Caribbean Reports
Introduction
This section contains elective reports from the Caribbean. Use the menu above to select a particular hospital/region.
Barbados
Queen Elizabeth Hospital, Bridgetown
| Submitted by: | Vim Gokani |
| Date of visit: | Dec 2004 |
Destination contact(email):
>none availableDestination website:
>none available
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.
St Kitts and Nevis
Joseph N France General Hospital, Basseterre
| Submitted by: | Ivie Gbinigie |
| Date of visit: | April - June 2008 |
Destination contact(email):
>none availableDestination website:
>none availableLearning 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.
St Lucia
Victoria Hospital, Castries
| Submitted by: | Helen Davis |
| Date of visit: | Jan 2008 |
Destination contact(email):
>none availableDestination website:
>none availableLearning objectives
• To experience a healthcare system in a different country and the different health problems which arise.
• To experience a new culture.
• To gain more experience working in areas of medicine I enjoy
What I did...
I spent my time doing a mixture of General Medicine, Surgery and Accident and Emergency work, which gave me a very broad experience. Despite being a popular tourist destination, there is a lot of poverty in St Lucia, with many people not able to afford any healthcare at all. It was a great challenge to practise medicine without having access to various treatments and investigations. If a patient cannot afford a CT scan, they cannot have one. While I was there, I heard of several patients who had died of renal failure because they could not afford to have dialysis, there were long waiting lists for blood transfusions, and the antidote to paracetamol overdose was not available on the island. Many patients had the complications of diabetes and hypertension, especially renal failure, because of the lack of preventative medicine, and I saw much more advanced surgical presentations than I had previously seen, as well as presentations unusual in the UK, such as sickle cell disease and gunshot wounds.
