Published: 26/05/2005, Volume II5, No. 5957 Page 26 27 28 29

Be honest, after a long day at work you have thought about giving it all up and doing something else, swapping the life of a harassed professional for something less stressful. But do those dreams stretch to helping those who are less fortunate? Have tragic world events ever made you realise that you could put your skills to use elsewhere? Would you be prepared to sacrifice two weeks of lying on a beach to spend your annual leave helping out the health system of another country? Over the next four pages Emma Forrest talks to healthcare workers who are prepared to do just that. We hear why they decided to become volunteers, the different perspectives it gave them on the NHS and the effects it had on their lives.

Mental health in Rwanda

The horrific events of the Rwandan genocide may have been 11 years ago, but the effects are still far-reaching. While tens of thousands still await trial for crimes carried out during the tragedy, massive effects are still being felt on the country's mental health.

'It is difficult to believe that such a traumatic event happened in such a small country, but the basis for most trauma for those who are very depressed or are suffering psychotic or schizoid symptoms is the genocide, ' says Sue Piddington.

'There is a lack of trust and a high level of stress; people have to learn to live next to old neighbours again when they might have been after you with a machete during the genocide. Everywhere you look in the countryside there are memorials. The stories are heart-rending: people covering themselves in blood and hiding under bodies, and so many stories about running away, and hiding.' Ms Piddington has a particular perspective on these circumstances. She first went to Rwanda in September 2001 and spent 28 months working as a Voluntary Service Overseas volunteer teaching Rwandan nurses to specialise in mental health.

'I felt it was time to do something different with my life. My husband had died some years before and my son had just finished university, so some of my financial constraints had lifted, ' says Ms Piddington, now a clinical nurse specialist in drug and alcohol services at Hillingdon primary care trust.

An original placement to Russia fell through, replaced by the job in Rwanda. The different way of life that Ms Piddington would have to get used to became apparent just two days after she had arrived in the capital, Kigali, for the first two weeks of in-country training.

'We were having supper watching this old flickering TV when we saw the twin towers being hit. It added to the unreality for me; it had no connection with anything that was happening in Rwanda. In Kigali it was a non-event, ' she says.

After initial training, Ms Piddington moved to a hospital in Ndrea, a village 15km from Kigali.

She was unsure what to expect.

'I had been led to believe the hospital would be more barbaric than it was, even to expect patients in chains. It was not like that. It was very basic, but compassionate. They do the best they can with the resources they have, ' she says.

Daily life in the hospital was similar to the former mental asylum where she did her nurse training. There were daily discussions between staff and patients about life on the ward, and patients had a kind of occupational therapy by helping out in the kitchen and with cleaning.

Ms Piddington trained students to go out into the community and set up clinics, although she had never lectured before and had no formal training in teaching.

'I was the first UK volunteer so it was a bit of a shock for them at first too. But the students made it a pleasure. I only lived across the road and I got to know many of them quite well.' Ms Piddington did not have access to a phone or easy access to e-mail without going into Kingali, but improvements in the mobile phone network meant she could keep in touch with her family by text message. They would call her weekly.

She has since returned to Rwanda twice with Medecins Sans Vacances, an organisation that arranges short-term placements in the area. She says she is unsure if she will return to Rwanda after this latest visit - she left the day after talking to HSJ. But the depth of her feeling for the country is clear.

'Rwanda has become a big part of my life, ' says Ms Piddington. 'I never felt entirely at home. I was always 'msungu' [foreigner] to some people and every time I opened my door I would get a crowd of kids in my garden. Some were a bit reverential, but I did get the students to eventually call me Sue.

'But what I take away from it is people's resilience and dignity; their need to move on with their lives, to be safe and strong. It is such a complete change that it is hard to make comparisons, but it does change the way you do things: turning on a tap at home is never the same after You have had to collect and carry all your water.'

Guatemala vacation

Judith Rixon became a volunteer in 2003 with Cross-Cultural Solutions, a company that arranges short-term voluntary placements in developing countries.

'I am Catholic and had spoken to several priests who had done missionary work. I wanted to experience something like that myself. I had booked the leave and took what was available. I had never been to Central America before. If I had thought about it I would have thought of going to India, but was offered Guatemala, ' says Ms Rixon.

Her three-week placement was in a nursing and residential home for elderly women called Hogar de Ancianas St Vincente de Paul in Guatemala City. It is is funded by the state and charitable donations. The women had a variety of needs, from dementia to physical disabilities.

'I had basic Spanish, although I had not used it for 20 years. Coming from a health background also helped when it came to meeting lots of new people. They wanted someone who could pass the time with the women. I had been warned that I would probably be left to my own devices and when I first got there I was.

