by Work the World

We often have students come back to us saying that one of the big things they had to learn about in their placement was about what is expected of them in their healthcare role. Different countries have different sets of responsibilities attached to each position. When you are used to working as you do at home, it can take a bit of getting used too!

This week, we asked our students “how does the role of physio / nurse / dentist / medic or midwife differ overseas to what you are used to at home?”.

Natalia from Argentina was the first to respond. The three Scottish dental students in the house have found that their role combines dentistry with elements of nursing and with only two assistants for four dentists, they have to do a lot of the assistants work. Lauren also thinks the "style in Argentina is more old fashioned, in the way that here the dentist says what he is going to do and the patient accepts it. Back in Scotland, there is a lot more questioning from the patient, like the dentist has to justify what he’s doing and why he’s doing it, and presents a list of options to the patient with its implications and posible consequences, so that the patient is fully aware of the procedure and is able to choose". Briege and Rachael agreed, adding that "treatments are short term, there are not planned in advance as it is in Scotland. There is also no standard treatment, which means that the treatments are more subject to the dentist’s discretion". They are also all enjoying being called Dr's - in Scotland they do not get that title!

Saesol, from New Zealand, has been working in the public hospital and has found it to be fairly poorly equipped. Techniques are similar and graduated students are also trained for five years by a supervisor before they can finally become doctors, the hospital just really lacks funding. Something that still surprises her is how friendly they are. “I’m getting used to the kiss on the cheek and today I had mate with them”. She has found that this informal nature extends to the theatre.  In New Zealand everyone is "quiet and serious. In Mendoza the surgery room doors were open, the doctors were all talking and yelling and there was this patient who was having a wrist operation that was singing during the WHOLE procedure!”.

In Tanzania,  Freddy reported back from Arusha that the nursing students were finding their role in Africa a new learning experience.  Candace, from America commented that "at home we focus more on assessments of our patients. I  haven’t seen the nurses here do that.  Ward work is also different. On OG the nurses do nearly everything -  from delivering babies to stitching up lacerations - and on paeds, nurses serve more to help clean wards and prepare for the day”. Louise has also found the increase in cleaning very different to the UK, and that the role is very much deferencial to the doctors. "The nurses’ don’t appear to use their own initiative in assessing patient condition, they tend to wait for the doctor and just do what the doctor tells them". More positively she has noticed that "the nurses do not keep as much documentation as the nurses in the UK; this is not necessarily a bad thing!”!

The medics have found some similarities and some differences. Kim told us "Doctors in Arusha do day to day patient care as well as paperwork" which is the same as at home. In Tanzania though "doctors see patients 7 days a week. Nurses do the blood taking and admit the medication that is available. Their day is structured around the patient ward round in the morning and seeing new advisers in the afternoon".

In Dar es Salaam, Eva has found there is an increase in "patient contact, Medics take over nurses job eg changing IV, Monitoring drugs etc Bed side teaching - Medics are also expected to be able to perform the test & assist in blood taking". As with the dentists in Mendoza, Victoria has found that the role of Doctor is very authoritative compared to home "I think that back home huge emphasis is on 'teamwork' whereas here the doctor is still definitely in charge". Nicola is not so sure this is a good thing. "Doctors in Tanzania are a lot less considerate towards the patients. They don't explain things to patients and they don't reassure them". This is a problem that then extends to other areas of treatment. As a physio, we "often guess what is wrong with the patients who have been referred from doctors as the patients often have little understanding of what is wrong with them. Patients aren't informed or asked for consent for treatment, which is hard because often patients are sent for Physio who would be sent for surgery in England - treatment is very painful".

Our students in Ghana are mostly second year students, who do not have enough clinical experience to comment on the major differences in treatment but they have all noticed that "the patients have a high respect for the doctors". As with other areas of Africa, this can sometimes give the Doctor's a greater sense of power, and in in Ghana "sometimes the doctors can be quite rude". Heidi feels she has  learnt a lot from them though. As a nurse, she has found "doctors include us more in Ghana than in the UK and we follow the doctors during ward rounds". Unfortunately for Heidi the differences are not all ideal - Katie tells us that "the sister has to do more paper work here - at home it's more of a hands on role". Julie agrees " we also all look after every patient - at home you would be allocated patients for each shift. It can make it very confusing".

We have always heard that Asia presents the most obvious differences, so it was interesting to see Jay's response from the India house. The dental students were up first and commented that "Doctors prescribe a lot of antibiotics after each extraction, even if it is a simple one. In the UK antibiotics are prescribed only if the extraction is very complicated one. Also, Dentists in India are not in a position to handle Medical Emergencies like heart attack, high BP etc during the procedures and depend on the general medicine doctors to rush to the dental dept during such emergency. This is made all the more difficult as if patients have medical problems they hide it from the dentist in case they are refused treatment!". The students have also found that dentists in India only "fix the present dental problem and don’t give enough advice to the patients to prevent the same case in future". This perhaps explains why our dental outreach in India always finds such advanced cases.

In India, the role of nurses is completely different from that of in UK. They do the medication, injections, taking temperatures, taking blood samples, canulations, venipuncture etc and paper work. They are not directly involved in patient care as the patients relatives do so much. Only in ICU and post operative wards nurses do the nurses take over as relatives are not allowed to enter these units to control infection. "What is surprising is that people are only admitted to hospital if they have some relatives or friends who will take care of them. At home this would certainly not be the case"! 

The physiotherapists have also found India very different, relying on machines because there is not enough time to do hands on work with each patient. "Patients are not treated on an appointment basis, which means we  cannot plan the treatment. Also,  Doctors do the diagnosis and assessment, fixing the treatment plan which we then have to work too - at home physiotherapists assess, diagnose and arrange the treatment plan".

In Nepal they too have found similarities and differences. For Sally,"the doctors do the outpatients and the ward rounds, with the juniors presenting the cases to the main consultant, which is just like at home. Also, most of the doctors do private clinics". Amber agrees "how the patient is admitted, the history kept and the discharges.... it's all the same". It is perhaps the role of a nurse that has more notable differences. "Most of the personal care is done by the family or relatives, which is very unlikely back home. They are always there by the patients side and buy the prescribed drugs". Joanne also added that "nurses here do cannulation which only doctors are allowed to do back home".

Next week are are going to ask the students about work they have been doing outside the hospital. Using their own initiative, many of our students spend their afternoons helping out at local orphanages. "Have you spent any time working at a local orphanage and how have you found it?"

We'll see you back here next week for the answers!

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