As part of the MBChB programme, fourth year student doctors embark on a four-week elective placement which serves to expand their skillset and knowledge in a particular area of medicine. Student Doctor Taia Rothwell immersed herself in a brand-new country, travelling to Tanzania to undertake her placement across a wide array of different disciplines. Taia shares how her experience has contributed to her professional growth as a student doctor, as well as her delight at coming first place in the Elective Photo Competition receiving a £150 prize for her winning photograph.
Where did you spend your elective?
I travelled out to Tanzania and was based out of Haydom Lutheran hospital, which is in rural Tanzania. I think it's about 500 miles away from the capital and was about six to eight hours via road from the nearest city. It’s classed as quite a remote region, but it’s a well-known and well-resourced hospital and even has research links with the University of Liverpool!
I treated it as an opportunity to really assess where I was at with knowledge and to put myself out of my comfort zone in terms of what I’ve done. I felt if I stayed in the UK, I would have just ended up falling into something like a “regular” placement routine and only been exposed to ways of working I have already seen. Being in such a remote environment meant relying a lot more on core practice and skills but still trying to reach the same goal.
Tanzania's an incredibly beautiful country and it was a different attitude towards life than here in the UK. Things can often be a day’s travel away or weren’t accessible by road and people live in their own distinct communities outside of the bigger cities. Each community often had its own dialect of speech or beliefs, and the infrastructure varied from each tribe you might interact with.
Most people out of cities lived in huts, but there was an interesting thing where to build houses there, you buy what things you can when you can. House building can take about 30 years, because people will save up to buy 10 bricks, build those and then wait until they can buy 10 more. So, in a lot of places around Tanzania you’d see half-built houses when you were travelling around.
What led you to choosing to do an elective in Tanzania?
I chose it mostly to experience something different. Liverpool is very good for exposing you to a lot of specialties, so for me it was never about studying a particular medical aspect because I felt like I’d had good exposure here. I wanted to experience how medicine works in different settings and particularly to focus on more rural, community-driven care. I wanted to see what clinicians do in places where they don't have the facilities and infrastructure we have here in the UK. 
What was a working day like?
The approach was varied as Tanzania doesn’t have a centralised medical system, so we spent some time in hospitals but also time doing outreach into local communities. Healthcare practices there blend both traditional and modern approaches, particularly favouring holistic or family-centric care often involving local tribes’ beliefs. I did four different weeks, so every week was different in terms of practice, which I really liked.
On the Outreach weeks, you’d leave around 7:30am to go to morning prayers with the whole hospital staff, then you went to where you were practicing, sometimes by car, sometimes by plane, depending on where they were going. Before leaving you’d have breakfast together as a group, say more prayers and then you would go out for the day.
On Outreach it was mostly treating women and young children, so we covered a lot of Reproductive and Children's Health, but people would also just turn up to the clinics we were based in for general health issues as well.
On other weeks, you'd be based more at the hospital and go to a specific ward in much the same way we do in the UK. You’d attend a handover where the junior doctors would discuss any cases that they were worried about, or any deaths that had happened, then you’d go on ward rounds. Across the four weeks I did general medicine, general surgery obstetrics and gynaecology, neonatology, and outreach.
Were there any difficulties or barriers to practicing?
The main barrier was language – most people where we were based don’t speak English and you’d have to rely on local doctors/clinical staff to interpret. But in some cases, even the local doctors didn’t speak the language, as there are so many dialects within the region.
Locality played a big part in what we could and couldn’t do as well. Patients we treated were from a variety of different tribes and that impacted how they viewed healthcare. One patient required surgery which involved metalwork, and their tribe wouldn’t allow those kinds of things within the community. So, it became a more open discussion between the patient and doctors over what they could do to accommodate those beliefs in the treatment.
The structures were quite different too. They do have pathways, but they were made by the local doctors. Healthcare provision there is mostly provided by the individual doctors rather than governed on the national level. They don’t have the same kind of targets or patient pathways or guidelines we have here, but they recognize that they're useful - most of the time because the doctors have either practiced or trained in other countries.
Things were also taken a much more sedate pace clinically. You'd see things and be kind of ready to step in for an emergency. But staff would just say “polepole”, which means “slowly slowly”. Everything there is just at a much slower pace.
What learning outcomes did you take from your time there?
I think going somewhere else really does force you to assess where you're at skills wise. Stripping it right back really reinforced the reason you do things and how it comes into practice. Things like weighing babies are just parts of regular assessments here, but there it’s a key metric to check for general health and we had to do it with whatever resources were to hand at the location. So, it took you out of thinking of it as received wisdom and into asking why we do those assessments and what we can infer from them actively.
