Work the World

My three week elective with Work the World was quite possibly the best three weeks of my life, both educationally and socially.

The Pokhara house is a hotbed of activity, from breakfast in the morning, to dancing through the monsoon back to the house every night. I'll admit that I was hesitant about living in a shared house, having not done so for nearly ten years, but I really loved the social aspect that it brings to the experience. The house is huge and the rooms are well distributed so while there's always someone to talk to, there's also always somewhere quiet to go read a book.

It's also in a fairly ideal location, just a couple of minutes' walk from where the buses take you to the hospitals, and where the taxis take you wherever you like (after a good haggling session). I spent many an evening down in Lakeside (the nightlife district) sometimes on my own, making use of the free wifi and chatting to the locals, and other times in a herd, dancing the night away. One particularly memorable night involved randomly bumping into Prem, our wonderful Nepali teacher, dancing the Céilidh in the Jazz Bar, helping clear up after a motorbike crash, and running through the monsoon! On top of partying with Dr Janie and Dr Subash every Friday, it certainly made the taxi fare (and associated haggling) worth it!

We didn't need to leave the house to have a great time though, weekly BBQ nights on the roof were legendary, and they led to hours of lively conversation while the moon rose behind the mountains.

But now onto the serious stuff...

With over 700 beds, Manipal teaching hospital in Pokhara is the largest in the region and serves a wide variety of patients. The facilities were basic but better than I had expected. The radiology department had a one slice CT scanner, a 0.35T open MRI scanner, a CR x-ray room, and a CR fluoro room, which wasn't in operation when I visited. There were also two ultrasound rooms, a mammography suite, and the dental department had a CR x-ray unit. Downstairs in the basement was the radiotherapy department, with a linear accelerator and a treatment simulation suite.

The 3 weeks that I spent in the department taught me more about radiography and healthcare in general than I could have imagined, as well as reinforcing ideas and methods which I had already been taught.

In rooms where geckos and cockroaches wander freely, handwashing is a rarely practised procedure. Equipment is rinsed and reused, and surfaces such as the examination tables will still have fluids from the previous patients on them when the next patient is laying there. As you can imagine, infection is a very real risk to patients and the stories of antibiotic use are worrying.

Patient confidentiality and radiation protection are two concepts which are neither acknowledged nor adhered to in the x-ray department, but after a conversation with the medical physicist it appeared that this was an endemic problem caused by poor training and low salaries.

But aside from the depressing and unpleasant aspects, I saw some of the best examples of patient care during my placement. The staff I worked with, especially the CT tech, Shashi, were incredibly knowledgeable and I learnt so much watching him work. The radiologists were more than happy to show me interesting cases, including some which were in the process of being submitted to academic journals.

The breast screening program is gaining popularity, and every woman who has a mammogram will also have a follow up ultrasound of both breasts whether or not a malignancy is suspected. These scans will then be reported by two radiologists and the results will be provided the same day.

Unlike the long MRI waiting lists in the UK, a patient arriving with an MRI referral will usually be scanned the same day and it's the same for CT. Reports are produced immediately, usually with the input of all the radiologists in the room, meaning that treatment can be started straight away. This is absolutely imperative, as patients here don't tend to present with mild symptoms, and usually diseases won't be diagnosed until they are chronic and advanced. Tumours will be life threatening, and neurological conditions such as neuro-cysticercosis will be well beyond the treatable stages. Patients can be reluctant to go to hospital, partly because it can be expensive just to get there (ambulances are virtually non-existent) but also because it will mean having to stop work, which could result in catastrophic loss of income. There is also likely to be an inherent fear of the unknown, as they may not wish to be treated using methods they do not understand. In spite of this however, the patients I met were all friendly, especially the children, who were eager to have a conversation using basic Nepali, English and drawings! They were also, equally, some of the bravest people I have ever been around, undergoing painful and invasive procedures through gritted teeth. My elective in Nepal was hugely beneficial to me; it's a beautiful country with so much to offer, from the world's highest canyon swing, to stunning jungles, to raging white water rapids, and with breathtaking mountains everywhere you look.

I miss those mountains.

Reaching the airport in Dar I had mixed feelings. Firstly, I was relieved. Having never travelled or flown on my own before, just reaching Dar was an achievement for me. I was also very excited and nervous at the same time. I was lucky to have met a couple of other of girls in the airport that were also heading to Dar with Work the World so together we met a smiling Alpha and Mark who took us straight back to the house.

The house was better than I could have imagined. The pool was definitely a huge bonus! All the staff team was really friendly, helpful and was always there if I needed anything. The food was delicious and I thought Rehema did an amazing job to caterer for everyone; there was always something for everyone no matter what you liked.  Being on my own, I was initially very nervous to meet my other housemates but we all went out for a meal to get to know each other on the first night, we got on really well and I have come home with some amazing friends.

I worked in the district government hospital in Dar es Salaam for 3 weeks. With it being a smaller hospital, I was given a lot of hands on experience that I feel I wouldn't have got if I had gone to the larger teaching hospital. The radiography department consisted of a busy ultrasound room and an even busier general room, though it was probably the only department within the hospital with air conditioning which was a bonus!  I spent most of my first week in the ultrasound department as this was where the radiologist that was my mentor spent the majority of his time. The equipment was fairly modern and similar to the UK, however having not spent a great deal of time in ultrasound as a student and having no hands-on experience, I expected to be taking an observational role.  However, after a couple of days I found myself carrying out a number of scans under the supervision of the radiologist, which was extremely exciting.  I found it really interesting to see what kinds of scans were common in Tanzania compared to that of the UK. Also of interest, what the staff actually looked for in these scans. The majority were pregnancy scans as well as a few abdomens and the odd cardiac scan. What was intriguing was that the antenatal scans were not the typical 12 and 20 weeks scans, but could be as late as 38 weeks!

The rest of the time I spent in the general room which is where my interest lies and was a bit of a blast from the past for me. The equipment was very basic and included a wall suspended tube and film radiography, which I had expected but had never worked with before. Working in the dark room and processing the films was all very new to me.  It was an experience that I wouldn't have much chance of having in the UK and one that definitely makes you appreciate the efficiency of CR and DR equipment. The positioning of patients was similar to the UK; however with the patients paying for the x-rays it was crucial to get it right first time. Radiation protection was scarce. There was a lead equivalent screen for staff, however other patients were often left in the room without protection whilst x-rays were taken. 

I was able to undertake a number of x-rays often unassisted. The language was a bit of a barrier as the majority of patients spoke little if any English, but I managed to learn some basic Swahili and found that learning commonly used words such as 'breathe in' and 'stop breathing' was very helpful. The rest consisted of sign language and just placing the patients into position but I found this worked fairly well and the supervising radiographer Neama was never far away if I was struggling.

As I expected there were some things that were upsetting to witness but I found that going home and talking to the other people at the house about what had happened was a big help.  It was also really interesting to hear all of their stories and we spent a lot of time sharing our stories at the end of a busy day. It was also nice after finishing at the hospital to come home and chill by the pool.  The weekly Swahili lessons were always fun and very useful and we always found plenty to do on evenings even if it was just chatting or playing games after dinner. Of course, there was the Thursday night BBQ's to look forward too were the partying always continued into the early hours!

