For my elective I travelled to Siteki, Eswatini, a country in Southern Africa with a healthcare system vastly different to the NHS. Most hospitals are government run, with subsidised care for the majority population living in poverty. There are some specialists and private medical care however these options are often in the cities of Manzini or Mbabane and the cost of travel restricts access even before considering cost of medical services.

I worked with a charity called MME – Medical Missions Eswatini, set up by an ophthalmologist Dr Jonathan Pons. MME runs Grace Vision Eye Clinic as well as working with the local Good Shepherd Catholic Hospital (GSCH). They also partner with the Libumba Initiative, a charity working with disabled children and their families to provide support and education around disability, and MercyAir, a helicopter mission taking eye screening services to some of the most rural and mountainous areas of the country. I had the privilege of spending time in all these areas, giving me a broad overview of healthcare within Eswatini. I was able to structure my time with roughly a week and a half in each of the following:

-Paediatrics: including a day helping at the Libumba community playgroup and therapy sessions

-Ophthalmology: moving between general eye clinics and surgeries including cataract, strabismus and corneal transplants, I also collected data for a patient experience survey

-Community programs: this included a day out with MercyAir, time with the home-based palliative care team, and joining Ebenezer - a local nurse-led primary care clinic

My time on elective challenged me in many areas, both professionally and personally as I was faced with medical decision-making heavily limited by resource scarcity and the ability of patients to pay for their care, two factors that contribute significantly less to rationale in the UK healthcare system. It was common on the paediatric ward to see mothers and children having to stay extra weeks on the unit as family members raised funds to pay for their previous care, with their bill continuing to rise as they were still using a hospital bed to sleep in. I also found it difficult watching cannulation and NG tube placement practices that didn’t follow my teaching and UK guidance.

There were so many instances where I was encouraged by the powerful, prayerful attitudes of the team. Every day before the home-based palliative care team headed out, they prayed together an adapted version of the Maryknoll AIDS task force prayer. It was also a joy to join weekly Bible study and spag bol nights on Mabuda Farm where I was staying, a chance for all residents, regardless of religious background, to enjoy fellowship together. We also had the opportunity to join some local church services where I was reminded when singing together in English and siSwati how amazing it is that the church is so global and diverse.

My time in Eswatini also forced me to consider how I view my future career path within medicine, whether I wish to follow the traditional route of training within the NHS, becoming a full-time consultant or GP, or whether I would consider integrating aspects of teaching, charity or mission work. Wherever I do end up though, I would love to return to Eswatini, hopefully with a little more experience and training so that I can contribute to the communities and work I was able to learn so much from!

I am incredibly grateful to MMN for their generous donation that helped make my time in Eswatini possible and hope that many other students will also benefit from this in the future.