So first thing first, can you tell us what kind of activity are you in?
I randomly took a flight to a country so far away, and next thing I remember was me being at an clerkship exchange program organized by IFMSA, particularly by AEM-Marrakech, IFMSA-Morocco. I got to do a 28 days clerkship at obstetric-gynecology department, Centre hospitaliare Universitariat (or, literally translated to University hospital) Ibn Tofail and Mohammed VI from January 1st until 28th. Then I stayed a little bit longer after that, going around cities in Morocco.
Why do you choose to go exchange in Morocco and get obstetric-gynecology department?
Morocco is a beauty and a very open country! Yea, it’s kinda sad knowing that my foremost reason of choosing is for tourism purpose not some academic or it’s healthcare aspect (in fact, their healthcare quality is not good, even worse compared to ours right now. Morocco kingdom, as I know from my fellow Moroccan clerk, doesn’t really allocate much to the health sector). But it kinda it is, can’t help not telling the truth.
I don’t pass the obstetric-gynecology exam and I don’t get to study it over again (you fellow unej medstud know why haha). I want to have beneficial time on my exchange and what’s better than studying something you’re suck at? So like, yea, that’s pretty much how my decision was made.
How were the early days of exchange going?
It was so different from Indonesia, the weather, the language, the building, the etiquette, the luxurious cars wandering everywhere. So like yea, it was so exciting for me. The language, it kinda my biggest obstacle there, since they speak Arabic-french and I don’t speak any of those language, just know a little from high school lesson. French is also widely used everywhere, written and spoken. So I re-learned French there haha. All the patients only speak Arabic, so I cant communicate with them alone. However, the educated can speak English well, they helped me to understand and learn from the case, they even bother used English when I was around, it was so nice! Considering that they don’t use English in daily basis.
I used public city bus to go everywhere, it was cheap and liked it so much 😀 it was not that comfortable, but our government here doesn’t even bother to provide us a good mode of commuting aren’t they? At the hospital, I was so confused to differentiate between doctors-nurses-residents-students because they don’t wear particular badge or clothes that differentiate one role from another. There was even this one time that I asked what year was this guy in and turned out he was a doctor at the department. I was also a little bit upset with the doctor and patient relationship, because the ethics is different from ours here in Indonesia. The medical records and the medicine brochure is also in French and Arabic, so I translated the words and tried to understand the content, while learning French in the same time (I mean, French is the second most used language in the world, so it’s quite important, right?)
Can you tell us the process of one of the cases?
There is quite some amount of cases tho, because it’s obstetric-gynecology department. Let me sort some that’s quite interesting. Mmm… There’s a lot of case like the following case, and in fact, it’s not a special case in the department, but it’s kinda a highlight for me.
It was in the middle of the night, around 11PM I reckon. Amidst a very thick fog outside, a car rushed to the porch, brakes screeched, and the hospital guard running with ambulance bed rolling. From the car, now on the ambulance bed, it was a pregnant women screaming so loud, I can hear it from upper floor and yeah, hearing women screaming of the pain of labor like that is horrible, sad, and scary in the same time. The amniotic fluid flowing from her groin already, meaning she’s currently already on the first phase of delivery. From the medical records she brought from previous healthcare facility, I able to perceive that it’s her third pregnancy, none of the two previous pregnancy made it. That’s not good. Fetal heart rate was low, meaning the fetus is at a critical state, it need to be delivered as soon as possible. The woman however, had lost a lot of energy. I mean, yea of course she was, she came all the way from a rural, sent to this facility. She was on the red area of partogram. All that journey and the pain she endured on the way, she still had to work more, putting the remaining energy with the hope to deliver the baby. The woman was put on a lithotomy position, without any talk preceding the decision regarding the position, I assisted holding one leg while my friend holding the other. The doctor pushed the fundus from upper abdomen using his elbow to help adding power to the contraction of the propulsion. Had seen the baby head, the nurse secretly taking a surgical scissors off a table and the doctor took it directly, it seemed like a general code there, when to episiotomize and how to do it, everybody know. The doctor directly make the cut at 8’clock side, blood spurt off, a lot of blood, I felt dizzy like my blood was leaving my brain, the doctor quickly pulled the baby, the woman screamed of the pain, it was dead horrible, it even conflicted inside me.
The doctor team left the woman to the neonatology room. The woman was left there alone on the room, only me maybe, was seeing her from beside the door. It is in the middle of the very cold winter, I was wearing three layers of shirt inside my night shift pajama, still I feel the air in my bones. And there’s this women, survived the labor poorly, lost a lot of blood, in a shock state, and there, helpless on her misery. Her leg was shaking of the cold and the pain, blood (that supposed to distribute heat throughout the body) was flowing from beneath, escaping the vessel.
And like I said at the beginning of this story, this always happens in the night shift.
How’s the rest of the weeks?
I got used to eat what they eat, just except eating raw vegetables, that’s too new for me. I spent the rest of the week finishing my paper, corresponding with my lecturer in unej, and taking night shift when I want to. Because the day shift finished so early (started at 8.30 and finished at 12.00), I walked almost everywhere I could walk after the day shift, because the sidewalks is kinda wide and comfortable, the city is beautiful (or exotic to be precise), and also because I had a bus card, so I often took random bus route to sightsee the city, got lost, and figured out how to get back. It was crazy and scary doing that, it was possible that I couldn’t even got back, but I kinda liked the view, the bus, and the thrill, haha. I met and had conversation with people from all around the world, umm… maybe from major countries, and it was kinda nice, exchanged perspective from people with different ages, nationality, perspective, ethical principle, and identity. There was much more than that, and to be true, there was also a lot of bad experience, but I was only telling the good because it’s the website bruh! We can talk about the bad things unscripted. I mean, that’s fair right? You can’t expect every country (even the best one) have only good things, there is also bad things. We can enjoy the good things and learn from the bad things. I’m just being fair and honest (or so I thought) here.
What’s your favourite cases in the clinical times?
It’s gynecology-obstetric dude… only horrible things there haha. I don’t have any particular case I liked over another, every case is just the same for me. All of it always get me thinking and reflecting about how to make medicine I do become an effort that make everyone better in such a limited circumstance. How do medicine apply with the patients circumstance, their religion, their ethical-boundary, what we need to know from them, what we ought to do, and how to make an understanding for the patients’ best well being. Sorry for not giving you the answer you expected, but it the only opinion I have.
What kind of benefits that you had gotten other than clinical studies?
Mostly new experience, I met people from all around the world, various proffesion, and different ages. I got to understand myself, mainly, I got to see myself from another cultural perspective. What I did wrong and what I did right all along. Sometimes my routine here is so immense, I got caught up, and lost. By going away, seeing yourself from outside (literally or not) help me to know myself better. And lastly … I got to understand that I need to study more.
And the last thing, why are we as medical student should challenge ourself to study abroad?
In this era of free information, I guess the reason of studying abroad because they have better literature is no longer relevant. Study abroad is good because overseas, there is better culture, better work-ethics, and better-perspective, not to put our country in the worst position, Indonesia is good, but there is better country and we should learn from them. It made me realize that an institution is a house of cards. It depends on us, the people, to make this institution as we desire it to be. Every movement, every development, every milestones, everything we do is the cards that made our place we live in is what it is. This exchange, I think, is quite good if it aligned with your passion (especially if you’re really determined on, lets say, some particular specialistic). Be selective of the country you are going to pick, define what are you expecting from the exchange, and research about the country over the internet or your collagues. It can be a really good choice of exchange if it fits your purpose, but if not, there’s a lot more opportunities.
Article was written by Agung Anugerah