In my third week I went on the village experience, where I went to live with Mr Juma who lived in the village with his family. The village itself was beautiful and Zanzibar was a stunning island. It was a privilege to live with Mr Juma for the week; his family was very friendly and always made me feel welcome. He had two beautiful children who always kept me entertained. The hospital was only very small but extremely friendly, with very welcoming staff. The Radiography department was only very small with only about 15 patients a day therefore I didn't spend much time there which was good as it allowed me to view other parts of the hospital. I spent a day in theatre which was really enjoyable and a day in outpatients. It was really interesting to see what kinds of illness and symptoms the patients presented with and what treatments they received. The rest of my time was spent in maternity, which was definitely one of the highlights of my week, not only was I allowed to watch, but also to participate in a number of deliveries. As a radiographer this gave me the chance to do something that I would never be allowed to do in England and was a fantastic opportunity that I will never forget! The activities throughout the week were really fun, the highlight being attending a turtle sanctuary were I fed and held a range of turtles from 10 years old to 3 days old that had just been rescued from the beach. Alli, our local guide was just brilliant. I thought going on my own would be a bit daunting and lonely but he always ensured that I felt comfortable and was enjoying myself.  To top off the week instead of going back to Dar on the Saturday I went to one of the local hotels - Kendwa Rocks - for a Full Moon party on the beach. I was joined by everyone from the Work the World house and we all had a night to remember. It was a fantastic way to end an amazing week! We were never bored on a weekend as there were so many things to do to keep us entertained. We visited a secluded island called Bongoyo Island, travelled to one of the hotels beautiful beaches, spent a weekend in Zanzibar and of course chilled by the pool back at the house! There were lots of lovely restaurants to eat in nearby that were all pretty cheap and our Saturday nights were often spent in the local night club Maisha. Of course, a two day Safari at Mikumi National Park in an incredible experience not to be missed. 

All in all it was an incredible month. I did some fantastic things both within and outside of the hospital. It is something that I feel will definitely help me in my future career as a radiographer. I made some amazing friends and had an experience I will always remember and cherish.

Whilst researching global health and the quality imaging services available to those living in the developing world, it didn't take long for Jonathan to discover that two-thirds of the worlds population (approximately 4 billion people), have limited to no access to even the most basic of imaging exams. In order to learn more about this and aid in the issue of correcting it, Jonathan realized he would have to get some first hand experience.

As a radiologic technologist with over six years experience within the radiology profession, I have always enjoyed the comfort of job security. According to the World Health Organization, approximately 60% o the reasons that a patient seeks medical attention subsequently require some form of medical imaging in order to obtain a diagnosis for their ailment. Whether an ultrasound, CT/MR scan, or radiotherapy treatment is needed, there is an equal need for a medical professional who is trained in the art of medical imaging. Furthermore, more often than not, we RT's are provided with state of the art equipment that enables us to produce high quality images with relative ease. Perhaps the above statistic is also the reason why most of us living in the industrialized world can drive just about any direction for a handful of miles and be certain that we will have access to these necessary health-related services... It was this line of thinking that led me to question whether the abundant access to quality imaging services was a typical occurrence for the global community, or perhaps, and more likely the case, a unique perk to those of us living within the industrialized world. Well it didn't take too much searching to find another statistic credited to the WHO indicating that two-thirds of the world's population (approximately 4 billion people), have limited to no access to even the most basic of imaging exams. Although I was not entirely surprised by this finding, I could not help but wonder how it was that such a drastic global imaging gap could exist? Were there any non-profit organizations working towards correcting this massive imbalance? And on a more personal level, how could I learn more about this issue and aid in correcting it?

After contacting a few organizations (RAD-AID, WHITIA, Imaging the World) I was able to get a better sense of the hurdles that were associated with bringing radiology services to medically underserved communities. I learned of issues related to focused need, facility infrastructure, project funding, personnel training, governmental stability, etc, etc, etc. In fact, the more I learned about what was needed to develop a self-sustainable medical imaging program, the more amazed I was at the advanced health care network that had been developed within the industrialized world. More importantly, I made two important realizations... First, if I truly wanted to help, I had to do my part to raise awareness of the access to imaging issue by colleagues and peers on a local level. Just as I had taken for granted the ease in which I could have an injured hand or a prolonged cough assessed with the aid of medical imaging, the case was no different for the other RT's I worked with on a daily basis.

Secondly, if my goal was to recruit others to spread the word, I was going to need to need more than two WHO stats of interest to share. I was going to need some firsthand experience observing routine radiology exams within a medically underserved community and personal stories/photographs to help put the problem into perspective. Needless to say, fiscally conservative non-profits were unable to offer such an experience, saving their limited resources to make a larger impact than I could as an individual. This is when I turned to Work the World to help me coordinate my radiology experience abroad.

In only a month of initial contact with the company, I found myself starting a 7,650 mile trip to the Asian country of Nepal. Literally traveling to the other side of the world, it took three flights and a 7 hour taxi ride to complete my 38 hour trip to the city of Pokhara. Fortunately, a company liaison on-site guided me every step of the way, providing travel advice, connecting me with a hospital-based radiology department, as well as hosting me, along with other visiting medical professionals, in a community-style residence for the entirety of my two week visit.

Immediately upon arriving to the hospital in which I was assigned I could see the stark differences between the radiology work environment in which I was accustomed and the Nepali imaging department I was observing in. Placed in a privately run medical complex that was considered to be the best of the three hospitals that served the region surrounding Pokhara, a city of over 200,000 people, I was made aware that the government run facilities offered even fewer imaging services.

Although pleased to see that the hospital managed to offer magnetic resonance imaging, computed tomography, ultrasound and radiotherapy services, I soon realized that the equipment being used was far from anything I would expect to see back-home in the states. Especially considering that the hospital was a primary healthcare resource for a large region of the country. The MR system consisted of a 0.35 Tesla magnet and was one of only two in the entire region. The CT scanner was a single-slice model and did not have an automated power injector for contrast bolus studies. Although their single ultrasound unit was in good working order, the room with fluoroscopic capabilities was out of order, requiring esophogram exams to be performed using a blinded 'swallow and shoot' method. Lastly, the linear accelerator used for radiation therapy treatments was run by a single therapist, and needed necessary, though costly advanced calibration tools to ensure greater treatment accuracy.

Equipment limitations aside, I also had a chance to experience several other challenges that I was warned was to be expected when practicing radiology in a developing nation. 'Load shedding', or sharing of electricity, was a routine occurrence in which there wasn't enough power for the entire country so energy had to be distributed regionally on what seemed to be a random basis. Hospitals were left to rely on generators for as many as 14 hours a day, consequently forcing the medical facilities to conserve their energy usage with dimly lit hallways, an absence of air conditioning, and further parsing of energy to departments with the greatest need. I was even told that radiology departments in the public medical facilities would be forced to temporarily discontinue specific exams so that in-patients' heart monitors or ventilating devices could remain powered.

