Reporter: Sarah Taylor
Contact at destination: Dr Gaël Gheno
Year of visit: 2017
Institution: Centre Hospitalier Annecy Genevois
Department: SAU (SMUR, Regulation and Urgences)/Pre-Hospital Medicine, Ambulance dispatch and Emergency Medicine
Work / Study undertaken: The SMUR (Service Mobile d’Urgence et de Reamination) exist in every French département, and they seek to deliver medical care at the scene of the incident prior to transportation. The team are led by a specialist doctor, who usually also works part-time in ED, with a nurse and paramedic. The team are extremely well-equipped, with a vast array of medications and the capacity to intubate and ventilate on the roadside. They work alongside the pompiers (fire and rescue service) and the ambulance service to deliver Pre-Hospital Care to the sickest patients.
I spent 3 days/week working with the SMUR team in Annecy. I saw a wide-range of cases: from birth to death, and everything in between! I saw many life-threatening emergencies including heart attacks, strokes and anaphylaxis, and a wide variety of trauma patients who had been involved in industrial accidents, accidents in the mountains and RTAs.
The SMUR are also called to psychiatric emergencies as there is no French equivalent to the English ‘Crisis Team’. Annecy is the largest hospital in the Haute-Savoie, and consequently receives many patients from surrounding hospitals. The SMUR often transport the very sickest of these patients. I was involved in everything from neonatal transfers, to patients in their 80s and 90s. Patients are also transferred by road and air to larger hospitals including Geneva, Lyon and Grenoble.
There are always two teams on call in Annecy, and a further team who operate the helicopter which is located close to the hospital. As an elective student, you are given a beep and expected to respond with whichever team is going out. We also would take supplies down to the helicopter team. (Unfortunately, students cannot fly with them, but there was chance to look round the base.) The SMUR team provide lunch cover for the emergency department, and would worked in resus (déchoquage). This was a good opportunity to get involved with some history taking, examination and practical skills.
One day per week I worked at the ‘Régulation’-the call centre for the SAMU, ambulance service and fire and rescue service. Whilst this was not enormously medically relevant, it was very helpful for improving my listening skills, and widening my vocabulary of medical French. I would sit with the emergency doctor, and listen into their calls, and then we would discuss the cases after the call.
Description of destination: ‘The Pearl of the Alps’ is justly named! Annecy is a beautiful medieval city, with markets and ice-cream stores aplenty. The lake is stunning, and there are lots of walks for all abilities in the area. Swimming, cycling, climbing and watersports are all popular options. It’s also possible to explore further afield, with buses out to Lyon, Geneva and Chamonix.
Were the local people friendly? I worked with different staff almost every day, but everyone was very friendly, welcoming, and patient with my French!
Did you feel safe and if not why not? Yes. I travelled alone, and did not feel unsafe at any point.
What did you do in your spare time?
The hours are long on this elective placement: I was expected to work 8h00-19h00 on my SMUR days, and I would work until lunchtime at the Régulation. However, on my days off, I went walking or cycling by the lake (and ending the day with a swim in the lake), or went to the beach. I also enjoyed trying the different ice-cream shops and bakers! I visited Semnoz, Talloires, Sévrier and Menthon St Bernard, which are all close to Annecy, and I spent one weekend exploring Chamonix. My Airbnb hosts also invited me out with them to picnics, concerts and dinner; and I went to a party with the SMUR staff which was a good way to get to know people socially.
Is there anything that you would particularly recommend others to do? Depends what you enjoy! I particularly liked walking out to Talloires, and swimming in the lake at a beach on the far side of Talloires. The views at the top of Semnoz are also stunning.
What was the climate like? I had fantastic weather for pretty much my whole elective (bar two days of rain) which was in late August/early September.
What was your accommodation like?
I stayed in 2 Airbnbs, which was a great way to improve my French. There are a wide range of AirBnBs in Annecy, and I would recommend staying in one which is shared with your host as it provides you with invaluable conversation practice.
Was it provided?
If not who arranged it?
I found it on AirBnB. Definitely book early, particularly in summer!
How much did it cost?
I spent about £200/week on accommodation: easily the biggest expense of my elective.
Did you enjoy your visit?
Yes, it was a perfect combination of placement and holiday. I would love to come back!
Did you find it useful medically?
Definitely. I saw a wide variety of patient presentations, and the staff were happy to explain what was happening, and some of the doctors took the time to teach me between call outs. It was fascinating to observe the similarities and differences between the English and French systems, and to see the SMUR team in action as we don’t really have a national equivalent to them in the UK.
Has it improved your French?
Yes, immensely; I spoke French almost exclusively for 4 weeks! I would recommend speaking French to a reasonable level before you come, and then still be prepared to play charades sometimes!
How has it increased your knowledge of French culture?
Absolutely, living and working with the French taught me a great deal about their daily routines. It was particularly interesting to see how the staff interacted with each other professionally-I learnt a bit more about the social complexities of ‘tu’ vs ‘vous’, and who (and when) to kiss.
The SMUR placement is also a great way to explore the region a bit more, and see inside a wide variety of homes, workplaces and public buildings.
If you went back would you do anything differently?
How did you get there?
Flew to Geneva with EasyJet (cheap and frequent). I got the coach to Annecy, and used the website blablacar.fr to arrange a lift back. The website is probably the cheapest way of travelling to Geneva.
What was the approximate total cost?
No placement fees but it’s worth noting that the Haute-Savoie is one of the most expensive areas of France to live after Paris.
Flights £160 return
Living costs £300ish
Is there any other information that you think may be useful?
