Medical students on rural outreach

Second year Bachelor of Medicine and Bachelor of Surgery (MBBS) students of Divine Word University have planned weekend rural visits to remote villages in Madang Province. Two students KEVIN SENGI and JOE SILAS share their experiences of the rural visits.

During each rural visit the MBBS students are accompanied by a medical doctor, who is also a lecturer, from the Department of Medicine within the Faculty of Medicine and Health Sciences.

The most recent rural visit was to Ariangon in Bogia District, making the third after visiting Mogil in Bogia and Brahman in Usino-Bundi districts. This time five students went with Professor Jerzy Kuzma, the Head of Medicine, to Ariangon in inland Bogia.

The trip started with a three and half hour drive to Bogia on the afternoon of Friday 4th August, 2017. Early the next morning (Saturday 5th of August) we drove for a further hour inland from Bogia station to Ariangon through a muddy road.

The poor road condition, which in wet season is not passable, makes it difficult for the people to access to services and the area is under-developed. This area is affected by poverty stemming from low income, low education, inadequate access to clean water and sanitation facilities and very poor access to health services. These conditions have contributed to the high incidents of ill–health in this area.On our arrival there were over 400 sick patients waiting for us.

The first message to be heard from the people from there was “it was the first time in 30 years for such a health team with a doctor to visit this place”.

The health center staff members were present full and they assisted the doctor to sort out the waiting patients. They began by selecting those patients who would benefit most from seeing the doctor.

We, the students, worked under our lecturer’s supervision with a short break for lunch which the local people prepared for us. All in all, we examined and gave treatment to more than 120 patients. We were sorry for those who could not see the doctor. Some of the patients we referred to seek help in the provincial hospital in Madang, however many stated that it would be hard for them to secure money for the travel into town, which is over four hours away.

We experienced in part challenges faced to deliver clinical services to remote and rural populations. We also learned the advantage of rural clinical visit that exposed us medical students to practical upskilling opportunities and diagnostic challenges especially when laboratory tests and imaging were not available on site.

Working under the supervision of our lecturer, we also took the opportunity to deepen our clinical skills and exercise clinical thinking in a real low-resource environment. The people came with so many diseases; common were tuberculosis, pneumonia and sexually transmitted diseases.

The visit also gave us the opportunity to refine our examination techniques.

One female student shared her experience this way: “I learned the different respiratory sounds and what they mean and the possible diagnosis that is accompanied with each. What I noticed there was a need for a pathology laboratory where specimens for TB and other diseases like the STIs can be checked for diagnosis. “Moreover, I also saw a need for things like hospital beds, water tanks, medicine and other equipment in the village health centre.”

Another female student added: “There were what seem to be hundreds of people gathering at the local health center when we first arrived. When I saw this, I pity those unfortunate people. Majority of these people couldn’t make it to Modilon General Hospital in Madang town because of the road distance and lack of money. They told me the PMV fare was K60 which most of them cannot afford.

She added: “As the saying goes: seeing is believing. You will not feel the pain these people face every day unless you actually see what they are going through. With that, my mind is fixed; I am willing to serve the rural majority wholeheartedly in years to come. “

Another MBBS student also shared his experience of the visit to Brahman health center: “What inspired me the most in our visit to Brahman was seeing the hope that the people had when they heard that a doctor was coming to see them.

“Because such rural places hardly have doctors, many people from very far away villages walked to the station upon hearing the news.

“We attended to more than 60 patients, and unfortunately, there were still more when we left because of insufficient time. Also, many couldn’t be helped due to insufficient basic medical resources.

However, I do believe that some patients got healed one way or another that day because they believed that doctors were there for them and just by listening and attending to them attentively made all the difference.”

These rural visits are helping us the MBBS students appreciate what the needs and challenges are in the rural and remote areas of our country where majority of the population live.

We feel that by going to the rural and remote areas constantly and seeing the people, we can identify the gaps in existing health delivery and we can contribute meaningfully in addressing these gaps in our primary health care and save lives in our country. We feel that as a team we can make a difference in addressing the gaps in primary health care in rural areas in PNG.