Further complicating matters is the lack of local technical support for radiology departments in the developing world. In the industrialized West, when an imaging system goes down, the RT on duty typically contacts the local service engineer. We are accustomed to a service professional being on site the next day, often with part in hand; this is not the case for the few radiology departments scattered throughout Nepal.

For this reason, equipment maintenance is a key responsibility of Nepali radiologic technologists. For example, there is a constant concern for limiting tube loads to ensure an extended lifespan for the x-ray generating devices. Any equipment malfunction might lead to weeks of department downtime, and a further delay in much needed medical imaging services. On a personal level, it was humbling to see the level of respect and careful handling that technologists exhibited for equipment that holds a relatively low market value in the West.

Besides the differences in equipment and work environment, I also saw different types of cases than those that I am used to. These differences may be partially attributed to the inefficiencies of a relatively unstable government as well as the native culture of the local people.

First, approximately half of the patients that were sent to the radiology department had histories of traumatic injury, most often from motor vehicle accidents. With no apparent enforcement of traffic laws, the streets of Pokhara were packed with cars, scooters, bicycles, feral dogs and free roaming cows that made transportation a leading cause of hospital visits.

Secondly, of those seen for reasons other than trauma, it was rare that imaging did not present some form of gross pathology, indicating chronic conditions that had long gone undiagnosed. For a combination of reasons, including the default to home-based remedies for acute onset of symptoms, living in villages hours away from the closest hospital and a simple lack of financial means to pay forý medical costs, the patients that did finally show up for medical care were almost always too sick to be treated.

Overall, my radiology experience in Nepal provided me with the experience that I needed, and quite a bit more than I expected. Perhaps the most motivating aspect, however, was when I learned of efforts taken by a Nepali radiologist who brought an ultrasound machine to the outlying villages surrounding Pokhara in an attempt to encourage early disease detection. It was clear that without adequate funding, his good intentions were relatively futile in the grander scheme of things. However, perhaps if like-minded radiology professionals on a global level were to combine their efforts with a little guidance from established international non-profit organizations, I am confident that we could work together to produce a sustainable and meaningful answer to the global imaging gap.

With a love of all things outdoorsy, Richard decided to head out to Nepal and take advantage of the glorious Himalayan Mountains as well as gain some incredible hands-on experience with the Dental Outreach Project in Birethanti.

Soaring, not so smoothly, over the Himalayas in a Yeti Airlines propeller plane, my first experience of Nepal was an awestruck one. The mountain backdrop out of the window was significantly more impressive than anything the Lake District has to offer. Yet, Henry in the adjacent seat, head in hands, seemed more concerned with the plane staying in the air and avoiding, in his mind, a near certain death.

We arrived in Pokhara airport slightly relieved but excited about the weeks to come. After picking up our bags and receiving a friendly welcome from the Work the World project leader Sunil, we set off to meet the rest of the students on our Dental Outreach Project. After one train, three flights and about two hours sleep in as many days we were less than looking forward to the two hour mini-bus journey and subsequent trek to the village of Birethanti. However, upon meeting the people we were to spend the next fortnight with, the cheerful, exciting atmosphere soon cured our tiredness. Once the road became too rough for the minibus to pass over, we continued on foot along the valley floor, using rope bridges to cross ferocious rivers, feeling a little bit like walking an Indiana Jones set.

Upon arriving in Birethanti, we received a flamboyant and slightly unexpected greeting from the mothers of the village. With flower garlands placed around our necks and 'tikas' marked on our foreheads, any fear of an awkward reception off the villagers soon passed. We finally settled in Green View Guesthouse, a small family run establishment in an amazing setting overlooking a Himalayan river, complete with waterfalls and rapids. After an extremely welcome meal and an introductory talk off the Work the World team leaders Durapata and Bom we headed up to the school classrooms from which we would conduct our dental treatment over the following days. Here we were immediately confused by the jumble of temporary dental chairs, air compressors, an electric generator and other equipment. However, upon the arrival of Sunil and our dental supervisor, Dr Anil, things were soon organised to a level where we could commence treatment the following day.

In the fortnight to come, an attitude of work hard, play hard was adopted by all. We would head up to the school every morning at around 8:30 where we would set up for the day to come. Work the World had done a good job of spreading the news of our presence and thus, a lack of patients was never a problem. In a make-shift marquee outside, patients waited to be first screened in one classroom and then, if required, treated in the one next door. In my opinion, things ran extremely smoothly considering the complexity of the operation and limited supplies and equipment when compared to hospital dentistry. Treatment included simple scaling, conservation and simple exodontia. Everyone became extremely proficient at extractions over the two weeks, tackling often difficult retained roots and badly broken down teeth. This was aided by the expertise of Dr. Anil, who never failed to remove buried roots when our experience reached its limits, despite the extremely limited supplies of surgical equipment.

One thing that can be said for the outreach project is that it is just that! The difference from 'western' dentistry and health care attitudes was huge. Levels of cross-infection control that are expected in hospital environments simply cannot be maintained in a temporary clinic miles away from the nearest large town. It was often necessary to overlook poor levels of cleanliness and lack of sterilised equipment and concentrate on the good we were doing in providing dentistry to those who had often never seen a dentist before. Often patients had been suffering with recurrent pain and inflammation for a number of years before we were finally able to remove the source of infection. Overall, our work was greatly appreciated with patients often walking for a number of hours to receive treatment. Excellent support was provided by a few locals acting as translators whose help and friendship helped make the project so enjoyable.

Once our work was done the evenings allowed us to relax and enjoy ourselves in the amazing setting that none of us had ever experienced before. Early evenings consisted of trekking the various paths in the valleys around the village and swimming in the less than peaceful rivers with the translators' local knowledge assisting us in not being swept down stream, probably all the way to India. One memorable activity consisted of planting rice on a mountain side paddy field. This soon turned into a half hour mud fight in which no-one was left who wasn't absolutely caked, head to toe, in the contents of the field. However, a convenient 20m waterfall around the corner provided an excellent, if not slightly violent, shower in which we could wash off. When darkness set in we would head back to the guesthouse for a well earned evening meal, which gave us an excellent opportunity to experience the local cuisine. Nepali beer and local wine often accompanied Durapata's 'sharing time' in which an enjoyable time was spent sharing our experiences from the day. Following this, the evenings turned to socialising, joining in with the locals dancing to Nepalese music and at least one extremely competitive game of monopoly.

Half way through the project we returned to Pokhara to enjoy a well earned weekend relaxing and exploring the various restaurants, bars and clubs the city had to offer. Unfortunately, however, the local police failed to enjoy group singing at 1a.m. quite as much as us. Upon returning to Birethanti we continued the project focusing more on treatment over screening in order to get through the vast amounts of patients already seen. The rotations were changed to include extractions being carried out on normal plastic chairs, reserving the temporary dental chairs for restorative treatments. Despite frequent power cuts and a continual flow of new patients by the end of the week I believe we had managed to see all the patients that required treatment.

