Thomas Holt

I was inspired to undertake an overseas placement to experience how medicine is provided outside of the UK in a different environment with different pressures on staff and services. 

My placement in Sri Lanka offered excellent learning opportunities regarding tropical diseases I would not otherwise see in the UK. While this was undoubtedly a highlight, I was also able to develop my knowledge and clinical skills with a wide variety of general surgical and medical cases.

My clinical knowledge was developed through consultant-led teaching during ward rounds and daily organised teaching sessions depending on the department. 

Registrars and house officers offered excellent bedside teaching on the wards and in theatres. This ranged from physiology to ultrasound for point-of-care tests, to name just a few. Under good supervision, I also practiced clinical skills from simple cannulation to the intubation of patients undergoing elective surgery. 

My placement hospital in Kandy was impressively large, serving a large patient population and offering a wide range of services. It was a busy hospital with very welcoming and friendly staff at all levels. 

I observed lots of memorable cases across the many departments I had a chance to experience. In the surgical ICU, I observed a patient with 50% surgical burns from a kerosene lamp accident. The patient went on to develop fluid overload and sepsis, requiring complex multi-organ management. 

In the dermatology department, I witnessed a patient with paraneoplastic pemphigus. In general medicine, I observed a patient in the critical phase of dengue on HDU with all the hallmark features of dengue hemorrhagic fever. 

On the ETU, I saw the treatment of a patient who fell from a jackfruit tree due to an epileptic seizure and sustained multiple skull fractures and a hemopneumothorax. Further to this, I also witnessed a cardiac arrest with unsuccessful resuscitation, significant tension hemopneumothorax, and hypertensive-associated intracranial hemorrhage. 

There were few to no general practices in Sri Lanka, and most Western healthcare was available at smaller rural hospitals or large central ones, such as the one in Kandy.  

Ayurvedic and indigenous medicine were practised throughout urban and especially rural areas, and patients who engaged with these types of medicine were frequently encountered in the national hospital. 

The hierarchical structure in the healthcare settings in Sri Lanka placed consultants in a greater position of authority than in the UK, with a broadly paternalistic approach to patient interactions. However, this varied significantly from individual to individual. 

Resources, from basic equipment to more complex equipment, such as scanners, were significantly limited in Sri Lanka compared to the UK.

Kandy was a great place to explore during the week, with a variety of markets, cafes, cultural sites, and activities to get involved with. Many of these were best enjoyed with your fellow housemates or by yourself, including visiting the temples, exploring the town, seeing the wildlife around the lake, and visiting the local bars to enjoy the nightlife. 

Weekends were a great opportunity to explore more of Sri Lanka. I visited cultural sites such as Sigiriya and Polonnaruwa, relaxed on stunning beaches, and explored the coral reefs in Trincomalee. I also visited Ella by train for stunning views and a more vibrant nightlife.

With so many options and unknowns, choosing the right destination and organisation to help organise your overseas elective can feel overwhelming. After my first call with the team at Work the World to confirm my placement details, I was instantly reassured that I had made the right decision to travel with Work the World. 

After arriving in Sri Lanka and meeting the incredibly supportive in-country team, I knew that my time there would be well spent. 

My six-week elective in Kandy and the rural village has been a once-in-a-lifetime experience. It’s been an incredible opportunity to learn all about the healthcare system in Sri Lanka, explore the beautiful country, and meet some of the friendliest, genuine, and hardworking people I have ever met. 

I highly recommend this elective to everyone.

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