My elective experience – Rebecca Bromell

Kia orana to all!

I have just finished my three-week elective placement at Aitutaki Hospital in the Cook Islands, having swapped the Dunedin winter for something a lot more tropical – I left New Zealand with a high of seven degrees, and was welcomed to Aitutaki with a high of twenty seven! So far my experience has been eye-opening and one I’ll never forget.

Aitutaki is one of the outer islands of the Cook Islands, with a population of about 2,000 locals, plus tourists. It’s best known for it’s incredible lagoons and beaches, offering great experiences both in and out of the water.

From the moment you step off the plane you get an idea of just how laid back and welcoming it is – I was greeted personally with a lei of fresh flowers and directed right away to my hosts for my stay here.

Aitutaki Hospital is the sole medical facility on the island. Compared to what I am used to at home, the facilities are rather basic, with the ‘wards’ being very open, and missing some of the things I took for granted back home – wall oxygen and central air conditioning for example.

There are 28 inpatient beds in the hospital, and so far we have no more than three inpatients at a time. Most of the work we do at the hospital is in outpatients: the hospital also performs the primary care services for the community, with two rooms used Monday to Friday for drop-in or appointment-based GP style visits.

Often patients will simply turn up when they need to with no booking ahead, so the line of people can get rather long! The majority of patients speak english, and those that do not often come with someone who can translate for them.

At the same time, I’ve endeavoured to include Cook Island Māori in my consultations, which often surprises or amuses the children who come in.

Students here tend to get good opportunities to work independently and build their skills in all aspects of primary care. If you’re someone who likes to get stuck right in and use their practical skills to help others, Aitutaki is a great option for your elective!

While some of the things we see at the clinic are the same as back home, there were certainly some surprises in the prevalence of some conditions. There are approximately 450-500 patients with Non-Communicable Diseases on record, which translates to at least a quarter of the population. The incidence of Type 2 Diabetes and Gout far exceeds what I am used to back home.

The staff at the hospital have all been incredibly welcoming, kind, and easy to get along with. The doctor is very patient and easy-going despite the busy workload, and the nurses, some of whom trained in New Zealand, are a never-ending source of information about both the hospital and Aitutaki itself.

It’s also very easy to get involved with other areas of healthcare – myself and the other trainee intern here have both spent a day with the public health nurses travelling around the island to perform duties such as baby checks, following up on recent inpatients and providing education in the school.

Some of the main medical challenges I’ve noticed with being in Aitutaki are really to do with the isolation and lack of resources. The available medicines are decidedly limited compared to what I am used to back home, and the options for investigations are far fewer – while there is an x-ray machine and the ability to do some bloods on site, the majority are sent to Rarotonga (a 40 minute plan ride away). Any more advanced imaging requires referral to Rarotonga and often from there to New Zealand, as there is no CT scan or MRI available in the Cook Islands.

This leads to some rather involved thinking about likely diagnoses as well as reasonable treatment options, given the limited availability.

There are sometimes barriers formed by medication non-adherence too. While health education is moving in leaps and bounds to educate children and their families about NCDs, barriers still exist with the understanding and use of medications.

“That being said, living in Aitutaki has been overall a pretty great experience!”

Our workload at the hospital tends to diminish after lunch, so I’ve often been able to work half days and spend the rest of my time exploring or simply relaxing in what really is a tropical paradise.

The size of the island means that it’s easy to get involved in the various activities on the island, from simply spending time at the beach, to a lagoon tour, to seeing cultural shows and eating amazing island food.

Diving and what watching are also fantastic options! The climate has also been great, with daily sunshine and temperatures rarely below 20 degrees. Sometimes the heat at midday can get a bit oppressive, but thankfully the hospital is up on the hill, so it is a bit cooler and breezier during working hours.

Scooters are one of the main forms of transport on the island, and I highly recommend them! Even for someone as clumsy as myself they’ve been easy to handle and they make trips to the beach, around the island and to work a breeze.

One of the things that definitely helped before going on my elective was reading past elective reports and talking to students who had gone to the Cook Islands before, as this gave me the best idea of what to expect as both a traveller and a medical student.

What I wish I would have been told though is the important of being ready for the processes involved in organising your House Officer transition while overseas. The DHBs often require certain medical testing among other documents, so if you wish to begin your elective during the two-week break between third and fourth quarter, as I did, it’s important to have sorted these things out in advance.

I was fortunate enough that the latter part of my elective required many of these results from me before I left, so I already had them at hand, but for anyone who hadn’t anticipated this it may be difficult to organise last minute.

I would again like to thank MAS for their assistance in allowing me to make the most of my time overseas and truly get involved in the community here. The extra monetary help has definitely allowed me to get to explore all that Aitutaki has to offer and learn more about the people whom I am serving.

I’m about to head off to Rarotonga for my next placement, and I’m excited to see what new adventures await me there. I’m definitely going to miss the friendly and laid-back paradise that is Aitutaki, and I definitely want to come back here someday soon!

MAS Elective Scholarship Recipient
Rebecca Bromell

Rebecca is in her 6th year of Bachelor of Medicine and Bachelor of Surgery at University of Otago. Rebecca travelled to Aitutaki, Rarotonga and Boston during her elective.

Rebecca believes that medical students who develop a rapport with the culture and local communities while on their medical electives can become an asset to medical provision.

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