John William's elective year as a young doctor in Zambia led to a lifelong ambition to work abroad once he had retired. At 60, the end of his career as a consultant obstetrician, he was offered a three-month stint in Cambodia with VSO.
The placement made use of his lifetime's experience of management, teaching and clinical work to improve the healthcare services in three hospitals in obstetrics and gynaecology. It was challenging but rewarding and John, now 71, accepted a second VSO position in the country the following year.
A new challenge
My elective in Zambia working as a newly qualified doctor was a life changing experience. I came back a different person. From then I knew that I wanted to work abroad again once I retired.
Ten years ago I did just that. I approached VSO and eventually we found a place in Cambodia as an Obstetrics and Gynaecology Medical Advisor.
Such a placement was always my plan. I had a lot of experience of management, teaching and a huge amount of clinical experience. Those three things were very much needed.
Skills in demand
The situation for obstetrics in Cambodia was almost dire. The specialist training for doctors consisted of a three-month course, with no follow up or supervision. Doctors were left to their own devices.
After the wars in Cambodia, there were only 10 doctors in the whole country. It meant that in some cases people were running hospitals having been appointed as a ‘doctor’, on the basis that they just had some medical connection.
In one hospital, surgeons did the obstetrics care. In some places, the theatre would be very clean but the rest of place was anything but. I worked at one hospital where the obstetrician was on strike; I had to persuade him to come back.
Learning to make do amidst scarcity
In terms of resources, there was no comparison to the UK. Equipment in Cambodian hospitals was old, not working or broken and thrown away. In one theatre, the water to wash your hands came from an open, standing water source.
You had to make do by the seat of your pants- that’s part of the thrill of this work. And there were harrowing situations.
I remember one woman we induced because of pre-eclampsia and she went into heart failure. We had to do a Caesarean where we found undiagnosed twins- they survived. She had pulmonary oedema, which was very serious. I wanted to treat her with drugs, but the ones we had in the UK weren’t here. Most drugs aren’t available. I went to see her in the recovery unit and found her being ventilated by her husband because the staff weren’t there to do it.
You have to carry on despite the situation in developing countries. You do it to improve people’s standards of care.
I’m proudest of producing a pre-eclampsia wall chart that convinced the director of midwifery and the Krachie Referral hospital to use Mannitol in pulmonary oedema – that became a National Publication.
I liked obstetrics because it was such a wide range of work. On a single day, you could have a wide variety of emotions and things to do; one minute you are doing a successful forceps delivery and saving a life, the next you are telling someone their baby has died or that they have cancer. Every half hour there is a critical decision to make.
Advice to future volunteers
I did three months with VSO and came back the following year. Since then, I’ve been abroad around four times a year for the past decade with the Liverpool School of Tropical Medicine.
If you’re retired and thinking about VSO then go for it. It is a fantastic organisation. You are very well prepared and looked after. I felt completely safe in their hands. Donating your time and skills is more useful than just giving £10.
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