This week GibGirl talk to Melissa Bautista about her trip to Peru last year for a medical placement in Hospital Goyeneche, Arequipa. The reasons behind it, her experiences out in Peru and why she decided that she wanted to become a doctor in the first place.

I just remember the moment of relief when we all heard the baby’s first cry and knew she was now safe . . . That was my first impacting moment 

Melissa worked in Hospital Goyeneche, Arequipa, Peru from 27th June – 29th July 2016, this is how it all came about.

So tell us a bit about yourself, how long have you been working and studying to be a doctor?

Hey GibGirl, I’m Melissa a 23 year old Gibraltarian currently living in Manchester. I started my studies in 2012 at the University of Liverpool to become a doctor. I’m currently in Liverpool finishing off my final year before I qualify in the summer of 2018. Once qualified, I’ll start working as a Junior Doctor in the UK for a couple more years and then hopefully come back to Gibraltar.

What made you decide that you wanted to be a doctor?

Hhmmm, that’s a tough one. I actually originally wanted to be a Vet!

I always wanted to go off to University and when I had to start applying for courses I had to really think about what I wanted to do . I loved science and my grades were pretty good so I thought something along the lines of being a vet/doctor/dentist. I organised a 2 week placement in St Bernard’s Hospital where I ended up rotating around a couple of departments and meeting many inspiring people who spent their days looking after the sick.

Sand dunes, Huacachina, Peru

However, the moment I realised medicine is what I wanted to do was when I witnessed my first birth… When I say birth, it was actually an emergency C-section. I was expecting to watch some teeth extractions in one of the operating theatres when we were told to prepare the theatre for an emergency. At this point my young and sheltered thoughts (and heart) were racing, I was petrified of what was I going to witness. The surgery was a C-section due to a lady’s pregnancy having complications and her baby was in distress and needed to be delivered. I just remember the moment of relief when we all heard the baby’s first cry and knew she was now safe, and how calm and collected everyone remained under such pressure. That was my first impacting moment … and just a tiny fraction of the many magical moments full of emotion and passion that occur inside of a hospital.

I will never forget my first taste of medicine and how from then on, it’s all I can imagine myself doing. Why would you not want to spend you life helping others, be an investigator and problem solver, working under high pressure, being the helping hand during peoples best and worst moments? I could not imagine my life doing anything else. I was lucky enough to be given a couple of offers for medicine and since then I have never looked back.

How did you hear about this program in Peru and what made you decide to volunteer?

I completed my medical school finals in June of 2016 and once these were done we had to complete a 5 week medical elective. An elective is where we are able to choose in what and where we want to have a medical placement. I decided I wanted to do a placement in a less developed country where I could have more of an impact and experience things I wouldn’t be able to in the UK One of my flatmates had done her elective the year before me and had organised it with a company called Work The World (WTW) who organise medical related placements in hospitals around the world.

They have several destinations and one of them was Peru. I didn’t really know much about Peru at the time apart from it being a Spanish speaking country in South America and the home of Machu Picchu. I then did my research and instantly fell in love and wanted to explore what this country had to offer and at the same time be able to practise medicine in Spanish. Machu Picchu, Rainbow mountain, Nazca Lines, deserts and jungle all in one country . . . the decision was easy. Work the World had spaces available in a hospital in the white city of Peru, Arequipa, with a list of specialties to choose from, I chose Paediatrics and Obstetrics.

How did you feel about travelling to a country at the otherside of the world to take part in something you’d never tried before?

I decided to go alone. My best friend had travelled South East Asia alone and I was in absolute awe of her bravery and the confidence she gained and so I decided, if she can do it, so can I.

Before finalising my placement, I was terrified and had many moment where I thought I wasn’t actually brave enough to do it myself. Coming from a sheltered upbringing surrounded by family and friends, doing things alone was something I wasn’t used to. My parents were not happy with the idea, but it was a dream and I wasn’t going to let any doubts or insecurities stop me… Anyway there wasn’t anything to lose but everything to gain, in terms of experience. I read plenty of online blogs about women travelling alone and was reassured that It was something I could do. I then began to plan the trip and the fear dwindled into nothing but excitement.

I finalised my placement and just had to sit my exams and then I would be off to South America. I had a number of calls from WTW before the trip to brief me on my placement. They explained that there were vast differences between the medicine we practise here in UK and how they did things in Peru. They were trying to prepare me for what I was about to experience. When the time came, I literally had one day between sitting the hardest exams of my life and setting off into the big wide world, alone. The moment was full of anxiety, stress and excitement and practically all emotions heightened …. in combination with being an over-thinker, I was absolutely terrified.