On the final night in Birethanti almost the entire village turned up to our guest house for a farewell party making us feel greatly appreciated for our hard work. This included thank you speeches from the local villagers, the Work the World staff and ourselves, as well as being dragged up to dance with the locals and then us dragging the locals up to dance with us by the end. A great time was had by all with the party continuing till the early hours of the morning. The next day we awoke to a few more hours of treatment followed by packing up the clinics and an extremely emotional farewell with the friends we had made in the village. Back in Pokhara we had a final night out with our fellow students, some of the translators who had journeyed from the village with us and a few other students on Work the World projects based in Pokhara. The following day everyone was extremely sad to be saying goodbyes but looking forward to a variety of subsequent trips including Vietnam, Bali and India.

Henry and I had decided to stay in Nepal for the following 3 weeks and although very different to the dental outreach project the time had was equally enjoyable. One highlight included a 6 day round trek to Annapurna Base camp where there were breathtaking views of the Himalayan peaks. On the way back down we passed through Birethanti again and were amazed and glad to see a few of the village children wearing our Work the World t-shirts that we had left in the guest house. It was amazing to catch up again with the friends we had made in the village and some of the patients we had treated.

Following the trekking we did a three day safari in Chitwan National Park enjoying riding on elephants through the jungle and navigating crocodile infested rivers in a dug out canoe. We visited bat caves, hired boats on Lake Phewa and trekked to the World Peace Pagoda on top of a hill overlooking the city of Pokhara. In order to see fellow students from Newcastle University and the Work the World staff associated with our project we decided to visit another dental outreach project, based on a hillside on the side of a large lake. This beautiful scenic setting, well away from any towns provided an excellent relaxing retreat before heading back to the bustling city of Kathmandu.

In Kathmandu, Bom, who had been one of the two Work the World staff staying with us on our guesthouse, got in contact with us and told us he was in the area. With him as our guide and friend we were able to explore the side streets, markets, temples and national parks of the Kathmandu valley much easier than if left on our own. Kathmandu itself is an extremely busy, noisy and polluted city, however, there are many impressive sights to be seen and a short stay here should not be avoided when visiting Nepal. After saying our emotional goodbyes to Bom we set off home having had a hugely enjoyable and once in a lifetime experience in Nepal.

I would thoroughly recommend Nepal to anyone. The Himalayan scenery is second to none, the people are some of the friendliest and welcoming I have come across anywhere and with so many things to do and places to explore I could easily have stayed there for numerous extra months and will be going back in the future. The Dental Outreach Project ran by Work the World was an excellent opportunity to see dentistry in an often shockingly different environment, whilst helping people whose access to dental care would usually be very limited. Work the World took all the trouble out of organising something that would have been next to impossible to sort out on our own and provided me with an experience I will always look back upon with fond memories.

My trip to Sri Lanka started with mixed emotions. It began with a nervous, tiring flight on my own but then as soon as I arrived at the airport and was picked up by Kavinda the organiser, I felt very much at ease and a large weight had been lifted off my shoulders as the hardest part was over. He made me feel very welcome and explained everything that would be happening over the next few days.

The journey to the house was very scenic and once I arrived I met all the other students who were all lovely. They were very valuable to speak to about their experiences and places to see. The house was always so clean, my room was very spacious, the views from the balcony were picturesque and sometimes we could even see cute monkeys playing around in the garden! The chef cooked delicious meals and some evenings after a tiring day at the Hospital we would play fun monopoly and card games.

The placement at Kandy General Hospital was quite different to UK standards - especially with cross-infection! I was shocked at the fact that they re-use gloves after certain procedures! I spent most of my 4 weeks in main OPD clinic and working alongside another dentist, after gaining good rapport, I was able to undertake plenty of hands-on work giving local anaesthetic, undertaking temporary GIC and amalgam fillings, extractions and scale and polishes. All the dentists and nurses were very friendly and most were able to speak English so communication was not a barrier.

I spent a day on the orthodontic clinic and gained experience on the different types of malocclusions and how to treat them. I also spent some time observing maxillofacial surgery which was fascinating. The dentists also taught me a few key words in the local Sinhalese language such as 'open mouth' and 'close mouth' so I could communicate with the patients more effectively and when I used the words they became quite impressed!

The dental elective really opened my eyes to poverty and made me realise and appreciate how lucky we really are to have so much more advanced equipment and medication compared to less developed countries.

In our free afternoons we sometimes headed into town to experience some of the local culture. A fun part of any journey was riding a TukTuk 3-wheeler - being in the Hill Country with windy roads it was quite entertaining and feeling a nice breeze in the hot weather is well worth the rides! The local people are all very friendly and always happy to help! The local fruit is very tasty and Sri Lankan dishes were also quite stimulating on the taste buds! There were plenty of opportunities for sight-seeing in the afternoons - A trip to the Elephant Orphanage and beautiful Botanical Gardens are a must!

During my time I was lucky enough to see the Perhara festival - a bright colourful parade of locals dancing and elephants dressed up in stunning textiles! Visiting the stunning Temple of Tooth is a significant appreciation of Buddhism!

On weekends we planned trips together to travel further towards the different coastal areas. The beaches in Unawatuna and Trincomalee were like true paradise and I did not want to leave! I also had such an exciting time learning how to surf in Arugam Bay!

When I was in Newcastle airport early on a Sunday morning I was wondering if I'd made the right decision when I decided to spend my elective in Tanzania, when I was waiting to board my second flight in Amsterdam the nerves were fading and by the time I'd landed at Kilimanjaro airport in Tanzania the nerves had been replaced by excitement!

Early the next morning I took a short internal flight to Mwanza, the scenery was amazing and the views of Kilimanjaro from the plane were breath taking and given that the summit was higher than the aeroplane I was glad that I'd decided not to climb Kilimanjaro, as Lake Victoria and the rock city came into view I couldn't wait to get on the ground and start exploring.

Mwanza airport was very small and missing a few of the fixtures and fittings we're accustomed to in Europe, one being the absence of the luggage carousel but the airport staff were very efficient and I was quickly reunited with my bags. As I made my way towards the exit I received a very warm welcome from James, it was nice to see a friendly face, on the journey back to the Work the World House James got me up to speed with local information. Although I'd seen pictures of the Work the World House I was amazed when we arrived, the house was really nice and the views from the house of Mwanza and Lake Victoria were amazing. I was greeted by the other people living in the house, they were all very friendly and welcoming and understood that it took a few days to learn everyone's name, the other elective students were great sources of information which made adapting to life in Mwanza a lot easier.

My first day in Bugando was an experience, it was very different to any hospital in the UK, the dental department was quite small, three dentists work in the department, two nurses and one technician although the lad hasn't been completed for the technician to date. All the staff were very friendly and although I had a few Swahili lesson in the Work the World house the staff could speak English so communication wasn't a problem, the Dentist's were very keen to learn how we treat patients in the UK and what my opinion was on their treatment plans. I was given the opportunity to be as involved as I wanted to be in the treatment of patients, I provided some routine restorations and extracted some teeth, numerous patients presented with mandibular fractures on a daily basis, I was inexperienced in treating mandibular fractures, I did not feel pressured to treat these patients, I was allowed to observe the treatment of these cases, it was interesting to compare how they were treated in Mwanza in comparison to Newcastle.

