Electives : planning your trip

One day Jesus called together his twelve disciples and gave them power and authority to cast out all demons and to heal all diseases. Then he sent them out to tell everyone about the Kingdom of God and to heal the sick.

Luke 9:1-2 (NLT)

The link between the spread of Christian faith and healthcare goes back to the example of Jesus and the early disciples. Preaching and healing have often gone together in the history of Christianity, whether it was the Christians in Roman times caring for plague victims, monasteries in the Middle Ages becoming centres of healing, or the establishment of mission hospitals throughout the world as part of the spread of the Gospel in the last 250 years.

Christians continue to make a significant contribution to global health and in many low- and middle-income countries faith-based organisations form a sizeable proportion of the healthcare system. I worked in Papua New Guinea where 50 per cent of healthcare was provided by church health services, which often have a reputation for serving under-served populations in remote areas with dedication, integrity, and limited resources.

An elective placement provides students with a special opportunity to learn about global health and see a different healthcare system first hand. In a globalised world, such perspectives are vital in understanding the patients we see every day in the UK. Experience in resource-limited settings can equip healthcare professionals with skills and ideas that they can bring back on their return.

As Christians, we are called to ‘love our neighbours’ — this can have global dimensions as we understand the challenges faced by others around the world and we see how we can be involved through prayer and action.

Some students use their elective to spend time in a global centre of excellence in the speciality of their choice and certainly there can be value in this, particularly if they are wanting to work there in the future. Other students choose to spend much of their elective time travelling or taking an extended holiday. So, it can also be a good thing to enjoy the journey and take time to appreciate the people and places we visit, within the constraints of what your university requires of your elective time.

The unique opportunity an elective provides to explore the health challenges and healthcare experienced by people in the majority world of low- or middle-income settings is particularly valuable. Christians may want to use this as an exploratory first step in a journey in global health and mission and see first-hand what it is like to work in medical mission. This may lead to further cross-cultural service in the future or equip you to support medical mission in other ways such as prayer, giving, and friendship.

For me, a medical elective in a rural mission hospital was a first step in a long journey to serving in Papua New Guinea. At the time I wrote:

Probably one of the best few weeks in my life, a real challenge but I enjoyed the medical work and opportunities for friendship. A good time to think, read and learn about mission work and life in another country and how others see the world. The six-week medical experience was worth about six months of training in the UK.

I was able to return to the hospital where I did my elective as a newly qualified GP for five months. After that I did further training to be equipped for medical mission — including Bible, mission training and tropical medicine, before going back to Papua New Guinea for another four years.

Medical electives are all about training, but students with more experience who are approaching their junior doctor years can often be quite useful to the receiving team. The key is in coming with a humble attitude as a learner and being flexible and willing to help. It is important to recognise your limitations and only work under the supervision of others and be able to say ‘no’ to things you are not comfortable doing clinically. In some low- and middle-income settings the hospital staff may be used to students being able to perform more practical procedures — it’s important to be able to say if you don’t have the experience and need supervision.

planning considerations

There are a surprising number of steps to work through in planning an elective and you should start the process 18 months beforehand. Leaving it too late can make it impossible to get through the required steps.

Here are some factors to consider in deciding where to go and what to do:

