Emma was in Ghana on her nursing elective when she was suddenly inspired to step things up and tackle a degree in medicine. We spoke to Emma to find out how it all happened and where she is now. Read the interview below.
So, let’s start from the beginning. What inspired you to travel overseas with us the first time?
It all started back when I was a nursing student. As part of my nursing degree at the University of Edinburgh, we were entitled to undertake an elective placement and travel wherever we wanted.
A lady from Work the World came to my university to speak to us about our options. Me and a group of my friends were really interested in what she had to say. It sounded like an amazing opportunity, so we just went for it. We were all keen on the idea of travelling to Africa, and eventually we decided on Ghana.
What was it about Ghana that interested you in particular?
I think it was the fact that at that time we didn’t want to go somewhere that was a big city. Takoradi was away from Accra (the capital), it was near the beach, the hospital was a slightly smaller hospital. It just ticked our boxes.
CAN you remember what your first impressions of Ghana were like when you arrived?
I wasn’t sure what to expect, but it was amazing. I remember thinking how beautiful it was. It was clear straight away that were loads of places we could hang out after placement. The Work the World house was fairly close to the beach and that was a highlight too.
- A day of surfing on Ghana's coast -
What about your first impressions of your placement hospital? Just fire off the first things that jump to mind.
Well it was the first time I’d been to a developing country, so it was a bit of a shock. Things were under-resourced and crowded compared to what our facilities are like back home. I was initially in the labour ward. It was all so basic and there were a lot of cultural differences compared to what it would be like at home.
Let’s explore that. What were the biggest differences when it came to culture and practises?
One of the main things was the attitude of staff towards patients. In the UK, I think we’re more empathetic, or at least more sympathetic. In Ghana they seemed to have a much harder attitude. They didn’t have even some of the most basic things we take for granted in the UK, like pain relief.
- A new baby on the labour ward in Takoradi -
Patients presented much later than they do in the UK too. There aren’t many screening programmes in Ghana, so patients presented with diseases that were very advanced. Patients in Ghana have to pay for certain therapies as well. I spent some time in the paediatric department and there were kids who didn’t get treatment because their families couldn’t afford it.
How did you find being an observer in those situations?
It was upsetting at first. I didn’t realise how confronting some of the cases would be. Seeing people in pain and suffering in situations that just wouldn’t happen in the UK. I even saw people pass away under circumstances that in the UK would never have arisen.
- Getting organised in A&E -
Are there any particular patients or cases like this that stick out in your memory?
There was a child in the paediatric department who had meningitis and tetanus. The child’s family was really poor, and the hospital couldn’t actively treat the child because the family couldn’t afford it. They wouldn’t let the parents take the child home either. It was difficult to just stand by because nothing was really being done to try to treat this child, but I had to respect cultutal differences.
I spent some time in the ED too and I remember they didn’t always have basic resources like oxygen. I had one patient who came in that was unconscious and needed oxygen, but because we didn’t have any, the patient ended up passing away. We never really worked out the cause. He was a young patient too, probably in his 20s. Those are the two that stick out to me. Memories like that really make me appreciate what we have in the UK.
That can be tough. How did you process that sort of situation while you were over there?
So, there were other Work the World students in the paediatric department with me and we often debriefed together. Actually, that was one of the huge advantages of travelling with Work the World was we had that big group of fellow students around us.
- A visit to the rural village for health check ups -
We always debriefed at the end of the day. We spent time discussing things we’d seen and asking each other questions. There was always someone to discuss it with.
So, changing the tone a little, are there any stand-out positive experiences that spring to mind?
One big thing is that patients there were really appreciative. They were so grateful for healthcare. Whereas here in the UK people can take it for granted. But in Ghana I found that everyone was positive and didn’t really complain. The staff were resourceful too. It made me realise how much goes to waste in the NHS. In Ghana they reused so many things that we just throw away. I took this away as a learning point to try not to waste so much at home.
- Emma and fellow students with the A&E charge nurse in Takoradi -
you were getting all of this practical nursing experience while you were in Ghana and on your nursing degree at Edinburgh. But then you decided to switch to medicine. How did that happen?
Funny you should ask at this point, because it actually happened when I was in Ghana. We were sharing a house with some medical students and I chatted to them a lot. I remember asking them about their course and what their careers would be like. It was around then I realised medicine was actually something I’d be quite interested in.
I remember asking them about the application process, and that gave me a much better idea of what I needed to do to start studying medicine. It was when I came back to the UK that I started the process of applying to study medicine.
When you had these conversations with your housemates, what kinds of things were they saying? What were the magic words that made you think ‘this is for me’?
To be honest they just seemed to know more than me and my colleagues. I wanted to learn more — about illnesses and diseases and treatments…. I wanted to expand my knowledge in those areas.
I came to the realisation that I wanted to be more involved in diagnosing and planning treatment for patients. Nursing is much more about the care of the patient.
I trained in adult nursing, which is obviously geared specifically towards adult nursing. With medicine, you get to see all aspects of healthcare.
I think I just felt like it was the right time to go for it before I went into a full-time job. If it didn’t work out, then it didn’t work out. I came back from Takoradi, finished my nursing degree and set about applying for a place on a medical degree.
And what was that application process like?
