Award Report - Irum Sunderji

A 26-hour plane journey away from London on the sleepy island of Ovalau, I completed my two-month medical elective.

Irum Sunderji.jpgThe hospital was understaffed, the facilities and equipment often lacking and internet was a luxury that the hospital simply could not afford. With only three doctors to staff the hospital, elective students were warmly welcomed and put to work!

My interest in women's health naturally led me to spend a greater amount of time in antenatal and postnatal clinics. Prior to my elective, I had noticed cervical cancer to be the most common cancer of women in Fiji. In clinic, I was able to inform women about cervical cancer and the screening process.

A combination of poor education, cultural differences and transportation issues on the island meant patients often did not present to hospital until advanced stages of disease. Life expectancy at this point was as low as six months, with no cure available. Preventative medicine and effective use of disease screening tools were an even greater priority for this reason.

Using records that had been manually documented over the last five years, I was also able to look in to how effectively the Fiji MoH Smear Programme had been carried out on the island and discovered less than 30% of women had been tested and less than 10% had been re-tested as per the guidelines on an island of almost 2000 women of child-bearing age.

Before leaving, I presented this data to the hospital staff with guidelines on how these figures could be improved. This included simple measures such as opportunistic screening during outpatient clinics.

I also compiled an electronic database consisting of all previous smear records to provide a more structured and methodical approach to re-calling women who had had abnormal smears as well as those who were in need of a repeat smear.

To say my elective experience was all work and no play would be an unfair comment. Aside from the hospital work, I found time to climb coconut trees, learn the ‘bula' (welcome) dance and sit with the locals as they drank ‘kava' (a Fijian grog made of plant roots). I saw breath-taking sunsets from the island peaks, swam with sharks and manta-rays and spent the evenings watching fire-dancers compete with one another.

My experience of healthcare in Fiji was worlds apart from the system in which I have grown up and studied. The importance of public health promotion and the deficits in healthcare in the developing world had never been more apparent, and my appreciation of our National Healthcare System never greater.

With special thanks to The Lady Eleanor Holles School, Royal College of Obstetricians and Gynaecologists, Wellbeing of Women and Ethicon for their generous donations in helping to make this elective possible.

Irum Sunderji, LEH 1996 - 2006