• What would you like to get out of the elective in terms of training experience? Are you looking for experience in a specific specialism or something broader? Most mission hospitals offer a wide range of experience in medicine, surgery, anaesthetics, paediatrics, O&G, and tropical medicine, which is useful for students and doctors in the initial stages of training. If you are interested in education, primary care, and public health, there can be opportunities in these areas too.
• Could this be a first step in medical mission that would lead to going back to the same place in the future? If so, is this a place where you could see yourself serving at a later point in your career, perhaps as an F3 doctor or junior nurse?
• Can you speak another language already? If not, you probably want to stick to an English-speaking elective experience as the language proficiency level needed to practice medicine is quite high.
• Would you like to go through a mission agency to be able to benefit from their experience and support?
• The electives database on the CMF website has listings for countries and mission agencies. cmf.org.uk/global/electives There are also elective reports from previous students. If you have questions or would like some guidance about good places to go, please get in touch.
• Is this a safe place to go? Your medical school may ask you to prepare a risk assessment document. Road travel, personal security, and access to medical help if you become seriously ill or injured are crucial factors. You will need travel insurance. Consult Foreign Travel Advice from the UK Government: gov.uk/foreign-travel-advice 
• Do you want to go on your own or with a friend? Travelling with others is better for security and safety and gives emotional support, as you have someone to share your experiences with before and after the elective.
• Once you have found an organisation and placement, you will need to apply for a visa, volunteer work permit, and fulfil any health clearance requirements, eg. HIV testing, and a chest X-ray for TB. These steps can take a few months. I would not recommend booking your flights until you have a visa and a work permit sorted out, as there are often delays.
• Seek out travel health advice. Websites such as fitfortravel.nhs.uk/home and travelhealthpro.org.uk will give you an overview of what you need. A specialist travel clinic is even better, and they can often provide vaccines and antimalarials. Some can prescribe HIV post-exposure prophylaxis in the event of a needle stick injury. This is a medicine you should take with you. Sexual health clinics may also provide this — your medical school should have guidance about this.
• Consider specific interventions to reduce your risk of malaria, such as insecticide treated bed nets, repellent, and clothing that protects your legs and arms from bites. Malaria can present several months after your return to the UK, so be suspicious about any febrile illness, particularly in the first year after your return.
• Don’t be put off by the costs of an elective. God can provide! If you reach out to people who have been significant in your life and have an interest in medical mission, you will find that others may be willing to support you in your journey in global health and mission through prayer, giving, and encouragement. Consider reaching out to friends, family, church, youth leaders you know, your local CMF group, and organisations that provide funding for electives (see CMF website for details). There are often specific bursaries available, eg. CMF has a bursary for students going to the Leprosy hospital in Nepal. Your medical school may have special bursary funds too. Consider the environmental impact of your elective in your choice and incorporate carbon offsetting into your budget. You can offset carbon emissions through Climate Stewards who also have health-related projects (climatestewards.org). 
• After your elective, arrange a debriefing session with the organisation that organised your elective, or someone from your church or CMF group. Write a report and thank any donors or prayer supporters. When you take photos on your elective, ask patients and staff for permission to use them in reports and online. Please send us your report to include on the CMF website as a help to future students.

what should I take?

• Ask the people you are visiting what might be helpful to bring. Take some small gifts, such as a solar light, caps, T-shirts, chocolate, or shortbread.
• Useful medical equipment and gifts would include a strong head torch, stethoscope, and pulse oximeter. Lifebox.org can supply robust anaesthetic pulse oximeters that beep. Cheaper alternatives are available via Amazon.
• Consider a journal, even if you are not in the habit of using one. There is so much to take in!
• Be ‘street-smart’. Why not take a decoy phone and wallet with you just in case.
• A small Bible.
• Travelling Light devotional book from CMF — cmf.li/3umQui9 
• Oxford Handbook of Tropical or Clinical Medicine.
• Dictionary, phrase book or language App. There are courses in medical french and spanish available.
• Stickers for children. A bubble wand might go down well too!

summary

• Consider the elective not just as a one-off experience but as a first step on a journey into global health and mission. Is this a place you could return to after qualification? Is it something that you could support going forward by prayer, giving, or staying connected personally with a health worker you met?
• Start the planning process 18 months in advance — there are a lot of administrative steps.
• Go through a mission organisation to benefit from their support and expertise. They have years of experience of helping other students organise electives and can help you avoid some of the pitfalls.
• Go with a friend if you can for added security, emotional support, and the opportunity to be able to process what you experience.
• As you travel, enjoy the journey, and take the time to appreciate the people and places you visit.

Further information

• CMF website electives resource including elective handbook. cmf.org.uk/electives
• The Electives Network, electives.net
• Electives planning webinar (CMF YouTube Channel) — to be uploaded.
• We can offer a ‘1:1 Elective Zoom advice call’ — contact dave.moore@cmf.org.uk
• CMF International Facebook Group (for CMF Members)
• Short training courses, Developing Health Course (5 days) — July 2024
• Global Track (18-month training programme alongside your study/work) — September 2024

Look out for CMF Global at the 2024 Student Conference, where we will be doing a seminar, and come talk to us there at our Global stand.