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The immediacy of what we can do as doctors can be both a blessing and a curse as an overseas volunteer. It felt fantastic that even during my first weeks as a volunteer in Zanzibar, Tanzania with fairly limited resources - antibiotics, fluids, perhaps oxygen if I was lucky - I could walk in to the hospital and save lives. And yet at the same time, Westerners sweeping in and believing they know what to do is a pretty problematic dynamic globally.
After six months with the NGO HIPZ (Health Improvement Project Zanzibar), I still don’t know what the answer to this dilemma is, but I do think that a model based around the idea of quality improvement fellows has a lot of promise.
In schemes like the Darzi fellowships in the UK, there is a sense that in placing trainees in organisations new to them, fresh external eyes is a strength: it means that fellows need to learn and hear from people locally and that there is no weight of pre-conceived expectations. I tried to view my role in Zanzibar in this light: aiming to be the extra capacity that meant the hospital staff’s own ideas about projects could move forward.
These are high ideals, and not always remembered in the day-to-day bustle of rushing between - for example - a dying stroke patient, new babies, and a ward of malnourished children. A clear focus on collaboration however, is why working on HIPZ’s mental health project in particular has been so rewarding.
Originally set up three years ago on the suggestion of one of the hospital’s experienced nurses, the hospital now has a thriving weekly nurse-led clinic for psychiatric illness and epilepsy. During my time there, we set up a second clinic at another site, drawing on existing learning and shadowing opportunities.
We learned so much from this process: not just about ways that mental health problems present in Zanzibar, but also working out the necessary logistics for a new clinic, how to talk to government ministers about mental health, and the frustrating minutiae of the Zanzibari drug ordering system.
For me personally, I have gained insights into management and service development which I would never have got at this stage in my career in the UK. The clinic nurses have been given the opportunity to specialise and lead a service, which probably wouldn’t have been possible without the extra capacity of a volunteer. And now there are two outpatient mental health services for the rural populations of Zanzibar, which simply didn’t exist before.
I would very much recommend volunteering with HIPZ to anyone with an interest in quality improvement and global health - to find out more visit hipz.org.uk
Bryony Hopkinshaw is an ST1 in paediatrics in London.
Dr Hopkinshaw, along with Bristol psychiatry CT3 Pete McGovern and Lindsay Solera-Deucher, who is currently volunteering with HIPZ, submitted one of the winning entries to this year’s BMA Doctors as Volunteers poster competition
Find out more about the competition