Dominic Dee
Role Medical Student and Researcher

I am a medical student at Barts and the London School of Medicine. Having so far studied there for three years, I decided to take a year out from my degree to get involved in a number of projects before returning to fourth year. I therefore spent two months in Jimma, Ethiopia, working on a research project, as part of the THET non-communicable diseases programme in rural health centres in the region. This was my first long-term experience of medicine in a resource-poor country and I found the opportunity eye opening.

Learning about global health was what made me want to pursue medicine as a career in the first place so this was an opportunity to do what I had always wanted to, years earlier than I thought would be possible. In the future I hope to specialise in infectious diseases and tropical medicine and aim to work in Africa for a substantial part of my career.

The research study I worked on in Jimma was based at five rural health centres in towns outside of the city. I was initiated to learn more about why some patients are not attending their appointments. The clinics were set up by THET to allow patients with chronic diseases, such as epilepsy, diabetes, asthma and hypertension, to receive medical treatment and regular follow up. It is important that patients attend these appointments so the nurses and other health care professionals can ask about symptoms and adjust treatment accordingly. Unfortunately, if patients do not attend appointments as intended, the clinics cannot provide the care they should. This study looked into why some patients were not coming back to the clinic. A number of reasons were found, from having insufficient funds to preferring to visit traditional medical practitioners. Understanding these reasons and ensuring the clinics are being monitored and assessed properly will allow improvements and adjustments.

To access this information, I had to do a number of things over the course of my two-month visit. Working with a local nurse, I first visited five of the clinics and looked through over 1000 patient records to find the names and details of patients that had stopped attending. A questionnaire contained questions about socio-economic details, information relating to their disease and current symptoms, and about the reasons for discontinuing treatment at the health centre. Finally, the questionnaire asked about visits to traditional medical practitioners and use of alternative or traditional medicine. Once we had gathered a list of patients and divided it into regions, we spent six-days training over  100 local health extension workers from all regions in how to perform the study questionnaire. Once we had trained the health extension workers, we provided them with blank questionnaires and the names and addresses of patients to survey.

I enjoyed visiting the rural health centres and meeting the health professionals that are working so hard to provide chronic disease care to a growing list of patients. I learnt a great deal about conducting a research project and about how essential making strong relationships with local people is. Without the face-to-face communication with the nurses, health extension workers, health officers and health bureau managers, the project would not have been possible.

The project was challenging at times and there were some difficulties and setbacks that delayed progress. Some of the organisation and data collection, for example, took longer than I had originally hoped and because the health extension workers are so busy, it was difficult to arrange the training on a day they were free. However, having to deal independently with these issues and make decisions that I have not previously had to make meant that I learnt a great deal from my time in Ethiopia, from leadership and organisational skills to delegating tasks and communicating with a broad range of people.

Whilst volunteering to help with the project, I myself have benefitted in numerous ways. This was the first research project I have worked on and has given me the skills and confidence to pursue other projects in the future both in the UK and abroad. I will also go into my final two years at medical school and into the beginning of a career in medicine with a broader perspective. I have learnt skills that will not only be vital in future research projects but also useful in clinical scenarios.