Although there were difficult days in the hospital there were many positive days where I felt I made a real difference, within the Work the World house there was a great support network, there were always people there to listen and offer advice when you had a difficult and day and equally there were people to share the success stories with. I had a fantastic time living in the house, some of my most treasured memories are from the barbeque nights, this was the one time in the week when we all had dinner with the staff, as well as preparing wonderful food Diana would demonstrated some traditional tribal dancing, all of the staff in the Work the World house were very kind and friendly and they made my stay in Mwanza very enjoyable.

As well as the dentistry I had time to have some fun in Tanzania, I went on safari one weekend with some other people from the work the world house, it was an amazing experience. We also spent some time at a local orphanage which was very rewarding and I'd strongly recommend spending some time in the orphanage while you are in Mwanza. After my elective I spent a week in Zanzibar which was wonderful. My time in Tanzania was wonderful, I encountered some fantastic people and I would return to Mwanza tomorrow if it was possible (but I'm stuck in Newcastle as I've got finals to prepare for!) My elective was an experience that I'll never forget.

As a newly-qualified midwife just a few weeks out of training, I was very nervous about coming out for a professional placement and truly did not know what to expect. Despite the fact that I had always planned on experiencing a developing country early on in my career, I had not had the time to plan an elective placement during my degree. Work The World were incredibly helpful and understanding in assisting me to find a placement that was right for me.

I arrived in Mwanza hot, tired and apprehensive, but James's friendly nature soon put me at ease. I was introduced to the housemates and given a tour; it was very reassuring to have staff and housemates present who welcomed me and gave me a good idea of what to expect of general life here. The view of the lake was simply stunning, and sunrises and sunsets were really something to behold in Mwanza, especially on the lake shore.

The following day I was shown around the hospital, the maternity department and introduced to some of the staff. I would be based mainly on the labour ward for the duration of my 4-week placement, although I also spent time on the antenatal, postnatal and admission areas.  

Bugando is quite a large hospital, and the labour ward was bigger than I expected, and almost always buzzing with activity. During my first week I played a largely observational role. The staff are used to medical students observing but the concept of midwifery was a little unusual to them; most deliveries were conducted by nurses or doctors.

I was able to be more hands-on as I progressed through the placement however, and was involved in many interesting cases, including malaria and tuberculosis in pregnancy, twin births, breech births and numerous emergency situations such as shoulder dystocia and neonatal resuscitation.

It was fascinating to see the differences in healthcare approaches, but also shocking and upsetting at times because I knew how differently events would be managed at home. I initially found this difficult, but I had to keep reminding myself that I was there to experience a different environment. 

Being around the housemates and knowing that they were also struggling with similar issues was a great help. Discussion of cases was a very valuable aspect to the whole experience and made the difficult days a little easier to cope with. The social side was a fantastic part of my time in Tanzania; we took a trip to one of the islands in the lake, experienced many local restaurants, explored the city, had a painting lesson and frequented some local bars and hotels on days off.  

I also managed to spend a weekend in the Serengeti on safari, which was a truly incredible experience. I really recommend it and if you can get a group of people together it's very do-able on a budget. It's also very accessible from Mwanza and is only a two hour drive away; there are companies in the city who take groups of tourists out and there are contact details for the more reputable organisations at the house.    After the placement I also spent some time in Zanzibar, which, although beautiful, was a true tourist destination and therefore could be very pricey. However, if done in the right way it can be budget friendly, and the tropical island is unforgettable.

For those considering a midwifery placement; I would say try and prepare as best as you can. Obstetric emergencies are common place and whilst you may not always be expected to be involved; sometimes you are the only spare pair of hands. The risk of HIV exposure is also very real here; nearly every woman was positive for the virus and the bodily fluid exposure during birth can be very great! I recommend acquiring a post-exposure prophylaxis (PEP) pack before coming out and ensuring you bring your own personal protective equipment such as eye goggles and gloves.

The most important thing to remember is This Is Africa. The level of education, training and equipment is not the same as the UK; and as such the practices can sometimes be very questionable. One of the things I found most difficult to deal with was the attitude to care from the staff, which was very different from our woman-centred approach at home. Women were shouted at, hit on occasion and only allowed to labour on their sides and give birth on their backs, no matter what their discomfort levels were. Although this seemingly uncompassionate approach was, at times, shocking, it's important to realise that the level of value placed upon patient care and upon the birth of a new baby differs from what we are used to in the Western world, possibly because of the significantly higher perinatal mortality rates.

Overall my time in Mwanza was very valuable and truly life-enriching. The hands-on care I experienced helped me develop my confidence in my own midwifery skills; and presented some interesting alternatives when the medical equipment we would have at home isn't always to hand! I made some wonderful friends and learnt about other professions too; there was a great mix of medical students, physiotherapists and nurses who bought many alternative perspectives to different situations. I feel privileged to have been able to live and work in this interesting and vibrant part of the world.

As a midwifery student we appear to be in the minority when it comes to going abroad for elective placements. As we are only allocated 3 weeks including travel time the majority of students will opt to stay on their current placement or travel elsewhere in the UK. However, my friend and I decided to go abroad as we knew this would be an amazing opportunity!

We chose Work the World as we felt we would benefit from some assistance in organising our placement, after looking through the website and discussing the various destinations available we chose Nepal!

After months of planning the day finally came for us to go. We landed in Kathmandu on a Saturday afternoon which is the day of rest in Nepal so it was quieter than usual (which we found hard to believe!) After negotiating our way around the airport and various porters trying to help us with our bags we finally made it out into the heat! We stayed one night in Kathmandu which was definitely an experience, it would have been nice to have spent a couple of days there to fully experience the city but the next morning we caught our flight to Pokhara.

On landing in Pokhara the temperature was noticeably higher than Kathmandu but the whole place was definitely more laid back which was nice. We were met by Sunil who was really welcoming and it was lovely to have someone to take us to the house as we were a bit overwhelmed by everything!

The house is lovely, light and clean. The weekly BBQs on the rooftop are fantastic and sitting up there at night is a must. Krishna is an amazing cook and we were well fed every breakfast and dinner! There's always food in the kitchen if you want to make lunch or fancy a snack, and if you fancy eating out there are loads of restaurants and cafes on Lakeside (moondance and olive cafe are personal favourites!) Sunil is always on hand to ask questions and our briefing session and local orientation were really useful. But the best part was definitely living with all the other students. It was great having so many people around to chat with who are going through the same experience as you. We had plenty of nights out at busy bees and I've definitely made some lifelong friends.