'I spent two days wandering around introducing myself and then started to help the women who could not wash and dress themselves. They were not over-endowed with nursing staff.' A palliative care nurse at West Hertforshire trust's Mount Vernon Hospital, Ms Rixon says her time in the home reminded her of some of the basics of patient care.

'I went into palliative care because I believe in looking after the emotional and spiritual needs of the patient as well as the physical needs. But palliative care has developed so much that there is not always the time to hold someone's hand or give them a hug. In Guatemala, just holding the women's hands and giving them some one-to-one attention was as important as anything else; the nurses are too busy for that.'

Conditions in the home were poor by UK standards; beds often had only the most basic linen and requirements for privacy and dignity that are thought of as a 'given' in the NHS were almost non-existent.

'There were very few home comforts: rooms were shared, there were no shower curtains and often no privacy for women using the toilet. And there were cockroaches everywhere. But after three weeks I began to see it in context and got used to it, ' says Ms Rixon, who stayed in accommodation provided for CCS volunteers and had the relative luxury of a cook, driver and bodyguard.

'I should have worried about hand hygiene and cross-infection, but that is difficult when there is not always hot water - electricity is expensive - and just one sponge and bar of soap for everyone.' Ms Rixon only worked mornings, with afternoons taken up by organised tours to learn about the country and weekends free for exploring.

'It is a beautiful country - volcanic and green - but extremely poor. Illiteracy is a problem and everything is hard work. I came back to the NHS feeling impatient; people here seemed to have so much yet did not appreciate it. I was also challenged by the amount of waste, when everything there is recycled as often as possible.' Ms Rixon returned to the home for two weeks a year later and also spent one week at Mother Theresa's Home for the Elderly in the city.

'I was glad I went back because it made me realise how much my efforts had been appreciated. Some of the women were overjoyed.

We shouldn't think we can't do much with little. I will probably go back again, ' she says.

VSO in Cambodia

Rebecca Dove is a former PCT primary care manager who left London to go to Cambodia in February 2003. She is a Voluntary Service Overseas management adviser at the 60bed Stung Treng Referral Hospital.

Stung Treng is a remote province in the north east of Cambodia and borders Laos. The population of the province is approximately 100,000 and in addition to the hospital there are eight health centres. Many areas are accessible only by motorbike, and in the wet season only by boat.

'I applied to work for VSO because I was keen to experience working in a developing country and also attracted to the prospect of working as a volunteer. The two placements that came up after I was accepted were in Cambodia, ' says Ms Dove.

'The director and management team [at the hospital] had years of experience but very little management training, so lacked confidence in carrying out their work. But working with them is very rewarding. They are keen to learn and to develop.' Work aside, it sounds as if Ms Dove's placement has allowed her to lead a glamorous social life.

'There are quite a lot of formal events in Stung Treng, ranging from weddings to governor inaugurations. Because It is a small place I am often invited to attend with my colleagues, ' she says.

'When I am in Phnom Penh [Cambodia's capital] I take the opportunity to go out and party.' She meets up regularly with the handful of foreigners who also work in the Stung Treng area, particularly two other local VSO volunteers, and spends weekends travelling round the countryside by bicycle or motorbike. She has also done some fundraising work.

'Last year Nikki [a fellow volunteer] and I organised a sponsored bike ride. We had 24 participants and raised over $3,000 for the hospital's paediatric ward.' What sounds less fun is that the Stung Treng district enjoys only five hours of power a day - in the evening - although temperatures regularly reach 40 degrees during the day. Understandably, Ms Dove says she misses 24-hour access to electricity the most - along with chocolate and cheese.

Ms Dove is unsure about what she will do when she returns to the UK; she has already extended her original VSO placement to the end of May.

She plans to travel in Laos and Thailand before completing a handover period to her replacement.

She has resigned from her job in the UK.

'There is a possibility that I will not return to work in the NHS. I want to take some time after my placement to look at my options, but I am keen to continue to work in management development either in the UK or abroad, ' she says.

'My placement has more than lived up to my expectations. The best things are working with a committed team and seeing the increase in healthcare for the poor; but you can get frustrated at the slow progress. The lesson I have learnt is that if development is to be sustainable it can take a long time to create the changes, but they last longer than if I jump in and do the work myself.'

Bangladeshi rehab

Emma Corry, a Glasgow pharmacist, found that a voluntary placement made her remember why she wanted to join the profession.

On a placement in Bangladesh with Challenges Worldwide , while still a student, Ms Corry worked in a rehabilitation centre for people paralysed through injury.

