Australian Youth Ambassador helps to strengthen medical teaching resources and capacity in Fiji

Shaun Flint was an Acting Honorary Lecturer/Senior Registrar with the Fiji School of Medicine from April to October 2006.

The Fiji School of Medicine

Fiji is a Pacific country of islands and atolls, but beneath the idyllic setting lies a history of political turbulence, significant poverty among vulnerable groups and emerging health challenges such as diabetes and HIV. The capital is Suva, where the Fiji School of Medicine is located. The school is the major tertiary institution in the South Pacific for the training of health professionals and for the study of the health sciences, with programs in all the major health disciplines except nursing. It is responsible for the training of both undergraduate medical students and postgraduate specialist doctors with the large majority of medical practitioners based in Fiji and surrounding regions having undertaken its degrees.

The Assignment

My 6 month assignment - undertaken as part of the Australian Youth Ambassador for Development program - was to help strengthen the teaching resources and capacity of the Internal Medicine section of the Department of Medical Sciences. It was a small section, consisting of Robert Moulds, Professor and Head, and two other part-time physicians, Dr Anne Drake and Dr Joji Malani, with the large responsibility of teaching medical undergraduates the practice of hospital medicine during the latter years of their degree. The Internal Medicine section also administers and teaches the Master of Medicine (Internal Medicine) degree, which qualifies its graduates to practice as specialist physicians in the Pacific region.

The Experience

My first impression of my AYAD workplace - the Colonial War Memorial (CWM) Hospital in Fiji, was of peeling paint, colonial-style buildings and ageing equipment. Fiji does not yet own an MRI machine, and continues to use chloramphenicol, an antibiotic that although quite effective is no longer used in Australia because of the risk of rare but serious complications. However, fairly quickly this all came to seem normal, and what ultimately impressed me was the commitment and expertise of the local medical staff in applying their substantial experience and knowledge to achieve some remarkable outcomes within such a resource poor setting.

One of the unique aspects of the placement was the chance to combine my teaching responsibilities at the FSM with an active involvement in the day-to-day provision of medical care to patients at the CWM hospital. So a typical day might begin with the morning ward round, seeing anything from five to fifteen patients and deciding on their care for the day. I would then normally spend some time at the FSM, working on the ongoing task of revising and upgrading both the undergraduate and postgraduate teaching material. There is often a lunchtime clinical presentation to attend and then in the afternoon I might take some bedside tutorials or see patients in a busy outpatients clinic.

Lessons learned

The skills transfer was emphatically a two way process; in addition to my own formal and informal teaching of others I found myself learning much from local colleagues, particularly about making decisions about resource allocation in a country which spends between five and ten percent as much on healthcare per head of population compared to Australia. I also gained more specific skills in managing diseases like leptospirosis, typhoid and tuberculosis - all conditions seen with relative frequency on the wards at the CWM hospital but uncommon in southern Australia where I worked previously.

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