A Pre-Medical Gap Year Experience in The Gambia

By soon to be Imperial medical student, Hannah Lewis

photo with crocI will start my medical course at Imperial in October 2015 and I was lucky enough to spend 5 months in Gambia at the beginning of the year, gaining insight into medical research in resource-poor settings. It is the smallest country in West Africa, and it is where the British Medical Research Council (MRC) has a big research unit. I worked closely with the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) group, who are looking at the link between hepatitis B and liver cancer.

Initially, I was concerned that, with no previous medical training, I would not be able to learn as much from the experience as fully-fledged medical students. Security was also a concern, if more for my parents than for myself. Although Gambia was unaffected directly by the Ebola outbreak, we still had concerns about it. Despite this, I was excited for the chance to travel there. After a brief training period at St. Mary’s Hospital, it was with great excitement and some trepidation that I travelled to Gambia.

Hannah in labUpon arrival, I had thorough training in laboratory practice at MRC Gambia and I developed my skills in handling laboratory equipment and biomedical samples. I became more dexterous and efficient in many laboratory techniques. These could then be put into practice to aid the PROLIFICA study.

I used my time to gain clinical experience in a very different setting to the UK, not only observing health professionals at work in a resource poor setting, but also learning how to take blood and measure basic observations, which allowed me to help with collecting samples for the study. Discussing cases with doctors and listening at the MRC hospital in Fajara was very interesting and where I acquired most insight into medicine. I also spent a week at the Edward Francis Small Teaching Hospital (EFSTH) in the capital, Banjul, which was eye-opening. It differed greatly from hospitals in the UK, with limited resources and less advanced infection control measures. I found the health care workers to be very helpful and keen that I gained as much learning from my time with them as possible, which I really appreciated.

I had the chance to travel upcountry to the MRC unit in Keneba, a more rural inland area, where the clinics were often poorly resourced. It was interesting to see how the medical teams made decisions using the limited information available. I also visited the supplement clinic for malnourished children and joined field teams performing finger prick tests for an anaemia study.

In one month, a colleague and I conducted an audit of adult liver patients who were admitted to the MRC Hospital ward. I had the chance to present and take questions regarding the results at the Clinical Services Department seminar. I also wrote a report on the Ebola crisis in West Africa and whether the response to it has been justified. This was subsequently accepted for publication in the Pan African Medical Journal

Hannah with monkeyThe gap year offered me a great deal of life experience. For the first time I had the chance to live independently, immersing myself in a wholly different culture. Learning some Wolof and Mandinka, two local languages, helped immensely in the clinics. The other students who were living there created a support network of friends that was essential and made the experience great fun. Colleagues often invited other students and me to their homes. There was a vibrant social scene with many people coming in and out of Fajara from around the country and everyone was very welcoming and friendly.

Looking back, it is clear that I learned a lot and grew in confidence from this experience. I expect that the laboratory techniques I learnt will prove useful for future research projects in medical school, or later in my career. Most importantly, I think that I became more thoughtful about the medical research process. I also believe that I am more informed for future medical decision-making, but I think I am most proud of how I have managed to adapt to working in an unfamiliar environment. This has certainly reinforced my aspiration to study medicine and I cannot recommend this experience highly enough.

I am grateful to Professor Simon Taylor-Robinson from IGHI, Professor Sue F. Smith and the team at Imperial College Faculty Education Office for giving me this opportunity and to Dr Ramou Njie at MRC Gambia for hosting me. I am also grateful to Dr Jessica Howell and the PROLIFICA team for their time, expertise, patience and friendship. Dr Wafa Khamri, Dr Debbie Garside and Mary Crossey were very helpful in preparatory training in London. Dawn Campbell sorted out my travel arrangements and was always on hand for questions when and if I needed.

Hannah with group

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