Our first day at the hospital was a real eye opener. Sunil took us on the local bus which only costs about 10p, and it was great travelling to work with all the locals. Then we arrived at Gandaki (Western Regional) Hospital to start our placement in Obs and Gynae. It was incredibly hot (especially when you're wearing your white coat!) and ward rounds are long so make sure you take water with you. We were introduced to the head of department and the sister in charge who told us to follow the ward round. This was difficult to watch at times as the lack of time and resources mean the staff cannot always provide the level of care they would like to. However the main struggle for us was observing the lack of privacy, dignity and consent, as this is something that has been drilled into us from day one of our training. There are no sheets over the women or curtains round the beds and watching procedures such as VEs and ARMs being performed in these conditions was quite shocking. However, after we settled in we came to realise that we cannot compare their care system with ours and once we had come to terms with that our experience became much easier to undertake. Our language lessons with Prem were invaluable - as soon as we started dropping Nepali words into conversations with staff members they opened up and were much more chatty and involved us even more. The sister in charge was lovely and always able to answer our questions. They undertake 12000 deliveries per year (pretty much double what we do at our hospital at home) and these are all undertaken on 3 delivery beds in one delivery room, so you'll definitely get the chance to witness some babies being born! The more you show interest and speak to the staff the more you'll be allowed to get involved. Try and go to the twice weekly antenatal clinic where they see around 400 women. Also try and get to theatre to watch some elective caesareans which are also done twice a week; they perform a lot of classical caesareans which are interesting to see.

If you have the time it's worth trying to spend some time at Manipal Hospital to see the difference between government and private healthcare. Really, your time in Nepal will be what you make of it and the more you put in the more you'll take away.

In our spare time there was plenty to do; Lakeside is great for shopping and booking activities, or having lunch. You can hire rowing boats on the lake which was lovely for an afternoon. The Tibetan refugee settlement is great for buying jewellery and honing your haggling skills! We also trekked up to the peace pagoda which was a long walk but totally worth it when you see the view (make sure you take lots of sun cream though!) We also went paragliding which was incredible, we were both really nervous before taking off but it was absolutely amazing and definitely worth doing! There is a local orphanage which always welcomes visitors. We spent two afternoons there and took along balloons and little toys and sweets which the children loved. It was a really worthwhile experience and really fun singing and dancing with them.

Overall our trip to Nepal was amazing and something I'll never forget. Our time in the hospital has opened my eyes to how lucky we are in the UK to have so many resources, and has made me rediscover just how amazing women are to be able to give birth! I've been really lucky to make some amazing friends, and have some incredible experiences both at placement and in my time off. Work the world were really supportive and always at the end of the phone to answer any queries. Staying in the house was fantastic and made the trip even better - I just wish my time there had been longer!

I have to say from the start it was the best choice I have ever made. I travelled alone and felt very nervous but as soon as I arrived at Accra airport I was welcomed by Prince and Alhassan, who are part of the work the world team. I arrived in the evening and Alhassan accompanied me in a taxi to a local guest house.

When waking in the morning I was still shocked that I was actually in Ghana, in Africa and believe me you have to keep pinching yourself though out your stay... well I did!  We travelled the 4 hours to Takoradi on the VIP bus and arrived at the house around lunch time. I was given a tour and had chance to meet some of the housemates, it was a Sunday afternoon so most were away travelling. 

I started work on the Monday morning at the local private maternity clinic, which is only 5 minutes away in a taxi from the house. All the staff in the clinic were fantastic and very welcoming. They are always interested in you and why you wanted to come to Ghana. I felt valued, welcomed but scared and nervous about what I may experience.  The midwife I was due to spend most of my time with was very special; I find it difficult to put it into words. I will always remember her and I feel her kindness and passion to be a midwife and do all she could for every woman she saw will stay with me forever. I worked at the clinic for my full three weeks, Monday to Friday, mainly from morning to afternoon. They were flexible and you could do whatever shifts suited you. The clinic is mainly for maternity; however it does have a general clinic as well. There is an antenatal clinic, labour ward with birthing room, postnatal ward and a theatre which also has a pre and post-operative ward. I also had the opportunity to observe the Obstetrician while carrying out ultrasound scans which was interesting and well worth doing.

Every evening during the week Ophelia (the master chef of Takoradi) will cook your evening meals.. these are fantastic and you should try everything once! The house I stayed in was great. I lived with about 16 people but the house can hold more. Your housemates are key to your time away, they are the people that understand what you are experiencing and how you feel and if you are finding it hard they are the ones that will get you through.

The work the world team or should I say your extended Ghana family are amazing people who are always there for you at any time of any day. They make you feel welcome, safe and immediately part of the family. Joe, Prince, Alhassan, and Ophelia will help you and ensure your stay in Ghana is enjoyed and runs smoothly. They will always entertain you, especially on a Thursday night, BBQ night!!

You will work hard through the week so why not enjoy yourself at the weekend and see some fantastic parts of Ghana? I went to the Wli waterfalls which was hard work but absolutely worth it. I also did the Kakum treetop canopy walk and stayed in a tree house in the jungle, which was equally amazing! There is so much more to do so use all the spare time you have.

After my shifts at the clinic I would generally come home and have lunch with the others and usually we would go to Africa beach to chill out on the sand or maybe do a little shopping in market circle or harbour view. There is a man in a hut that does the most amazing paintings.. well worth a look and he will paint whatever you want if you ask him to!

The other important thing you must know about this trip is the organisation from Work the World in the UK. If I ever had a worry or a concern about anything no matter how small or silly I thought it was, they answered it in a heartbeat. Everything is planned for you and you can see what you need to do and when you need to do it by on your My Trip section of the website after you have booked.

All I would say is; you have come this far, you are reading the case studies so you're obviously very interested.. so go on, just do it! I promise it's an experience that will stay with you forever and you will make friends for life. Go with an open mind, expect to be challenged by what you see but learn from everything.

As a 3rd year physiotherapy student, I decided to do my four week elective placement in Ghana. Through research and recommendations from other students, I found the Work the World website and contacted them regarding the placement.

From the initial contact, pre-flight departure phone call, to the post trip debriefing the work the world staff were helpful, friendly and provided guidance and advice regarding the placement and life in Ghana. I was offered a placement in the physiotherapy department in Effia Nkwanta regional hospital in Takoradi.

Arrival in Ghana

On arrival in Accra, we were met by Prince (programme representative) with a big smile and an Akwabba (welcome) and taken to the hotel for our 1st night in Ghana. The next morning, we left for the four hour journey to Takoradi on an air conditioned coach. My first impressions of Ghana were hustle and bustle, a fast paced, yet friendly, colourful environment. My first day in Takoradi included an orientation of the hospital, the area where we are staying, the market and meeting my new housemates.

The work the world house

The work the world house became my second home over my four weeks in Takoradi and the staff and other students became my second family. The wonderful staff there are Ophelia who cooks an amazing breakfast and dinner, so you get to try a wide range of Ghanaian foods such as Red Red and ground nut soup with rice balls. There is Alhassan who takes care of the house, Prince the programme representative and Joe the programme manager. The staff are always around and available if you need anything. On Tuesdays, we had Fante lessons taught by our very own Fante teacher, where we learnt general terms that allowed us to communicate better. Thursdays is the best day of the week because it is barbeque day complete with dancing to Ghanaian tunes e.g. 'I love my life'.  Living in the house gave me the opportunity to meet medical and nursing students from different areas in England and Canada whom I formed friendships with over my four weeks.

