Colonial War Memorial Hospital and the Fiji School of Medicine, Suva, Fiji
The Fiji Islands are well known as a holiday destination in the South Pacific characterised by stunning beaches, extraordinary snorkelling and diving and incredible sunsets (www.bulafiji.com). Look behind the resort veneer, however, and you will find that the modern Fiji is a friendly but complex society that is currently confronting a number of health-related issues within a relatively modest healthcare budget. These include a high and increasing incidence of diabetes and related diseases and a much smaller but increasing incidence of HIV in addition to the ongoing problems posed by tropical infectious disease: tuberculosis, typhoid, leptospirosis ...
The medical school:
The FSM is the major tertiary institution in the South Pacific for the training of health professionals and the study of the health sciences (www.fsm.ac.fj). It is the only institution other than the UPNG which has an MBBS and MMed postgraduate program. Most medical practitioners based in Fiji and surrounding Pacific Island nations undertake training through the FSM.
The CWM is the tertiary referral hospital for the Fiji Islands and a teaching hospital of the FSM. It is the best resourced hospital in Fiji, possessing a relatively comprehensive range of services including the country's only CT scanner however any visitor will quickly identify areas of need (in medications, staff and equipment). For example, oncology services are by no means comprehensive, there is no renal dialysis program despite a high incidence of renal failure, there is a limited and occasionally erratic range of available medications (although adequate for most, not all, needs) and emergency services in the hospital are poorly developed. Nevertheless, the CWM's consultants and registrars are more than competent, some important investigations (such as echocardiography) are more available at the CWM than many peripheral Australian hospitals and the overall clinical outcomes are impressive given substantial resource constraints.
My placement was arranged through the AYAD program (www.ayad.com.au) and the Department of Medical Sciences at the FSM. The AYAD program is an AusAID funded program which places "skilled young Australian volunteers, aged 18-30, on short-term assignments in developing countries throughout Asia and the Pacific.". Other potential sources of funding (without age limitations) might be the VIDA program or the AVI program, also administered by AusAID.
This particular attachment was specifically targetted at the physician trainee who had successfully completed their Part 1 exams and in broad terms its purpose was to help strengthen the teaching resources and capacity of the internal medicine section of the department. This section has the responsibility of teaching clinical internal medicine to later year undergraduate medical students and of teaching and administering the Master of Medicine (Internal Medicine) degree, which is a postgraduate qualification designed to allow its graduates to practise as specialist physicians within the region.
My activities with the department evolved over time but fell across three major areas - time spent developing resources for teaching, actual clinical teaching and time working as a doctor at the affiliated CWM hospital. Overall, my experience working with the department was overwhelmingly positive. I left having gained specific experience managing common tropical diseases, experience helping deliver a comprehensive teaching program in clinical medicine, and with a broader and deeper perspective on issues in international health. One of the particular benefits was the ability to combine teaching responsibilities at the medical school with an active involvement in the day-to-day provision of medical care to patients at the CWM. A typical day might begin with the morning ward round, seeing anything from five to 15 patients and deciding on their care for the day. I would then spend some time at the FSM, working on the ongoing task of revising and upgrading both the undergraduate and postgraduate teaching material. In the afternoons I would usually take some bedside tutorials or attend a busy outpatients clinic.
The placement was for six months, which was barely long enough to make a useful contribution ... were I going again I would try and find at least nine months, and maybe twelve.
Living in Fiji:
Living in Fiji can be remarkably comfortable - certainly my (government provided) accommodation - although basic - was more luxurious than many rural Australian hospitals will provide. I was based in Suva (the capital), which meant that vaguely decent latte's and other such luxuries were not out of the question. The cost of living is comparable to or less than Australia; while local food and clothing are cheap, accommodation if renting, any imported goods and prices at resorts are comparatively expensive. English is an official language (and used widely at the hospital); the two other main languages are Fijian and Hindi - I'd recommend taking up one or the other although it's by no means essential. There is plenty of scope to travel around Viti Levu - the main island (and thus to experience the resort side of life in Fiji). It's a little more difficult (in terms of time required) to travel to some of the other islands, but well worth the effort.
Professor Robert Moulds
Department of Medical Sciences
Fiji School of Medicine
Suva, FIJI ISLANDS
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