Working in Africa

Editor - For the past four years my wife and I have been involved in organising medical electives at Kiwoko Hospital. During this time we have seen a change in the attitude of medical schools to students who want to work in sub­Saharan Africa. From being one of the most popular destinations many students now seem to have to fight to be allowed to come here.

Medical schools fear that their students will contract HIV, even though in Africa they are more likely to do so through sexual contact than a needle stick injury. Students do not seem to be dissuaded from travelling to South East Asia or to an HIV unit in the developed world.

At Kiwoko Hospital we hope that students have far more experience of clinical conditions and ward management than they would in the developed world, preparing them for life as a house officer making life and death decisions on their return home. We are, of course, aware of post­exposure prophylaxis and we wear double gloves and goggles to operate.

The medical schools' attitude shows three things: paternalism-we know best, but in six months' time you will be a qualified doctor and you can stand on your own two feet; (neo) colonialism-we still want to control the developing world through our policies; racism-you can go to one country but not to another.

Deans should allow their students to make up their own minds, and post­ exposure prophylaxis should be more available and cheaper for those who choose to spend their electives abroad.

Medical students have a part to play in sharing their knowledge and experience with us, and we hope that such partnerships can be strengthened for the benefits of everyone concerned.

Nick Wooding, medical superintendent, Kiwoko Hospital, Luwero, Uganda


studentBMJ 2001;09:261-304 August ISSN 0966-6494