Normal work day

Each day begins with an early wake up at 6:30 am in order to be ready for breakfast at 7:30 and be at placement at 8:30. The working day in the gymnasium includes, assisting patients with their exercises in the gym, teaching new exercises and techniques and assessment and treatment of new patients. Also twice weekly, I was able to work with the paediatric patients and their mothers. This was my favourite part of the placement as it provided an opportunity to observe and treat paediatric cases which are rare in the United Kingdom. I also worked in the electrotherapy area where I learnt to use various electrotherapy equipment such as microwave and infrared and different massage techniques. There was also an opportunity to assist the physiotherapist in the wards, with referrals mainly from the orthopaedic, surgical and children's wards. The types of conditions I saw during the placement were adult patients who suffered from stroke, road traffic accidents and general musculoskeletal conditions and paediatric patients with cerebral palsy, injection palsy and Erb's palsy. The physiotherapists and assistants were friendly, knowledgeable and always willing to help me understand anything new I came across. It was easy to get along with them and they were experienced in working with students from England and other countries. I really enjoyed working with them and learned a lot from them.

Takoradi and weekend trips

Travelling around Takoradi was easy as there were plenty of taxis and tro tro's (mini bus) available. There is an internet cafe and shops an easy distance from the house and a 10 - 15 minute drive via taxi or tro tro takes us to the local market, where I was able to find all kinds of supplies i.e. backpack, flip flops. There are also several beach resorts, bars and restaurants available which become our local hang outs after work. During the weekend, I had the opportunity to travel to various tourist attractions in different parts of Ghana with the other students. I was able to go to Elmina and cape coast castle, Kumasi, the stilt village, Kakum national park and different beach resorts. These trips allowed me to explore Ghana, the people and their culture and make great memories.

Overall, my placement in Ghana enriched my professional and personal development as a physiotherapist, allowed me to gain further insight into an African culture, meet new people and have an amazing adventure.

When I received the phone call from the CSP to inform me that I had won a four week overseas placement with Work the World, I was ecstatic! I immediately began to research the available placement destinations.

I had always wanted to go to Africa, and after talking to a physiotherapy student who won this competition last year, as well as the Work the World team, I decided on Dar es Salaam in Tanzania.

After months of waiting, the time finally came for me to set off on the trip of a lifetime. I arrived in Dar es Salaam to be greeted by a smiling and cheerful Alpha, the programme manager. I was taken back to the student house and given a small tour.  The house was amazing, and became my second home throughout the four weeks of placement. The rooms were very spacious and comfortable and there was a pool which was fantastic  especially after a busy day on placement! There was no hot running water in the house, but it did not take long to get used to cold showers in the Tanzanian heat!

I had arrived at the busiest time of year so the rooms were all full with around 30 students there, all studying a variety of health professions. I soon got to know everyone and over the course of my placement the friends I made became like my second family.

The staff at the house were brilliant and could not do enough to help. They were a wealth of knowledge and were willing to help with anything, making themselves available at any time of day or night. Rahema did a brilliant job of cooking for everyone, always making sure there was a variety of different food available including vegetarian options. BBQ Thursdays were the best, with both food and banter top notch! I spent a thoroughly enjoyable and highly interesting four weeks of placement at the orthopaedic institute of a large, national referral Hospital. As this was quite a distance away from the student house, myself and some of the other students travelled there by the most common form of public transport: the dala dala (shared taxi). There was no limit as to how many people could fit in a dala dala, and more often than not the commuters were crammed in like sardines. Although this could at times be uncomfortable, it was all part of the experience!

A typical working day for the physiotherapy department was 8:00am  4:00pm. There were 10 qualified physiotherapists, along with the head of department. From 8:00am  11:00am, each physiotherapist would visit the ward they had been assigned to at the beginning of their rotation. A roster was created for me so that I was distributed amongst the staff and given the chance to experience the different areas of the hospital which included ICU, neurology, and trauma and elective orthopaedic wards, both public and private. From 11:00am onwards I would return to the outpatient department, where I would observe, or assess and treat a mixture of patients, sometimes with supervision and sometimes independently.

At first I found the hospital a big shock. There had very limited resources and the environment was massively different compared to the UK. The wards were so busy that patients slept on mattresses on the floor, or shared two to a bed. There were no curtains for patients to gain any privacy and there were mosquitoes everywhere. Infection control did not seem to exist, with very little soap available and nothing to dry your hands with. I always made a point of sharing my hand gel! Despite these conditions, the attitude of the patients was very humbling, and the positive ethos and spirit of both staff and patients alike extremely heart-warming. The first few days I felt completely out of my comfort zone, but once I became accustomed to the new setting and different way of working, I soon became more relaxed.

The majority of patients treated throughout the placement were involved in road traffic accidents with multiple fractures and severe brain injuries. In the outpatient setting, back pain was also very common. There were, however, some more unusual cases that I would not be likely to observe in the UK, such as Potts disease (tuberculosis of the spine) and malaria.

During the placement, it was arranged for me to spend two days in the paediatric department of the main hospital, where I gained the opportunity to work with children of all ages with cerebral palsy. As well as this, I also spent a day observing two surgeries being performed; the first a total hip replacement, and the second was the removal of a calcified iliopsoas muscle. Both of these surgeries were brilliant to watch, with the basic surgical set up varying only slightly from that in the UK.

I felt the greatest challenge that I faced while on this placement was communication. A number of the more highly educated patients were fluent in English but most only spoke Kiswahili, and so I found it very hard to interact with them at first. However, each week at the house we were given Swahili lessons, where we were taught greetings, numbers and body parts etc. This was such a great help and allowed me to gain the trust of both patients and staff and build up a good rapport with them, as well as develop my verbal and non-verbal communication skills. The physiotherapy teams English was excellent, and the staff were always on hand to help translate if I struggled to understand anything.

When not in the hospital I had plenty of time for sightseeing and soaking up the culture, as well as experiencing some of the local cuisine. Myself and a group of the other students spent a weekend in Zanzibar, where we learned the history of the slave markets in Stone Town. We also visited the peaceful and beautiful village of Jambiani, which was fantastic! We took a trip to Bongoyo, one of the local islands, and also went on a 3day safari where we camped for two nights. On safari we saw giraffes, elephants, hippos, lionesses and lots more all in their natural habitat. It was amazing! The safari cost around £200, and included all meals and drinks. Definitely worth it!

We also visited a local orphanage and took some supplies of soap, toothpaste, pencils, paper, cooking ingredients and sweets. The children were really friendly and enthusiastic, and most of them spoke fluent English!

A placement overseas really helped to boost my confidence. It has allowed me to enhance my clinical reasoning and communication skills, develop new skills as a student physiotherapist and also gain a cultural awareness. The whole experience was eye-opening, and one which I will never forget.

