In this blog, medical student Emma Johnson describes her four-week ethical elective in Blantyre, Malawi and the huge value she got from the hands-on teaching and learning environment.
“For my elective I wanted to be in a totally different setting to what we see at home. I felt that it was an opportunity to go somewhere I was unlikely to go for another reason and gain a much broader understanding of healthcare in a low-resource setting. I felt that this would improve my practice in the UK and also help me to decide if it is something I would like to be more involved in once I graduate as a doctor.
Contributing to the partnership
I joined the Malawi-Cambridge ENT partnership, which is supporting teachers, families and healthcare staff to enable more deaf children in Malawi to access education and continue learning. Based at Queen Elizabeth Central Hospital in Blantyre, I was involved in a project to conduct research with the audiology department, through a qualitative research study that aims to understand the experience of children living with chronic otitis media – a common middle ear infection.
The project builds on the work already being done in the partnership, by establishing a baseline for the challenges faced by these children. As a research project, it involves local medical students and staff from the audiology department. This gives them, as well as us, the opportunity to be involved in primary qualitative research and to gain experience and publications from that. Our visit was an opportunity to get final ethics approval for the study, and I was instrumental in persisting with the application and ensuring we kept on top of all the various aspects of it.
Once the research is complete, it will help to guide interventions from both the hospital and education system. We were able to meet the Chief Education Officer while in Malawi and they were very keen to hear the results of our research once complete, especially if it points towards alterations in current practice that could support children in schools with hearing loss.
Being thrown into an intense placement in a healthcare system and culture I was unfamiliar with has given me greater confidence and a stronger willingness to push myself beyond my comfort zone.
Building confidence through hospital placements
During my elective I also undertook placements in the departments of A&E and internal medicine, and these were definitely the most challenging parts of the experience. I witnessed far more deaths and late presentations to hospital with advanced disease than I have ever seen in such a short space of time in the UK.
However, being thrown into an intense placement in a healthcare system and culture I was unfamiliar with has given me greater confidence and a stronger willingness to push myself beyond my comfort zone. Professionally, it was a real eye-opener. I spent a lot of time watching consultants do incredible diagnostic work with just the basics—a good clinical exam and a detailed patient history. Without the usual advanced diagnostic tools, they had to rely on their clinical examination, history taking and experience. This made me realise how much I depend on tests and technology back home. It was a great lesson in sharpening my own clinical skills and trusting my judgment more.
Adapting to the low-resource setting was another big learning curve. I saw how they made the most of what they had—like using cannulas instead of lumbar puncture needles and finding ways to deliver oxygen even when the proper equipment was missing. The level of problem-solving and practical thinking involved in treating patients with limited resources was impressive and something I know I’ll take with me.
One of the most memorable experiences during my time in Malawi was after a tough afternoon in the ED. We had a young child in critical condition, and despite our best efforts, the CPR attempt failed. It was a hard moment for everyone. After the shift, the team decided to go to a nearby cafe to unwind and make sure everyone was okay. They invited us along, and I appreciated how they made us feel part of the team. Sitting together, we had the chance to talk about the day and get to know each other better. We sat in the cafe as the sun set, which was quiet after a hectic day.
Learning from different healthcare systems
Being part of a global health programme made me think a lot about the benefits of learning from different healthcare systems. For example, the style of medical education in Malawi was much more hands-on and practical than what I’m used to, and I found that approach effective. It’s made me realise that there’s a lot we can learn from other countries’ approaches to medicine, especially in how to teach and train future doctors.
In Malawi the students are given a few patients on the ward to look after – ensuring they are up to date with the case, presenting to the consultant at ward round and following up on investigations. There are two ward rounds a week designated for teaching, with a consultant discussing the diagnostic reasoning with the students and quizzing them on the presenting illness. They also have case presentations every morning – an hour slot where two medical students each present a case and fellow students, registrars and consultants. This was invaluable learning and teaching unlike anything we have been exposed to in the UK. Being given more responsibility and high-quality teaching made us feel much more valued and part of the medical team and will be missed by both of us when coming home.
Embracing a different environment
The social aspect of the trip—meeting such a diverse group of people from Malawi and across the world—also gave me the opportunity to broaden my perspective and understanding of different cultures and provided me with a unique insight into how people live in different parts of the world. I was impacted by the resilience and warmth of the Malawian people – their sense of community and the importance they place on relationships taught me valuable lessons about the strength of human connection.
Living in a new environment pushed me to become more adaptable and independent. I had to navigate a different culture, language barriers, and unfamiliar living conditions, all of which contributed to my personal growth. A big adjustment was getting used to “Malawi time,” where people were very relaxed about being 1-2 hours late. Initially, this was challenging, but over time, I began to appreciate how this more laid-back approach contributed to a less stressful way of life. The experience has taught me to be more relaxed about things that don’t matter as much and to focus on what truly does. I also became more self-reliant and learned to embrace uncertainty, which has made me more resilient in the face of challenges. Overall, this experience has made me more open to future opportunities and different ways of living.
The level of problem-solving and practical thinking involved in treating patients with limited resources was impressive and something I know I’ll take with me.
Looking ahead
I would definitely recommend global health work to my peers. I think that the experience I gained from this trip will be invaluable in my approach to medicine in the future. Despite theoretically understanding some of the challenges faced by another system and having been told about the hospital by others, this did not compare to the learning I gained from spending a month in the hospital.
It made me appreciate the value that international healthcare partnerships bring to both healthcare systems and how rewarding and enjoyable it is to be part of this and have the opportunity to visit and work in another place.”
Emma’s trip was made possible by funding from the Thriplow Charitable Trust.
Find out more about ethical elective opportunities with CGHP’s partnership programmes, or contact us at info@cghp.org.uk
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