Award Report - Anna Wood
St. Vincent is an independent nation forming part of the Windward Islands in the Caribbean and is part of the British Commonwealth. It has a population of approximately 120,000, about one tenth the size of the city of Birmingham where I am a medical student, now in my fifth year. This spring, I spent my elective placement at the Milton Cato Memorial Hospital in the capital, Kingstown, the main secondary care hospital on the island. This was an opportunity to see how medical care is delivered in another country with different problems and fewer resources.
I spent my five-week attachment in the 30 bed male medical ward. The majority of cases were of a similar nature to those encountered in the UK such as heart attacks and strokes, although patients did tend to present at a much later stage due to a lack of knowledge and money. However, there were several cases of diseases that I had not seen in my clinical attachments in England including late-stage syphilis and Weil’s Disease which is mostly spread by rats. I was also able to visit other areas of the hospital including the two-bed Intensive Treatment Unit and the maternity ward. I learnt that many of the health and social problems on the island were caused by the ‘rum culture’, exacerbated by high unemployment.
There are large differences in the way the hospital was funded compared to the NHS. Although the hospital was government run, there was a small charge per night for each patient. Medications also had to be purchased by the patient, even when given on the ward. Equipment and drugs were often donations from other countries and there was not a steady supply, meaning treatments were often changed depending on which drug they had in stock or what could be bought in from a neighbouring country, often Barbados. If a patient needed a blood transfusion, a family member or friend had to donate the equivalent volume of blood to the hospital blood bank.
Resources were often lacking for investigations seen as simple in the UK. For example, paper for the ECG machine was unavailable for several days, as were many blood tests. For more advanced investigations such as MRI scans, patients had to be flown to a different country to obtain them, all at the patient’s expense. This was a common topic of conversation between doctors and relatives, because if the family could not fund the trip, it could not happen.
In spite of these shortages, the medical and nursing staff managed to provide a high standard of care for the patients and I was made to feel very welcome at the hospital.
During my time in St Vincent I was able to explore the island, which is dominated by an active volcano and has both black and white sand beaches, semi-tropical rain forests and banana plantations. There are few tourists as the island has no international airport and is not a regular port of call for cruise ships, which means that most of the beaches are deserted. The main attractions are some dramatic waterfalls and several colonial forts built by the British in the early nineteenth century to defend the island from French invasion. I would like to thank LEH for their kind contribution towards my elective.
Anna Wood, LEH 1996-2007