I had to pay for lunch each day: 4.80 euros will get you a 3 course lunch which is eaten with the whole team in the hospital canteen.
Reporter: Donald Waters
Contact at destination: Dr Gaël Gheno
Year of visit: 2014
Institution: Centre Hospitalier Annecy Genevois
Department: Accident and Emergency
Work / Study undertaken: Contrary to my expectations of an emergency service fairly identical to the NHS, I actually spent my first week flying around alpine roads at speeds of up to 200kph with the Service Mobile d’Urgence et de Reanimation (SMUR)! In France, although general ambulance cover is provided by the all-purpose emergency service (the Pompiers) along with several private companies, for potentially life-threatening medical scenarios such as acute chest pain a physician-led ambulance unit is sent out, consisting of two highly-trained paramedics and an emergency medicine consultant. They provide acute medical care at the scene, up to and including intubation and ventilation, before stabilising patients and returning them to hospital. Annecy hospital has two SMUR teams on constant standby, one of which can also be dispatched by helicopter to incidents such as severe skiing/mountaineering accidents. I spent two weeks with the SMUR team, shadowing the doctor on the time and helping out where I was able. The rest of the time I worked in the hospital A&E department, comparable to that of Edinburgh both in size and caseload. I was expected to clerk patients on my own, present them to a senior doctor and write their case up on the electronic system, enabling me both to gain a huge amount of practice of my medical French and also see a wide variety of acute medical and surgical conditions.
Description of destination: Annecy is an incredibly beautiful place, sitting at the top of a sparkling blue lake and surrounded by majestic snow topped mountains. The Haute-Savoie welcomes tourists from all over the world every year and it is easy to see why! It was really nice however to feel like you were there with a purpose rather than just being a tourist.
Were the local people friendly? The whole hospital has a really friendly feel and I was welcomed incredibly warmly by everyone I worked with. Patients were also very accepting of having a bumbling British medical student taking charge of their care and were surprisingly happy to put up with my grammatical errors!
Did you feel safe and if not why not? Yes. Annecy is a small and very safe city although I’m told has quite a lot of problems with pickpockets and bicycle thieves in the centre of town.
What did you do in your spare time? I did have to work pretty hard (8-18.30 every day and some weekend shifts) so didn’t have that much spare time but managed to cram it as full of stuff as I possibly could. Annecy is basically a gigantic outdoor playground and I spent a lot of time in the hills, mainly walking as I was sadly there in between the skiing and climbing seasons. There are many easily accessible paths up all of the incredible mountains surrounding the lake which are of varying difficulty to suit how energetic you are feeling and the views from the top are simply incredible. I also entered a fell race while I was there which was an amazing way to get up into bits of the mountains you wouldn’t normally see. If the hills aren’t your thing then the cycle round the lake is absolutely incredible and perfectly topped off by a jaunt in a pedalo on the water itself. Annecy is also a culinary centre and you can try numerous different Haute-Savioe specialties including the most amazing cheese I’ve ever tasted!
Is there anything that you would particularly recommend others to do? Perfect day: cycle round the lake, walk up an alp, eat lots of reblochon with a local beer to finish off.
What was the climate like? Variable and actually rainier than I was expecting however still a good bit more pleasant than Scotland!
What was your accommodation like? I ended up moving in with one of the doctors after a couple of days as he said he thought I would like it more than the student accommodation I had found (an indication of just how nice the staff at the hospital are). The student halls I moved into initially were nice however and very reasonably priced at about €350 for a month, website http://www.fjtromainsnovel.fr/
Was it provided? No
If not who arranged it? I found the student accommodation online. As Annecy is a student town there are many different halls of residence to choose from, most of which accept people for short periods of time if they are matriculated students.
How much did it cost? See above
Did you enjoy your visit? A huge amount, was incredibly sad to leave
Did you find it useful medically? Really useful. I was exposed to a huge range of things, many of which I hadn’t seen before, and my opinion was genuinely respected in a way you aren’t very used to as a medical student. I was also constantly on-call for any English-speaking patients as not many of the rest of the team spoke any English so was able to be of genuine use a couple of times which was really nice. The experience of pre-hospital medicine with the SMUR team was invaluable and something it is very difficult to find in the NHS.
Has it improved your french? I had to hit the ground running as they expected me to be able to practice medicine in French from day 1. I found this very tricky to begin with and clutched my AFMS handbook to me like a lifejacket for the first week or so but found myself pleasantly surprised by how quickly I became comfortable clerking and presenting in French. I also learnt a lot from living with the French doctor as it meant I was really speaking French all of the time.
How has it increased your knowledge of French culture? I learnt a huge amount from living and working with French people, both about their culture and about how Britain is perceived by one of its closest neighbours. My favourite moment was when one of the consultants sat me down and asked if life in Scotland was really as hard as the film “Trainspotting” suggests! I also gained a big insight into the lives of the people of Annecy by going into many different homes with the SMUR team.
If you went back would you do anything differently? I’d have gone for longer, 4 weeks flew by!
How did you get there? Cheap flights with easyjet to Geneva along with many other carriers
What was the approximate total cost? €700 in total. No placement fees. Easyjet flights from Edinburgh to Geneva were about €150 plus transfer for €15 although with a car share website you could get it much cheaper. I ended up only paying €100 for first few nights of student halls but spent a surprising amount on food and general living costs, partly due to the rather poor exchange rate.
Is there any other information that you think may be useful? All elective students get a free lunch in the hospital every day which is absolutely amazing, three courses including an incredible pudding and a glass of wine if you want one!