*Medical Student, ANU
I completed my five week elective in Samoa, which proved to be an eye opening and very worthwhile experience. While Samoa is a developing nation with its inherent health challenges, it is also a relatively safe and friendly country for naïve medical students to travel to and explore.
In September 2009 a submarine earthquake of 8.1 magnitude struck in the region of the Samoan islands causing a tsunami to devastate the southern coastal areas of Samoa. The loss of life was huge for a small nation but the effect on the psyche of the country was even more massive. While most of the country was physically untouched, the emotional impact was still resounding strongly when I (along with four other ANU medical students) arrived to do my elective term.
I went on several tsunami area outreach clinics and observed that most physical wounds were healing, save some lingering respiratory complications of near drowning. However, I witnessed much emotional damage, and it was distressing to see mothers break down when recounting their stories of the fateful day, or two young women so devastated by PTSD/depression that they could hardly move (both of whom had a nephew ripped from their arms by the wave).
Aside from clinic visits I spent much of my time in the public hospital (Tupua Tamasese Meaole Hospital, or TTM) in Apia. The hospital, while quite old and run-down, had some very dedicated staff, committed to improving the health of their fellow Samoans. Most of the doctors were in fact Samoan (and fluent in English, having trained in New Zealand, Fiji or Australia) and it was inspiring to witness their choice to stay in their country where pay and conditions were far below what we would expect in Australia.
The hospital could really do with some mosquito screens on the windows – not only would they help with mozzies, but they would also keep birds from flying through the wards! Dogs wandered freely through the hospital and it seemed at times that good hygiene was a figment of my imagination. However, the World Health Organization reported a life expectancy for Samoan females in 2004 of 70 years1, which certainly exceeds that in many developing countries. Much of this can be attributed to a culture which espouses clean-living and a caring family network system. One wonders how the obesity epidemic, and the subsequent diabetes explosion, will affect these numbers in years to come. Public health campaigns promoting exercise and diet improvements are being launched, but are yet to have a discernable impact.
I also occasionally trekked up the hill to the private hospital (MedCen). It was smaller and more orderly, and subsequently much less exciting than TTM! It was similar to sitting in on a GP clinic in Australia, as many of the patients were either expatriates, or more wealthy Samoans.
While on the wards of TTM (mainly paediatrics and medical), I saw fascinating pathology, met some incredibly strong people and witnessed patients deteriorate to death almost in front of my eyes from conditions essentially curable in Australia. Most of the time I felt helpless and frustrated: it astounds me that a country with so much potential allows a little boy with leukaemia die with no pain relief (blood transfusions formed the basis of palliative care). We ‘westerners’ can’t hope to understand a country like Samoa in five weeks, but I still felt the pangs of frustration and anger at seeing a country so rich in resources (fertile soils, good rainfall, beautiful scenery/beaches, and strong, intelligent people), become increasingly highly dependent on foreign aid. China in particular is having a huge impact, pouring money into very strategic infrastructure projects – what is expected in return is a bone of contention amongst the Samoan people.
However, amongst the sweat, dirt, and confusion there were afternoons of snorkelling, adventures at the ‘sliding rocks’, dips in the cave pools, sunbaking on beautiful beaches and eating delicious pancakes galore. Music filled my soul everywhere I went, and I greatly enjoyed fellowshipping at a church called Peace Chapel in Apia. We stayed at the Outrigger Hotel (devoid of air-conditioning, but it did have a pool!) and met some awesome people there.
If you are keen to go to a Pacific Island for your elective I recommend spending half your time in a developed world specialist hospital to experience the contrast and also to enjoy a little more teaching and direction! However, Samoa will saturate all your senses – and it certainly provided me with a truly eye-opening experience – an incredible elective, with memories that will stay with me forever.