I was treated in the same way as any other postgraduate applicants. I applied alongside everyone else — school leavers, postgraduates. Everyone. The application process involved an aptitude test called the UKCAT, and I had to write a personal statement then send my application in. Then I had to go for an interview. It’s quite a long process, but it wasn’t actually that complicated.
Obviously nursing and medicine are aligned in terms of their core focus, but information on a medical Degree has a greater depth. How did you find that step change in learning?
It was a lot, lot harder than I thought it was going to be. At first anyway. I struggled in the first year. It was a lot of science, which I hadn’t done since… Well I’d done basic science in nursing, but this was a lot more in-depth.
Actually, it was the first two years that were all really science and theory based, which I found quite difficult. By the third year we were into the clinical years and they were much more enjoyable. I’ve enjoyed the whole course, but the first two years were tougher as we didn’t spend any time on the ward.
- Emma out on a Ghanaian safari -
So, your nursing degree didn’t help you all that much with the science bit. Do you think it helped you in any other ways?
Oh, it definitely helped. As you say, not so much at the start, because what we were learning on the medical degree was so in-depth. But by the time I was in my clinical years and seeing patients, my previous placement experience helped massively.
It seems strange that I’ve only got one week of my degree left. I have to admit; it does feel good to be at the end after nine years at university! I’m about to move to Glasgow to do my two foundation years as a junior doctor
That’s brilliant news — It sounds like a big step. do you have any anxieties about it?
Definitely. It’s going to be a big learning curve, but I feel as though coming from a nursing background, I know how things work on the ward and I know the hierarchies, and I know more practical things to make life easier that other students in my year might struggle with at first, so I should be fine.
- Learning weaving during a trip to the village -
We’ve skipped ahead a little bit, so let’s go back to when you were on your medical degree...You actually decided to travel with Work the World a second time, this time to Lusaka in Zambia. What was it that made you decide on Zambia?
Well I knew I wanted to travel with Work the World again because I’d had such a good experience the first time around. It was so much easier than my friends who tried to plan their medical electives by themselves. They were all so stressed and the process seemed so much more complicated. Work the World pretty much organised everything for me.
- Housemates in Work the World's Lusaka house -
And I chose Lusaka because I’d had such a good experience in Ghana that I knew I wanted to go back to Africa. I noticed Zambia on the website, which wasn’t available when I travelled all those years ago, so my friend and I went for it.
It’s not often that people visit two of our programmes, let alone once as a nurse and once as a medic! It might be good to compare your clinical experiences in the two destinations.
Well in terms of the similarities, the attitudes towards patients is similar in both countries. I found that doctors just went ahead with procedures and didn’t really ask for consent. You could expect major disciplinary action taken against you for that if you did it in the UK. But I actually learned a lot from the doctors. They were really, really knowledgeable and they were constantly teaching us and quizzing us.
- Getting to know some Zambian medical students -
I went out to Zambia not expecting to get much clinical knowledge — I was really going to see the differences and for the cultural experience. But I learned so much. I was in obstetrics the whole time, and I learned more in Lusaka than I did on my obstetric placement here in the UK.
Why do you think that was?
I was with a group of local students and they had exams, so they were always asking me questions and testing my knowledge. We quizzed each other, actually. And whether we were in clinic or in theatre, the doctors were always asking us questions, which is different from the UK. Here we have scheduled teaching times, but in Lusaka they quizzed us all the time. Teaching and learning were a part of the day-to-day. It was a bit intimidating, but effective.
And what did you get involved in? I mean with particular patients and cases.
I was in obstetrics the whole time, so I was examining pregnant women, clerking the women as part of their admission to the hospital, delivered a few babies, I even assisted in theatre at one point.
What are the big differences between a delivery in the UK and a delivery in Zambia?
In the UK, women almost invariably have some sort of analgesia. In Lusaka there was no pain relief at all. There was a complete lack of monitoring equipment, so there were a few cases where babies passed away in the labour process. Most of these would have been preventable in the UK because we have very close monitoring.
In the UK, labouring women have a room to themselves most of the time. In Lusaka, women shared a room with three or four others.
There were no visitors allowed in during labour, so fathers weren’t allowed in or any other family members. It was just the woman who was allowed to be there. Things were massively different.
How do you feel like it has geared you up for a career in medicine do you think?
On the degree front, I’m glad I did it this way because now I’m that little bit older and have more life experience. I feel much more confident in what I’m doing than perhaps I did when I finished my nursing degree.
I’ve now got a much better idea of where I want my career to go and what I want out of it, which is one of the main benefits. Also, I’m glad I did both of the elective placements in Lusaka and Takoradi, they were the highlights of my time at university over the past nine years.
- A trip to Victoria Falls -
I’d say the second time, having a bit more life experience, I got much more stuck in and I asked to do a lot more and I definitely got a lot more out of it because of that. I’d recommend Work the World to anyone who’s thinking of travelling — and be sure to get stuck in while you’re there. The more you ask to do things, the more you introduce yourself and get to know people, the more you’ll get to do and the more you’ll gain from the experience.
You might not want to become a doctor, but an overseas nursing elective will help you push yourself to grow.
You might not want to become a doctor, but an overseas nursing elective will help you push yourself to grow.