What was the reception like at the hospital, were you, your experience and expertise welcomed?

The WTW company were incredible, they welcomed myself and 3 others into the WTW house and into Arequipa with open arms and were very supportive. However my first day at the hospital, was not quite the same. I was introduced onto the busy paediatric ward full of doctors and interns in their white lab coats. I had several smiles and about one introduction and then I was alone.

Paediatric Department

The doctors were busy and I must have just been another “extranjero“, probably in their opinions, who came from a shiny and cutting-edge world, here to experience what it is like where the grass isn’t greener. Also I would require effort to communicate with, so I don’t blame their coldness. However some people on the ward were friendlier than others but as I spent more time there I got to know who I would get most out of the experience with and gravitated towards them.

Some people were interested in learning from us and some just wanted to take photos. Most were surprised I was able to hold a conversation in Spanish and I found they warmed up to me when they saw an effort was being made.

In terms of my “expertise”, that was not very welcomed, the way they did things was very different from UK I learnt this was due to a combination of differences in medical training, culture and the availability or recourses. The hospital was very under resourced and the standards were extremely poor, nothing comparable to anything we have at home. Conditions were at some points astonishing and extremely concerning. Although difficult, I had to accept that the quality of their health care was not going to be the same as what I was used to. After all, I wasn’t in UK anymore. Although the shock of the quality of the hospital was hitting hard, I couldn’t ignore the universal reflection of passion and drive of some of the doctors and nurses, after all they were doing all that they could with the resources and medical training they had available to them.

Do you feel that had anything to do with your gender or nationality?

Definitely…nationality was a big one. Many assumed there was a language barrier based on my appearance and where quite surprised to find out I could somewhat communicate in Spanish. But before having to show I was capable of communicating, many doctors and nurses would avoid us, making it difficult to integrate ourselves.

Surgery

Gender I feel may have also been a reason, but like in UK I feel medicine is slightly harder as a woman. Although the gender inequality in medicine is more evened out with the medical school intakes having a slight female dominance, there are still some inequalities. Surgery especially, it is thought of as a male dominated profession and can be quite intimidating at times and this was still held true in Peru. Where the male to female the dominance was much bigger. it is not only the opinions of colleges that effects you but also the opinion of patients. As a woman, on many occasion it is automatically assumed we are nurses on the wards which although is complementary, it may limit the trust patients have in our medical opinions and this reflects the gender stereotypes we experience in society… Women are nurses and men are doctors. However I feel in some cases we may be disadvantage, we also have our advantages. I was placed in the labour ward of the hospital for one week and took this experience as a duck to water. I could empathise with the woman easily and thought this was reflected in their care. This might be slightly more difficult for members of the opposite sex.

How do our methods of treatment and care differ from theirs?

They both differed enormously. The treatments we give in developed countries mirrors extensive, rigorous trials and testing conducted by researchers to provide the best possible solutions available. This requires a lot of expertise, money and resources which are lacked in countries like Peru. The healthcare in Peru is one of the most under-funded in South America due to the lack of resources, poor management and natural disasters … basically free healthcare is unheard of. Peruvians with jobs get “seguro” which includes their healthcare but those who are unemployed get government subsidised healthcare. This subsidised healthcare, as expected is often of poorer quality and is the care they gave in the hospital I worked in in Arequipa. As this healthcare was mostly for those unemployed who cant afford the seguro, but the care was still at a cost and so most patients would present late on in illness and when their conditions were unbearable. I therefore got to see some shocking conditions which we would not have seen in U.K.

Teaching room in the hospital

A combination of lower education, lack of resources and cultural differences meant that simple things like changing gloves between patients, changing syringes, patient privacy and consent where unheard of. Some conditions are not treatable simply because there were no resources to do so. Simple painkillers like paracetamol and antibiotics which we take for granted were gold-dust. For example there was one oxygen tank with three masks for a ward full of children with pneumonia all needing oxygen. The care they could receive was very limited, but no only was it limited because of the resources but also the attitudes of doctors differed greatly. There was very little communication between doctors and patients and they were often not included in the decision of their care or even told what was wrong with them, leaving patients unnecessarily scared and vulnerable.

Do you think the experience was what you were hoping for?

