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At the heart of general practice since 1960

Working in a rural African health centre

Dr Costi Stavrianakis explains what it was like to take three months out of general practice to be a volunteer in Gambia

Dr Costi Stavrianakis explains what it was like to take three months out of general practice to be a volunteer in Gambia

A few years ago I travelled around east Africa and was totally captivated by this amazing continent. So, soon after qualifying as a GP last year, I decided that I wanted to do some voluntary work in Africa. I did locum work for six months around London before my trip and was also able to arrange some locum work for my return at my old training practice.

Previously I had done jobs in A&E, Medicine, Obstetrics and Gynaecology and Paediatrics, which I felt provided me with a broad background of experience. I did not have the Diploma in Tropical Medicine and Hygiene, however I read widely about the subject before my departure.

The voluntary organisation

I organised my trip with Mondo Challenge, a small British non-governmental organisation (NGO) which specialises in sending people of all backgrounds to work as volunteer teachers in schools abroad. It also runs health centres in Nepal and India. The difference from other NGOs such as Medecins Sans Frontieres is that I had far greater flexibility in terms of the timing, length and location of my project, however I did have to pay for the privilege as opposed to receiving a small salary. (see box below) As a qualified GP I was something of a novelty for Mondo Challenge, and I was allocated a placement in Bulok, a village in Gambia, west Africa about two hours inland from the coast.

Living conditions

The first two weeks were spent mainly adjusting to my new living conditions. I lived with the headmistress of the local nursery school and her nine children. Diet was mainly rice or cous-cous with a fish or vegetable sauce, and mangoes. There was no electricity, and drinking water was obtained from a well 1 km away. All houses in the village were made of mud bricks with corrugated metal roofs.

Gambian patients

Gambia is a small mainly Muslim country in west Africa. Several tribal languages are spoken and the official language is English. In the village where I worked the average annual income is £100 per year. The current HIV prevalence is 2%, and malaria is also a major public health issue.
One woman I saw had very high blood pressure but there were no hypertensives to be had, so I gave up a morning to get them from the hospital and made my trip on one of the many Ford vans that double up as buses. These vans are decked out with wooden benches and used by up to 30 passengers at a time.
The usual doctor-patient boundaries are more blurred in Africa. Once people realised who I was and why I was there I found I had a stream of visitors to my accommodation wanting me to look at particular ailments or simply to check their children were looking healthy. Eventually I did have to introduce my own boundaries.

The clinic

I worked at the village health centre most weekday mornings, alongside a locally trained nurse. She also acted as a translator, though by the end of my stay I could obtain a basic history in two tribal languages. There was also a locally trained village birthing assistant who dealt with obstetric matters.

The facilities were very basic. The treatment room had a couch, a table and a chair, and sets of adult and baby scales. The nurse had her own stethoscope. Medicines were very basic, comprising analgesia, antibiotics, malaria treatment in the form of chloroquine and fansidar, iron tablets, mebendazole and multivitamins. I brought out with me a sphygmomanometer, urine pregnancy tests, analgesia and antibiotics.

Presentations


The villagers presented with a variety of symptoms, many of which were familiar from UK general practice. Common symptoms were headache, fever, joint pain, epigastric pain and fatigue. The main issues facing me as a clinician were the differential diagnosis presented by these symptoms and the lack of diagnostic facilities. Conditions such as malnutrition, malaria, TB and HIV often formed part of my differential diagnosis. Where malaria was suspected I urged patients to travel to the nearest hospital one hour away, and more importantly, a 50p bus journey away, to get a blood film done. I tried to limit indiscriminate prescribing of chloroquine and fansidar.

Introducing change

The main changes to medical practice I made were simple ones, as I was conscious that I was only there for three months. I started a system of documentation of patients' height, weight and blood pressure. I also put a system in place where the nurse would take suspected hypertension patients' blood pressure 3 times at weekly intervals and then refer to the local hospital for treatment if necessary.

During my stay I attended the weekly HIV outpatient clinic at the government run hospital in a town called Brikama. I also regularly visited a mission hospital in a town called Sibanor run by the charity WEC International. It proved extremely valuable to be able to discuss cases with experienced colleagues.

Returning home


On my return to the UK I had to do as much adjusting as when I had first arrived in Gambia. It changed the way I thought about everything. Seeing one person driving a new car seemed so alien after witnessing 30 people piling into a single van.
Overall I found the experience of living and working in a close-knit community extremely fulfilling. I had a great sense of having achieved something and improved peoples' lives. I hope to keep in contact with the friends I have made in Gambia, and may return there one day for a further stint as a volunteer doctor.

Dr Costi Stavrianakis is a sessional GP in London

costs and preparation

* Cost of placement is £1,200 for three months, which covers the NGO administration costs
* Flights cost roughly about £300 for fixed return or more if greater flexibility is required
* Need to have valid medical protection organisation membership, can get a discounted rate for voluntary
* Need travel insurance that will cover medical work – I went through BMA - Dr Stavrianakis went through BMA which cost £144 for three months
* Need to register with Gambian Medical and Dental Council , costs £60
* Need to take malaria prophylaxis
* For more information go to www.mondochallenge.org

Dr Stavrianakis in Gambia Dr Stavrianakis in Gambia

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