Nitika was exposed to a variety of experiences during her elective at Sigatoka Sub-Divisional Hospital, including amputations, childbirth, and visiting rural villages to aid individuals unable to travel to the hospital.
For my final year of medicine, I traveled to my hometown of Sigatoka, Fiji Islands to undertake a clinical elective in public health. I was placed at Sigatoka Sub-Divisional Hospital. Here I hoped to gain exposure in the diagnosis, investigation and management of diseases commonly seen in rural communities. At Sigatoka Hospital, I hoped to understand the barrier to delivering tertiary services in a rural setting and methods to manage these patients accordingly with limited resources. This experience exceeded my expectations by giving me a hands-on opportunity to learn from the doctors, patients, and allied health staff to improve my clinical practice and cultural awareness.
I was fortunate enough to receive a BOQ Specialist Future Focus grant which allowed me to fund my flights and accommodation while I was in Sigatoka. I stayed in the local village, ate local food, and experienced the true Fijian way of life. Being originally from Fiji and after having trained in Australia, I was able to integrate my knowledge of the language and culture in my clinical practice. I wouldn’t have had the opportunity to go back to my heritage and serve the underprivileged people of my country if it wasn’t for the aid of this grant.
The first diabetic patient I came across on the ward was a frail, 74-year-old lady of Fijian descent. She was admitted for diabetic foot sepsis, with a GCS of 12, investigations showing clear signs of infection with her left foot presenting gangrenous changes. This patient had failed to present to hospital earlier due to attempting traditional herbal medicine in the village which involved wrapping leaves around her foot. Unfortunately, due to her lack of access to transportation and lack of awareness on the importance of antibiotics and debridement, the infection had progressed to osteomyelitis. This patient had to be transferred for a below-knee amputation. Here, I learned that the majority of the rural population lack any education about various diseases and their management, such as adequate glycemic control and podiatry care. I understood the importance of integrating both traditional and clinical medicine in the management of these patients to improve compliance. As Fiji has one of the highest rates of Type 2 diabetes in the world, education and de-stigmatisation around modern medical care is imperative to reducing the rates of this illness.
Midwifery maneuversAdditionally, I worked in the labor ward to assist the midwives with deliveries. Prior to this experience, I was aware of all the pain-relief options including Epidurals which are readily available in the tertiary healthcare systems in Australia. However, due to the limited supply of materials and Anesthetists in rural hospitals, this was not an option. Many women in Fiji deliver at home, in rural health-centers or nursing stations with minimal medical equipment and far from hospital. One of the babies I helped deliver, presented with shoulder dystocia. I was able to put my theoretical knowledge into practice, utilising the McRoberts maneuver which resulted in a successful delivery. Through these experiences, I feel more confident to assist women in such conditions by trusting my background knowledge on various obstetric maneuvers and implementing them accordingly.
The most rewarding opportunity I had was to travel to various rural villages in Sigatoka to provide healthcare to those who do not have access to the hospital. Our mobile clinic involved a multidisciplinary team including a doctor, nurse, dentist, physiotherapist, dietician, and health inspector. Through visiting these communities, I realised how fortunate we are in Australia to have basic resources including fresh water and sanitation measures. Diseases such as dengue fever, leptospirosis and typhoid were very common in these locations. By interacting with local members of the village I gained a deeper understanding of the barriers they face and realised the importance of equitable access to healthcare.
The Fijian locals were so hospitable and overjoyed to have us. They were very receptive to the health care advice we provided them and trusted us at their most vulnerable stages of disease. I realized that as health care professionals, we have the privilege to change someone’s life for the better. The faith these people had in every word we spoke and the kindness they showered us with, is something I will never forget. To be a doctor is one of the most rewarding careers - spending your life in the service of others.
On my days off, I also got an opportunity to explore the beautiful island and local attractions around Sigatoka. I travelled to the local Korolevu waterfall, swam in some local beaches. I also visited the Sigatoka rivermouth – where the river meets the pacific ocean.
ConclusionOverall, my elective in Sigatoka Hospital was an incredible experience where I gained the knowledge to integrate both patient concerns and clinical decisions in the management of disease. I upskilled my basic procedural skills such as cannulation, venipuncture and catherization, but I also grew to appreciate the resources available to us in Australia. As a future doctor, I hope to give back to those who are in less fortunate circumstances and take these lessons learnt from my experience in Fiji to improve my clinical practice holistically.
Thank you to everyone who made this a rewarding opportunity, or as the Fijian’s say “Vinaka Vaka Levu”. Ni Sa Moce or Goodbye from the beautiful island of Fiji.
*Note: All photos are used with permission for the purposes of this reflection
Developed exclusively for medical and dental students, each year the BOQ Specialist FutureFocus grants provide students with the opportunity to undertake an elective so that their commitment to helping others can be realised. Applications for our FutureFocus Grant open in May and close in August.
You can also access funds to help undertake an overseas placement, with our Student Banking Package.
FacebookLike and follow us on Facebook to keep up to date with all our student offers, events, competitions and more.