As a fourth year Physiotherapy student I was given the opportunity to organise a three week elective placement. I, along with two friends, approached Work the World for help as we wanted to undertake this in a developing country.

The staff were very helpful to get the placement organised and provided straight-forward guidance on how to prepare. I was very quickly offered an adult neurology placement in Green Pastures Hospital in Pokhara, Nepal. I would be working with patients that had leprosy, spinal cord injuries, amputations and strokes. Immediately I knew this was a unique placement offer and it lived up to its expectations!

General Impression of life in Nepal

The Nepali culture is great to experience. When in Kathmandu I had the chance to learn more about the main religions in Nepal (Buddhist and Hindu) from a friendly tour guide at Durbar Square. Some of the guides just want your money so it is important to make sure he knows what he is talking about! It is very common to have people approach you and try to sell you something. They might give you information or act as a porter and then ask you for money. We very quickly learned to be firm and say no - in Nepalese of course!

Driving in Nepal involves chaotic narrow roads, no road markings, and practically no rules! There are buses, taxis and motorcycles everywhere and lots of people walking. I found this so different from the culture in the United Kingdom, especially the Nepalese's major overuse of horns! It is a crazy experience but one you learn to love! The Nepalese are incredible people - very friendly and helpful. The best example I can provide is with regard to our lost luggage! On our first night in Nepal we stayed in the Ambassador Garden Home in Kathmandu, but we had to move on to Pokhara the following day. When our luggage finally arrived in Kathmandu, the kind manager of this hotel picked it up and sent it to us in Pokhara on a safe tourist bus, all the while not even so much as requesting a fee! Life saver!

Green Pastures Hospital

On my first day I was given a warm welcome by all the staff at Green Pastures, followed by a tour. The hospital was surprisingly well equipped, especially the Physiotherapy department. There was also an Occupational Therapy department, X-Ray department, a surgical theatre and orthotics workshop. We saw all the types of patients we expected to see and took part in lots of assessments and treatments. We found that the Physiotherapy staff were enthusiastic about passing their knowledge on to us. We were specifically allocated one long-term inpatient where we could take charge of the treatment sessions. This gave us the opportunity to act independently but also learn more Nepali.  Several times a day, the Nepalese have tea. Although this was frustrating as it meant less time was spent on the patients, we had to embrace the culture and also gave us a chance to get to know the staff at the hospital.

It was challenging at times to observe the methods of treatment that was sometimes undertaken. The Physiotherapists always had logical reasoning behind the treatments that were chosen. However, much of the treatments were passive and it was uncommon to prescribe exercises to inpatients to do in their own time. This is in contrast to Physiotherapy in the UK where we tend to encourage the patients to take responsibility for their condition. The Doctors commonly prescribed bed rest (usually weeks) which meant patients were becoming weaker through lack of exercise. Although treatment approaches were different we recognised that in all circumstances the staff had the best intentions for the patients. Overall, I recognised and appreciated how well developed the NHS is, and the experience served to make me desire to help encourage best practice in the future by returning to Nepal or another developing country.

Living at the house

Living at the Work the World house was brilliant! The house held about 19 people.  Some people came alone, while others had come in groups of three or four. We were the last to arrive to the house. We quickly made friends, and it was very comforting being able to ask others about good places to go and how to get there.  Some evenings we all stayed in and played board games, while other evenings we went to some of the little bars at Lakeside. We all had breakfast and our evening meals together, served up by Khrishna, the cook. These were always good and gave us all a chance to contemplate the day ahead together or reflect on what had happened that day. They were also good times to organise outings together.

Sunil and Aneeta, the Work the World staff were very helpful with giving information about the local area, especially regarding the local strikes called bandhs. They were also very helpful when some of us were ill, giving support and advice. One of them was usually around if help was needed which was very reassuring.

Much of the time in Nepal there is 'load-shedding' and therefore electricity blackouts.  This meant we spent many meals in candlelight! Although for some a lack of electricity may be worrying, but it was actually very easy to get used to especially as there were always torches and candles available. The only time where it was difficult was during our Nepali classes with Prem. He would teach while the sun was going down, so it became more and more difficult to see the whiteboard with all the new words written on! However, Prem is an excellent teacher and the classes were so interactive and enjoyable that it was not a big problem!

I had a great time in Nepal and it was down to the Work the World staff, the Nepalese, Green Pastures Hospital and its staff, and the other students living in the Work the World House. I miss it already and want to go back!

My first experiences of Mendoza in Argentina were amazement at the Andes Mountains on the horizon, bewilderment at my lost luggage, and thorough appreciation of Nat's big welcoming smile and hug as soon as I stepped out of the airport! The next three weeks of my medical placement there had plenty more amazement, bewilderment and appreciation packed in...

Nat, the programme manager in Argentina had managed to arrange a placement for me in the Plastic Surgery and Burns department at the Lagomaggiore hospital a short bus ride from the Work the World house. My Castilian Spanish and I would arrive every morning by 8am for the ward rounds, and try to squeeze some meaning out of the fast and furious, beautiful and quite Italian-sounding Mendoza Spanish - peppered with lots of hand gestures, grandstanding and melodrama (although that part may not be all that different to a UK surgery ward!).

I had the opportunity to firstly observe and then assist in a wide range of reconstructive surgeries, particularly on burns patients, but also on more unusual cases such as one elderly gentleman with Fournier's syndrome. I also saw advanced stages of the very rare pyoderma gangrenosum, open tibia fractures, Cushing's disease complications, and endless warm humanity in the friends and families of the patients on the wards.

The team of doctors who adopted me at the hospital were a wonderful and colourful cast, worthy of their own sitcom without a doubt. As a first year medical student in at the deep end, I needed to be shown the ropes, and that's exactly what they did, with great understanding, trust and warmth all the way through. Their command of English was minimal, and I was pleased to notice that my understanding of their outrageous humour, subtle politics and all-round camaraderie in Argentinian Spanish grew better and better through the weeks.

During the weekends, I became known as the slightly nutty adventurer, setting off on paragliding, high-wire canopy and kayaking excursions, roping housemates into the adrenaline rushes where possible. I was very glad to have invested in a scratch-, drop- and waterproof camera as a last-minute purchase at Heathrow airport before the 32-hour journey to Mendoza, as I tested out every single one of those claims and have some enviable photo albums to show for it!

Nat was great at organizing entertainment for the housemates as well, taking us out into town to check out the night life and even introducing us to her own social circle. During the afternoons after an intense morning at the hospital, I sometimes piggybacked on some of the intensive Spanish class activities, including private tango lessons and a trip to a local vineyard. Other times, I would sit and soak up the winter sun with a book in the yard behind the house.

When it was time to fly home after three weeks, I was already thinking about when my schedule would allow me to return to Mendoza and its warm people - a home away from home where my Spanish was changed to match the Argentinean rhythm and melody. In my suitcase (which did finally show up after 3 days and a lot of sartorial improvising), I packed once-in-a-lifetime memories, gifts from new-found friends, and an Argentinean football shirt bought in tribute to this most welcoming of places.