Authors: Emily Lomax, Alex Burns, Kate Darlow
Publication date: 22 Nov 2012
Emily Lomax outlines how you can volunteer with VSO, while Kate Darlow and Alex Burns share their experiences of volunteering with the organisation
Volunteering internationally gives health professionals the opportunity to develop new skills, respond to a broad range of challenges, and learn to do more with less. The international development charity VSO gives health professionals from all backgrounds the opportunity to volunteer and improve the quality of healthcare in developing countries.
VSO volunteers do not just fill vacancies in hospitals and provide clinical treatment: they share their skills with local health workers. This ensures that they will have a lasting impact in these countries by building the capacity of health workers to save lives. Volunteers improve health standards for poor and disadvantaged communities that face such challenges as under-resourced hospitals with a lack of trained staff. Volunteers live and work in such communities for between six months and two years, giving them the time to develop working relationships with local people and jointly to come up with sustainable and context specific solutions to problems.
The obstetrician and gynaecologist Kate Darlow and the general practitioner Alex Burns volunteered with VSO for six months and a year, respectively. Here they explain why they chose to volunteer abroad and the effects of their experiences on the organisations in which they worked and on their own careers.
Kate Darlow, 33
Volunteered with VSO for six months in Ethiopia. She has been back in the UK since August 2012
My six month placement with VSO was in the obstetrics and gynaecology department of Felege Hiwot Hospital, Bahir Dar, in western Ethiopia. The maternal mortality rate in Ethiopia is 676 deaths per 100 000 live births, which is almost 100 times higher than in the UK. Of the country’s 84 million people, 85% live in rural areas and are often very remote from healthcare services. Most women do not have a health professional present at their delivery. As a result, those who do go to hospital are often experiencing severe complications with their pregnancy or delivery.
By 2015 the Ethiopian Ministry of Health aims to have trained 8760 health professionals to meet its target of 95% skilled birth attendance. To support this initiative, my role involved teaching medical students and training hospital staff. Along with a paediatrician volunteer, I established training workshops for staff in obstetric emergencies and neonatal resuscitation. We started by training senior staff and then helped them lead the workshops with doctors, midwives, and anaesthetists from different wards. We used scenarios and delivery models to discuss how to respond to emergencies related to giving birth and neonatal resuscitation, as well as the basic care that is required when a baby is born.
The participants gave us really good feedback, and all performed well. Each day I saw how much their clinical skills had improved. One of our trainers, an anaesthetist, saved a baby’s life by using resuscitation skills she had learnt during the course.
I improved services at the hospital through the use of audits and managing acute and chronic inpatients. The reasons for the hospital’s high maternal mortality rate and stillbirth rate of 10% are complex, but small changes can make a difference. I improved the documentation in the hospital by creating a pro forma operation note, a simple procedure to remind staff to record important information. By collecting information about every patient with a ruptured uterus—a staggering one in 35 deliveries—we were also able to make improvements to patients’ postoperative care. When I left, the pro forma was being used regularly by most of the doctors.
I trained as a doctor in Scotland and am now in my sixth year (specialty trainee year 6) of the seven year training programme to qualify as an obstetrician gynaecologist. I was required to have reached specialty trainee year 5 as a minimum for my placement in Ethiopia. The experience I gained there doesn’t directly count towards my years of training in the UK, but it is invaluable in terms of managing complex cases and developing management and interpersonal skills.
If you’re thinking about working with VSO, do it, because you’ll regret letting the opportunity pass you by. The hardest jump is getting yourself organised and getting out there, but when you arrive it’s brilliant. Life experiences are worth so much more than a salary.
Alex Burns, 33
Volunteered with VSO for a year in Sierra Leone. He has been back in the UK since August 2011
Makeni Government Hospital in Sierra Leone was a hot and challenging place to work. The rooms had bare walls, no equipment, and often little other than a bed, a patient, and a nurse. The nurses did an amazing job but had responsibilities beyond their capacity. When I arrived with my wife, Tash, a paediatrician, the paediatric ward was staffed only by nurses and had no doctors. In fact, there was only one trained doctor in the whole hospital, despite it being the main hospital in Sierra Leone’s fourth largest city. The lack of trained personnel is the biggest problem for Sierra Leone’s healthcare; the country has one health worker for every 5260 people, compared with one for 77 people in the UK.