To be honest, I was hoping to be able to help more than I was able to. However I had to remind myself, that “I wasn’t there to change the way things worked” and fix the crumbling pillars Peru’s healthcare was built-upon, shattering due to national poverty, unemployment and blows from “El Niño” and the damaging effects of natural disasters… How can a 5 week placement change all that? I was simply there to observe and help where I could, to see the healthcare in a different and less developed country to try and broaden my knowledge and understanding of medicine around the world. Even though all I wanted was to try and improve the way things were done, unfortunately it wasn’t my job and wasn’t possible. And so the experience did what it was aimed to do, I was able to see conditions I would never have come across in U.K, it helped me understand cultural differences in medicine, and appreciate just how lucky we are to have the healthcare that we do have. It also allowed me to see the negative effects of lack of communication with patients has on their care and how vital it is to empathise and be caring. These experiences have left marks (and scars) which I will carry onto my practice in medicine and hopefully make me a better doctor in the future.

Is this something you’d do again despite the outcome on this trip?

Yes I would. There are so many different cultures and healthcare out there and so much of the world to see…I think the best knowledge in life is experience, it opens your mind.

I want to help anywhere and everywhere that I can, especially where help is needed the most. However, I feel I may have a better experience once I am qualified as the impact and help I can give may be greater, but I definitely plan to do something similar in the future and hopefully make a difference to some people who are not as lucky as we are.

I understand you spent some time after this volunteer work travelling to the Galapagos Islands, that must have been an incredible experience?

It was amazing! I grew up watching Animal Planet and listening to the voice of David Attenborough, and had always known of the far away land of the Galapagos. It has always been a dream of mine to go but I never thought I’d be able to live the dream for myself at the age of 22. After my placement in Arequipa, I had a couple of weeks left before I had to return to U.K. I decided to travel around Peru and tick all the things off my list and when this was done I would go to Ecuador. The Galapagos are an archipelago of volcano islands a two hour flight off the coast of Ecuador. When I found this out, there was no questions about it. I was going!

I booked a flight from Peru to Ecuador and planned to travel a bit of Ecuador and then fly to the Galapagos. I booked a 2 week return flight to the Galapagos. The excitement was unreal, it was literally a dream I was going to live. Although I was enjoying my time in Peru and didn’t want it to end, I couldn’t wait to get to the Galapagos.

When I got there, it was paradise with white sandy beaches and crystal clear water… and the wild life was unbelievable. There were sea-lions casually lazing around all over the place and fighting with pelicans for food. There was sharks swimming near the shores and you could spot penguins on distant rocks.

I booked a last minute cruise around some of the many islands of the Galapagos so I could visit places you are unable to do alone and have a better chance of seeing the wild-life I wanted to see.

It was incredible. We had daily snorkeling which often meant swimming with wild sea-lions, Galapagos turtles, the occasional shark and seeing the most spectacular fish. We hiked around the non-inhabited islands to explore the land wild-life including basking marine iguanas (the renowned iguanas from Planet Earth II scene of iguana Vs snake) and then spent the evenings above the shimmer of the glowing plankton in the sea and under displays of shooting stars amidst the most incredible glistening sky. It was such a surreal experience amongst the true beauty of nature and wild-life. If it is not on your bucket list- Add it!

What would you say to any aspiring doctors or young readers thinking of going into medicine?

Go for it! If you have drive and passion and don’t mind a lot of studying ahead of you then do it.

My personal (and probably biased) opinion is there isn’t anything more rewarding you can do but dedicate your life to helping others. It’s a career with endless opportunities where you get to meet incredible people from many walks of life. Medicine is full of ups and downs, it’s fulfilling and heart-breaking, will have you in tears of joy and sadness but it is rewarding beyond means measurable. Don’t get me wrong, it is difficult… long hours of studying and placement and pressure to always be on-top of your game with little to no room for error, added to the months away from home, It can be exhausting and stressful. But at the end of the day it builds you to be a strong and courageous person.

BUT, there’s small print…

Medicine isn’t a 5 year course… it is life-long. You contently have to be learning and improving. You will have to stay longer than your medical degree to continue your training away from Gibraltar, something I wasn’t completely aware of when I applied at the age of 17. Also, you might not know if you can stomach the sight of blood or internal organs until you actually see it yourself, so I recommend getting placements and speaking to as many doctors as possible to get their opinions and experiences and know exactly what you are getting yourself into. But I genuinely believe medicine is amazing and if I’ve inspired a few budding doctors then I will be very happy.

If you have any questions or want to know a bit more you can always drop me a message! 🙂

 

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