For my elective I spent five weeks in Eswatini, based in a rural town called Siteki with Medical Missions Eswatini (MME). It was an incredible opportunity to gain experience in a variety of specialties which included ophthalmology, home-based palliative care, paediatrics and obstetrics and gynaecology. As I’m still not completely sure which specialty route I want to go down, I appreciated the range of options that were available with this elective. Many of the staff from MME lived on Mabuda farm, located near the hospital. This was a beautiful place to stay, with plenty of trails for walks and runs.

Overall, all of the teams I worked with taught me different skills and offered varied perspectives into different aspects of healthcare in Eswatini. I found that all of the teams I worked with were incredibly friendly and welcoming, allowing me to get stuck in with the team and feel comfortable to ask questions, take histories and do examinations. The senior paediatrician in the hospital was very keen to teach and involve me in the team, which made such a difference to my learning and provided a valuable source of support when we dealt with some more emotionally challenging cases. Having had very limited exposure to ophthalmology in medical school, it was really interesting to experience more of this attending the Grace Vision Clinic run by Dr Pons and Medical Missions Eswatini. I was able to see a wide variety of clinics and surgeries. Nurse-led clinics provided an opportunity to practice detailed histories with a variety of patients, running in a similar way to a GP clinic. The other medical student and I worked together with the nurses to run these clinics and had regular contact with our supervisor who provided advice when needed. Each specialty taught me the importance of going beyond just what medications and treatment you can provide and continuing to see the wider context of the patient to make sure that their concerns are heard and they are involved in the treatment.

I learnt a lot from the home-based team about how to communicate and treat patients when resources are so limited. Much of the consultation time was spent listening to the patient's and their family's concerns. Although this was something that I knew was valuable before, seeing it first-hand in a rural, resource limited setting and the huge positive impact that it had on patient care has emphasised how this is an essential aspect of care which I aim to take forward into my future practice. Seeing how central their faith was in guiding patient care, as well as the faith of the patients treated was such an encouragement as well as a reminder of our reliance on God and how to still look to and praise Him through the moments where we may feel out of our depth or that treatment options are either completely exhausted or not even available in the first place. It was useful to gain more experience working with translators in the nurse-led community clinics as this was something that I only had very limited exposure to through Language Line on GP placement. I found it a challenge initially, as it took more effort to make sure that I was phrasing my questions and history taking in a clear way without leading or closed questions and was very grateful for the help of the nurses in the clinic who were incredibly patient with me!

Whilst my few days with the home-based palliative care team was one of my highlights, it also had various challenges. It was incredibly humbling to see the way in which the team were so selfless and Christ-centred in the way that they cared for their patients. Team meetings in the morning would always begin with prayer and worship before planning the day ahead. Many of the medications that we take for granted having such easy access to here in the NHS were significantly limited or not available at all, with Tramadol being the main medication of choice and even the availability of that was reduced. It was also challenging seeing how bad weather impacts access to healthcare in rural Eswatini. During my final two days with the home-based care team, heavy rain made many of the homesteads unreachable. The risky road conditions meant that we couldn’t do any more home visits that week. I found the limitations with what we could do to help the patients on those days particularly difficult and realised how much I take for granted the ease of accessibility to healthcare in the UK. There were a couple of occasions when communication broke down slightly in the hospital setting. I found these quite difficult to witness, particularly as a student who was only in the hospital for a few weeks and felt unsure about how to navigate these situations. I spent some time discussing this with some of the Medical Missions Eswatini team who provided support and taught me more about the culture and healthcare systems in Eswatini. I found the breakdowns in communication tricky, as it impacted patient care and outcomes could have been better if there had been clearer communication between the specialties.

Outside of placement, I thoroughly enjoyed exploring more of Eswatini at the weekends on Safari, hiking with the other students on placement and visiting local cafes and markets. A particular weekend highlight was a trip across the border to Kruger National Park in South Africa for a Safari! I attended a church in Manzini, one of the big towns in Eswatini, with one of the families from the farm, which was a great way to have community, teaching and worship whilst away from my home church as well as see how church runs in a completely different setting to what I am used to. There were also various charities based out of Mabuda farm, so I had the opportunity to get involved in some of the community outreach days for children with disabilities in the nearby villages, doing craft activities and games with them which were all focused around a Bible story. The residents at Mabuda farm provided an incredibly supportive and caring environment, with at least a couple of communal meals throughout the week. Wednesday spaghetti night always included a short devotional and fellowship together and Friday breakfast in The Green Shed cafe and its delicious coffee (a big highlight of Mabuda farm) was a lovely way to start the weekend. This was a fantastic way to form friendships as well as learn more about the wider outreach and roles of charities in Eswatini.

I am incredibly grateful to Medical Mission Network for the support and prayers throughout this elective, as it has been an amazing experience! I would also like to thank all the amazing staff at Good Shepherd Hospital, Grace Vision Clinic and the wider Mabuda farm residents who were so welcoming, eager to teach and share their lives for the 5 weeks I was in Eswatini.