My original learning outcomes were to explore the cultural effects of healthcare, and I also wanted to improve my tropical diseases knowledge. You got to see cases like cerebral tuberculosis, malaria, and lots of things that you would never see in the UK which was interesting to learn about and I suppose also that understanding of adapting your practice based on resources.
Since I’ve got back to the UK, I’ve noticed another important thing for me was understanding what patients want from the encounter. I’ve thought about that a lot more since my elective just because I think that they really focused on that as the point of treatment, whereas I think my approach was always, oh, “if you've got this and you have this and then it's better”. I am much better now at considering what the patient wants from the consultation rather than just considering the treatment pathways.
What was the experience like outside of practice?
I stayed on the hospital grounds which was a different experience. There weren’t really any local supermarkets so food had to be prepared by people at the hospital and it would be what was available where you were.
We did a safari camping in the Serengeti over a weekend which was great. We got to see lions, cheetahs, and hippos and, because we’d camped out in the plains, when we woke up one morning there were buffaloes and warthogs that had been sleeping around our tent which was quite cool!
I travelled with another student from Liverpool called Helen and we climbed Mount Hanang together, alongside other people that we were working with in the hospital. That was quite fun and sharing it with people who we worked with made it feel more like team building which was important. We also managed to squeeze in a trip across to Zanzibar Island, which was incredible.
Taia's winning photo entry, showing a baby being weighed from a tree branch.
Do you have any tips for students going on elective this year?
Start early. Contact a lot of hospitals because they will reply to you with more information than you can get just looking online. That shaped the places that we looked at - we originally thought that we would end up somewhere much different to where we chose. There wasn’t much information available about them to begin with, but then when we inquired, they sent across a lot, so cast your net wide.
Use the Electives network website, they give you contact details for lots of hospitals where students have done electives so that's a good base. Any places you’ve looked at, consider if they've had other students, consider things that you can do on weekends - not just because it's fun to do them but also because you might need the break. I think that you can gain more from an elective from being somewhere else rather than seeing a certain specialty. Instead put yourself in a real situation.
Lastly, I do think it's important to consider what you can do around your elective when you choose. Especially if you are going somewhere that's different because it can be really hard, you see a lot more challenging and advanced cases than you do here. At first that was very emotionally draining. So, it is important that you are somewhere that you can do things on weekends and get away for a little bit.
I was lucky that I was with someone else from the course to share with, as sometimes your phone signal could be hit or miss. It also made me realize how much more support we get here as well in preparing for and responding to those experiences. Junior doctors had to deal with a lot more, so it also made me quite grateful of the support we get here at Liverpool.
Your winning photo from the Elective Photo Competition was very interesting – could you tell us a little more about it?
That was taken during one of the Outreach weeks. There's a pilot whose part of MAF (Mission Aviation Fellowship) who is from South Africa. But he travelled up to Tanzania quite regularly to fly people from the hospital to remote villages that you just couldn't access by road. That was sometimes quite a nervous experience – having to fly out to placement – because the plane only had five seats and felt quite rickety at times! Because I was there studying, they made me be co-pilot which was equal parts fun and terrifying.
When we landed at the clinic for that day, there was someone who greeted us who was from the Hadzabi tribe and who still used hunter gatherer methods. So, he was there with a bow and arrow and was ready to just kill anything that might be around for food because that's still how a lot of people live that far away from major cities.
The women we treated would travel quite far with the babies just to make sure that they got checked. I asked how they know when the clinic is there and open because 50 to 100 women would turn up. I kept thinking it's not like you've got social media or an easy way of saying when it’s open. But apparently, it's just been the case that they'll travel out at the same time every month for years and years, so local tribes just know when to travel out for treatment.
The work was mostly antenatal and the photo I submitted was of having to weigh babies out in trees surrounding the clinic. Any babies that had lost weight would then get reviewed by the doctor, but we’d also be giving babies vaccines, as well as general health checks, and then contraception and health checks for the women as well.
I suppose an interesting anecdote is that one of the times I was doing an antenatal check on a woman and a chicken just ran in the room, then one of the nurses with us ran in and grabbed it. It turns out she’d arranged with one of the patients to buy the chicken off them, because there were none where she lived, and that chicken was to come back with us in the plane we travelled in to be dinner for the night!
I’m not sure if I’ll ever do a placement car share with a live animal again!
Discover more
- Planning for your Elective this year or in future years, head over to the Electives section of the student intranet (link) for support.