'My placement involved looking at the management of the centre's pharmacy and helping out in the special needs school attached to the centre. But after another volunteer drew my attention to some pharmacy issues I got totally absorbed by it, ' says Ms Corry, who spent three months at the centre during summer 2003.

'Pharmacy is not a feature in hospitals in Bangladesh and chemists on the street are not run by trained professionals like in the UK. I found all sorts of potentially dangerous practices and areas in need of attention.

'Once I looked into it, I did some initial work and arranged a meeting with people including the centre's assistant director and chair. I drew their attention to what I had found in the hospital and suggested some possible solutions. I tried to make it clear that these suggestions were only rough guidelines, but I felt confident that they took on board what I was saying and would be able to find their own way of working things out.

'I left them with some forms to be used in their daily practice to keep their procedures safe and cost effective. A lot of the measures I suggested were organisational rather than pharmaceuticalrelated. They just needed someone to identify these problems, ' she says.

Ms Corry says the work made her enjoy pharmacy for the first time.

'It allowed me to see a whole different aspect of the profession and made me realise what an important role it plays in healthcare.' Since returning to the UK Ms Corry has kept in touch with the hospital and remains keen to help; she recently sent some pharmacy reference books.

AIDS in Namibia

It is not every day that HSJ gets to speak to someone who is dating the son of an African tribal chief, but former VSO volunteer Denise Cosgrove is one. Ms Cosgrove, who initially went to Namibia to work in local government as a regional AIDS coordinator in October 2001, is now a wellness and HIV manager for a mining company at the Rosah Pinah zinc mine in the south west of the country.

The post is a result of the firm's attempt to curtail HIV infection rates among its workers which currrently are above the national average of about 20 per cent.

'I was coming up to the end of my placement after extending it for six months to train antiretroviral nurses. I was doing a field trip when I met the human resources manager here and he sort of headhunted me. After I decided to stay I looked for a job and was actually offered four in one week, ' says Ms Cosgrove, who has been in post since July last year.

She had previously done a variety of public and voluntary sector jobs for 10 years, all with some element of HIV/AIDS training and education. She had always intended to apply to VSO.

'I always thought I would go home after my placement, but I thought about the skills I had and thought I could do more here than back in a country where the prevalence of HIV is low and there are more professionals to work with them, ' Ms Cosgrove says.

At Rosah Pinah Ms Cosgrove's focus is on the miners and their families who live in the unofficial town that has sprung up beside the mine. Its employees account for 5,000 of the town's 12,000 population.

'On the surface Namibia looks quite westernised in a lot of ways, but the culture shock hit me when I started to see the nature of people's lives. The general standard of health is shocking. My role has changed to one of wellness because, as with any mining town, there is high unemployment and all kinds of health and social problems: high rates of drug and alcohol misuse, lots of sex workers, child abuse and domestic violence. Living conditions are poor; houses are made of zinc and cardboard, ' says Ms Cosgrove, who has trained over 40 local people to work with her as health education workers.

She also works one day a week at a local state clinic providing HIV/AIDS education and counselling. No state healthcare is provided in the settlement because it is not officially recognised as a town. In addition to her day job, Ms Cosgrove also does voluntary work at a shelter for orphaned and vulnerable children.

Ms Cosgrove, who comes from Liverpool, says her family were not initially happy with her decision, but that they understand why she has stayed. The things she misses most, apart from her family, are shopping, 'speaking Scouse', Liverpool and being a 'normal' person.

Ms Cosgrove believes she has integrated well - she is fluent in Afrikaans - and is trying to learn as many tribal languages as possible from the dozens spoken.

While clearly loving living in Namibia, her future plans are unclear.

'The job is permanent if I want it, but I am not sure how long I will stay. My boyfriend finishes studying later this year and we may think about going back to the UK.' But talking to Ms Cosgrove makes it clear she feels there is still plenty of work to do. 'I am in a privileged position compared to most here. It makes you appreciate the most basic things in life.

It is shocking to see the cemeteries filling and it feels so unfair to see children doing adults' work, ' she says. 'And as a woman I find it challenging to see the subservient role of many women.' 'I know it can be unfair to compare, but people in Britain spend so much time worrying about things that do not matter. Here you have old women who have lost four children to AIDS and have 18 grandchildren in the house. What I find most challenging is the lives of women and children here; it is their vulnerability to HIV/ AIDS that keeps me awake at night.' .

Find out more

VSO www. vso. org. uk/

Challenges Worldwide www. challengesworldwide. com/

Cross-Cultural Solutions www. crosscultural solutions. org/