Why did you decide to volunteer with VSO?
I had worked in South Africa a few years before and really enjoyed myself. My fiancé Tash (now my wife) is a paediatrician and we both wanted to work in Africa again. VSO had a good reputation and also NHS placements where couples can go together.
When and where did you go and for how long?
We went to Sierra Leone for a year from August 2010. We were in a hospital in a town called Makeni in the north of the country.
What kind of work were you doing there?
We were working in the hospital. I worked on the medical wards and on the maternity wards. I also helped Tash on the paediatric ward. We did do ward rounds but the main emphasis was to try to train up the local health staff to enable them to provide improved care.
A typical day started at 8am with a clinical meeting, which we instigated, where the cases admitted overnight were discussed. I then did a ward round in the maternity unit followed by ward rounds of the hospital medical wards.
The main emphasis was to encourage the local nurses to use the WHO protocols for common problems. An example would be the identification and management of pre-eclampsia.
After ward rounds I would meet up with the head midwife who ran the antenatal clinic and we would ultrasound scan patients she had identified from this clinic.
Afternoons were more variable. You could find yourself teaching basic drug calculations for the paediatric staff, performing a drug stock audit (which was a quick job as there were not many drugs), or doing some minor surgery or medical procedures. The day could be interrupted at any time with emergency cases, mainly from the maternity wards.
Did you learn any new skills from the experience?
I did learn some new clinical skills such as ultrasonography, and I had to dig out and polish my obstetrics from medical school.
But the main skills I learnt were in diplomacy and management. Trying to institute any change in a country very different from your own is a challenge.
Small victories can be hard won, and often involve persuading someone else that it is their idea.
What did you get out of the experience on a more personal level?
On a personal level it was the first time I had worked medically with my now wife and it was good to get along doing that as well. It was wonderful seeing the small changes you worked so hard for slowly taking place.
It is also a great experience to live in an entirely different culture, to walk along the red dirt road back home from a day at the hospital, soaked with sweat, munching on barbecued maize corn.
Memories that will stay with me are playing football with the local young men on a dirt pitch, Tash and I going for a run in the countryside with local children joining you for every section through the villages, walking to the top of the hills outside Kabala with the hooded vultures soaring all around you and sleeping in hammocks at the beach.
Has the experience made a difference to how you practise as a GP in the UK?
The experience has left me with a different attitude towards clinical governance. I know that many of us don't look forward to our appraisals, but working in a place where professional development support doesn't exist shows why these systems are so important.
Would you recommend volunteer work like this to other GPs?
I would recommend working in Sierra Leone to anyone, as I think that working in different systems enables you to look more analytically at our own. I think that it challenges your patience and perseverance in ways which are eventually useful. It reveals skills that you did not really realise you had.
What advice would you give to GPs considering this work?
My advice would be to go with an organisation such as VSO where preparation is emphasised.
Also be very realistic about what you will achieve. If you are going for one or two years the progress you make anywhere is likely to be limited. The diploma of tropical medicine and hygiene is a good starting level of knowledge, but in the absence of diagnostics or complex medicines it can be redundant.
The best preparation is travel in similar environments, or at least do a few clinics in the local sauna!
For more information about volunteering with VSO and details of current opportunities visit www.vso.org.uk