VSO’s aim in Sierra Leone is to help develop the country’s health services. My priority was to educate staff and help improve training on the job. I was exposed to a level of clinical and people management that I wouldn’t have had the opportunity to gain as a locum in Cornwall.
In the UK people access care early on, and a high proportion of patients are fairly healthy. In Sierra Leone everyone I saw was very sick. Whereas in the UK clinical signs are more subtle, in Sierra Leone they are often obvious. The cases I saw were far removed from those we come across in the UK, in primary and in secondary care.
Sierra Leone does not have the same access to drugs, staff, or facilities that we have in the UK. I researched the World Health Organization’s guidelines to find simple techniques that could be applied at the hospital and realised that I had skills I hadn’t recognised, such as the ability to find out how to treat a condition I haven’t come across, how to interpret an evidence base, and how to critically question ways of working that could be improved. One simple and cheap method I applied was the World Health Organization’s partograph. I hadn’t used a partograph since medical school, but after reteaching myself how to fill one in I was able to introduce it and teach others about it. This has saved many women’s lives.
I enjoyed working with Tash because she reinforced changes and teaching that I was trying to promote. I remember one young boy who had been extremely sick with vomiting and gastroenteritis for 10 days; he was really on the cusp of death when we saw him. Tash and I managed to get an interosseous line in to give him some fluid and get him rehydrated. It helped us to get across some of our messages: the nurses could see us working together and doing something we had taught them independently.
I helped to implement many constructive changes in the hospital, and the local population was mainly very receptive to the new ideas I introduced. There is huge scope for introducing these cheap and effective solutions more widely across Sierra Leone, and I think that further volunteers would make a great difference. You do not have to come up with fancy diagnoses or perform masterful surgery. The things that save lives are often the cheapest and easiest.
Working in Sierra Leone has also given me a clearer perspective on issues such as clinical governance. I know that many of us don’t look forward to our appraisals, but working in a place where professional development support doesn’t exist shows you why these systems are so important.
Professionally, volunteering with VSO inspired me to start a masters degree in global health policy, and I am increasingly interested in how health strategies can work with doctors on the ground to change systems. The skills I’ve gained will also help with future management roles.
How to volunteer with VSO
Doctors, nurses, and midwives who apply to work with VSO now will start working in Malawi, Sierra Leone, and Ethiopia from February to September 2013. Roles include implementing procedures and teaching practical skills to trainers, permanent staff, or students. Although the roles vary, generally volunteers will need two to six years’ relevant professional experience, a professional qualification, and some experience of supervising, mentoring, or project management. The charity regularly holds information meetings and events across the UK for people who are considering becoming volunteers.
All applicants undergo a thorough selection process, and, if they succeed, VSO will work with its partner hospitals and training institutions in the target countries to match volunteers with the roles that best suit their experience. Volunteers then receive training about what issues to expect in the area where they will be based and are connected with other volunteers to give them further advice. Throughout this period, which can take up to six months, volunteers are given information about the development challenges in each country and are supported with fundraising initiatives. VSO further supports volunteers by covering the costs of flights, visas, accommodation, and a basic living allowance.
Volunteers don’t just save lives; they pass these lifesaving skills on so that long after the volunteers have returned home doctors and nurses in developing countries are able to make a large scale difference to people’s lives.
To find out more about how to volunteer and the wide range of roles in various specialties across 33 developing countries, visit [Link] .
Competing interests: None declared.
- Central Statistical Agency Ethiopia. Ethiopian demographic health survey. CSAE, 2011.
- United Nations Population Fund. The state of the world’s midwifery report 2011: delivering health, saving lives. UNFPA, 2011. [Link] .
Emily Lomax head of UK volunteering
Alex Burns general practitioner Truro, Cornwall, UK
Kate Darlow obstetrician and gynaecologist Victoria Hospital, Kirkcaldy, Fife, UK