometimes leads patients to self-medicate with "bush tea", which may cause more harm.

Developing practical clinical skills
I had the opportunity to perform a number of practical tasks on a daily basis, normally under the supervision of the on-call doctor or a nurse.

I was able to perform venesection, insert IV cannulae, put up fluid drips, perform ECGs, insert urinary catheters and suture lacerations. This was at times challenging, as the procedures and equipment used were almost always different to those which I am used to. However, any technical difficulties were quickly overcome by frequent practice, providing a valuable hands-on experience.

Gaining more experience in medicine
I had numerous valuable opportunities to clerk new patients on my own. I was able to take histories, examine patients, formulate a differential diagnosis and then put together a management plan, which I would help to implement. I saw a huge range of relevant presentations, including limb injuries, chest pain, abdominal pain, ENT and neurological conditions, gynaecological problems, psychiatric conditions and more. As a result of being actively involved in patient care from point of entry to discharge/referral, I feel much more confident about seeing patients and planning patient care.