MEDICAL WOMEN’S FEDERATION
Tavistock House North, Tavistock Square, London WC1H 9HX
Tel: 020 7387 7765 email: admin.mwf@btconnect.com
www.medicalwomensfederation.org.uk
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Name
Rose Tiller
Email
Ret016@student.bham.ac.uk
Project title
A reflection on the ethical dilemmas faced by medical students
during their elective in the National Referral Hospital in the
Solomon Islands, a developing country.
Location of your Elective
National Referral Hospital, Honiara, Solomon Islands
Contact details for your elective (eg. Website
address or email address of your project coordinator)
What did you achieve?
Rosalind Aqorau: raqorau@moh.gov.sb
Following my elective I was able to analyse and reflect on the
ethical decisions faced by seven students, including myself, on
their elective placement in the Solomon Islands. The ethical
dilemmas were looked at in the context of clinical challenges and
cultural challenges.
A further objective was to consider the ethics surrounding medical
students from developed countries undertaking elective
placements at the National Referral Hospital. Conversing with
hospital staff as to the costs and benefits of having elective
students, in addition to considering the broader debate
surrounding ‘medical tourism’, enabled me to consider this issue.
Moreover, I hope to have gained a greater insight into the
priorities and practices of international doctors and consequently
broadened my perspective of medical work and international
health issues. I was particularly inspired by the large proportion of
female doctors in the Solomon Islands despite considerable gender
inequality.
Would you recommend this location / project to
others?
Location: If you are interested in undertaking a medical elective in
a developing country, the Solomon Islands are a fantastic place to
visit. Ranked 143 out of 187 countries on the Human Development
Index, with one major hospital serving nine hundred and ninety
two islands, the National Referral Hospital in Honiara has limited
resources, especially blood supplies and basic medications.
However, the hospital has incredibly dedicated staff who are keen
to teach and you will not be put in a position of excessive
responsibility unless you choose to be. There are also a continuous
stream of Australian medical volunteers who understand the
differences you will be facing and offer a fantastic support
network.
Project: I found a project based around ethics was incredibly
interesting and offered me an opportunity to experience all areas
MEDICAL WOMEN’S FEDERATION
Tavistock House North, Tavistock Square, London WC1H 9HX
Tel: 020 7387 7765 email: admin.mwf@btconnect.com
www.medicalwomensfederation.org.uk
@medicalwomenuk
www.facebook.com/MedWomen
of the hospital. Enlisting the help of the other six medical students
provoked stimulating discussions and debates. I would also
recommend looking at the impact of hosting medical students on
the hospital and country visited as this is an important
consideration when visiting a resource poor country.
Further comments (eg. Travel advice, tips for
organising an elective similar to this etc.)
Would you be happy for you feedback form to
be available on our website?
Further comments (eg. A review of your trip)
max. 500 words.

Start planning early! Our first elective plan (same project in
South Africa) fell through so it was really helpful to have
time to come up with a plan B.

Be realistic about expenses. For example, return flights to
Honiara cost £1,166 and living costs are similar to that of
the UK.

If there is hospital accommodation, apply for it as soon as
possible. Staying in a student house cost £6 a night in
Honiara, less than a tenth of the cost of finding our own
accommodation.

Choose a broad project title because your expectations
might be different to what you find when you get there.

If possible, ask if you can wear scrubs whilst on elective
placement. This saves lots of baggage space on smart
clothes and shoes.

Get stuck in – you will see amazing things – but equally,
don’t work too hard. Make sure you have time to learn
about the country and the culture too. Make the most of
your weekends!

Ask the locals what you should see and do whilst you are
there.

Make sure you have an unlocked phone before you go
abroad (check twice!).

Enjoy it!
Yes of course.
For my elective I spent four weeks working in the National Referral
Hospital in Honiara, the capital city of the Solomon Islands. The
National Referral Hospital is the largest hospital for the islands
with 400 beds. The departments include general medicine, general
surgery, anaesthetics, emergency medicine, obstetrics and
MEDICAL WOMEN’S FEDERATION
Tavistock House North, Tavistock Square, London WC1H 9HX
Tel: 020 7387 7765 email: admin.mwf@btconnect.com
www.medicalwomensfederation.org.uk
@medicalwomenuk
www.facebook.com/MedWomen
gynaecology, and paediatrics. Local doctors and nurses run the
hospital and are supported by a number of Australian volunteers.
However, in spite of this the hospital is chronically understaffed
and poorly resourced, especially short of blood supplies and basic
medications.
Initially I was interested in working with the Anaesthetics
Department because this is a career I am keen to pursue. However,
I quickly realised that Solomon Island anaesthetics is very similar to
that of the UK, so I ended up spending the majority of my
placement working in the Emergency Department. In the ED I
helped to triage patients and identify those who were most in
need of medical attention. I also took care of simple patients
alone, for example referring suspected fractures for x-ray and
following them through to the fracture clinic. Most patients speak
Pidjin English and although it is not necessary to understand the
language because family members and nurses are happy to
translate, it is easy to pick up which helps aid communication.
Although I worked mostly with the ED team, I also rotated through
each speciality to gain a comprehensive understanding of the
workings of the hospital. When visiting the busy Labour Ward I
assisted in deliveries with the support of the midwives. I attended
Paediatric ward rounds and saw diseases which I have never seen
before, including a variety of congenital heart conditions and
malnutrition. General Medicine gave me the opportunity to learn
about infectious diseases including malaria and dengue fever, as
well as increasing cases of cardiovascular disease. Furthermore, I
attended grand rounds and teaching with the interns weekly.
Throughout my placement in the Solomon Islands I completed a
project on the ethical dilemmas faced by myself and six other
students during our elective in Honiara. We encountered a number
of clinical and cultural challenges, including being asked to
complete procedures we were not competent to do. A secondary
aim of my project was to consider the costs and benefits to the
National Referral Hospital of hosting international students. Whilst
the debate surrounding ethics of medical electives in developing
countries is complex, I believe they offer an incredible opportunity
for students to experience medicine in a different culture and with
different priorities. I concluded that a pre-departure training
programme considering ethical awareness and assessment of
competence would be useful for future years and I hope to
recommend this to my medical school.
I feel very privileged to have had this opportunity and am
confident it has enabled me to develop my skills both personally
and professionally. Working in a hospital in a resource poor
MEDICAL WOMEN’S FEDERATION
Tavistock House North, Tavistock Square, London WC1H 9HX
Tel: 020 7387 7765 email: admin.mwf@btconnect.com
www.medicalwomensfederation.org.uk
@medicalwomenuk
www.facebook.com/MedWomen
country was an eye opening experience and I learned a great deal.
I would thoroughly recommend this elective to future students.