The benefits of taking a year out
Joanna Cook explains how her year out in Zimbabwe rekindled her enthusiasm for medicine
It was about this time two years ago, when I was an intercalated student, that I began to think that medicine was not for me. I have always been a bit of an idealist and the presence of these doubts perhaps bothered me more than their actual, rather vague, content. Perhaps it was a fear of commitment.
I found a leaflet on a university notice board calling for volunteers to work in "youth development" in rural Africa and I made an appointment to see my dean. The medical school was surprisingly sympathetic and I was given permission to defer my entry into the clinical school for one year. This gave me some time to think about my reasons for finishing the course and also the opportunity to broaden my horizons a bit--to go and live and work somewhere with a completely different culture. For one year at least I wouldn't be a medic. At the end of the summer I left London for Mashonaland East, in Zimbabwe.
There was a month's training
I arranged my placement through a London based organisation, Students' Partnership Worldwide (SPW). SPW sends young people from the developed world to work on health education and environmental programmes in rural Africa and Asia. Initially there was a month of training with the other volunteers on my programme, half of whom were European, while the rest were Zimbabwean. I was then sent with a local volunteer to a rural secondary school, about 100 km from Harare.
The school stood at the foot of a large rocky hill and was made up of three buildings, each with two classrooms. The window frames and doorways were empty spaces and every so often a cow would wander into class. There was no electricity, and we collected all our water from a bore hole well. Next to the school was a small shop selling provisions, such as salt, sugar, and fertiliser, which couldn't be grown or made by the villagers. The students lived in homesteads, which are small groups of thatched round mud huts, and some walked for several hours to attend classes.
I taught guidance and counselling
I was not allowed to teach formal curriculum subjects as it is thought that the use of voluntary teachers encourages an inappropriate reliance on Western donors and also exacerbates the high unemployment rate. How-ever, I was allotted time tabled periods where I had to teach guidance and counselling--subjects which the school would not otherwise be able to offer. Guidance and counselling is a combination of general health and sex education, with a bit of current affairs and citizenship thrown in. When I was at school we thought of personal and social education as rather a waste of time. Even though I attended a mainstream school the emphasis was, I think inappropriately, always on academic success. I now believe the aims of secondary schools should be much broader than this.
Most of my students would become subsistence farmers, and placed in this context, social education is very relevant. A knowledge of malaria, cholera, and bilharzia prevention and the ability to analyse and make informed judgments about contemporary social issues are surely more important attributes than plotting points on a graph or reciting lists of chemical reactions.
Rural Zimbabwean culture is very conservative and sex is not openly discussed. Similarly, the accepted traditional ideas about hygiene and infectious diseases, gender issues, and social values are rarely questioned. My village was relatively isolated from the outside world; there was no television or radio, but AIDS was prevalent--everyone seemed to know someone who had died and some of the children's parents were dying.
Reluctance to change behaviour
The vast majority of school children in Zimbabwe know how HIV is transmitted but, as in the United Kingdom, they often don't associate the risks with themselves and are reluctant to change their behaviour. The staggeringly high HIV rate in Zimbabwe is perhaps a tribute to the ineffectiveness of the Dickensian fact based approach to health education. We used non-formal education techniques, such as drama, sports, and creative writing in our lessons, and got an enthusiastic response from the students. By encouraging young people to question their values and opinions, and by personalising the consequences of their actions I think it is possible to genuinely educate--that is, to allow people to make decisions and modify their behaviour, properly informed of any risks.
I really enjoyed my year abroad and I do not think that I will ever regret going. Sitting through lectures and conveyor belt clinics it is easy to forget why we are at medical school. In Zimbabwe I was able to use a different approach to health promotion, but the ultimate aim was similar--to encourage a personal freedom from the effects of sickness. At the end of the year I returned to medical school and I think that the meaning of medicine had returned to me.
Joanna Cook, third year medical student, St George's Hospital Medical School
Email: joanna.cook/oo@hotmail.com
studentBMJ 2001;09:261-304 August ISSN 0966-6494
