Guadaloupe


Report 1

Reporter: Paul Morillon

 Contact at destination: Dr Serge Ferracci (Emergency Department) / Dr Bruno Hoen (Infectious Diseases) / Marie-Line de la Reberdiere (Elective Administrator)

 Year of visit: 2016 (April to June)

 Country: Guadeloupe

 Institution: CHU Pointe-à-Pitre

 Departments: Emergency Department / Department of Infectious Diseases

 Work / Study undertaken: 

I spent six weeks in Guadeloupe – three in each department.

The infectious diseases department was a good opportunity to see care of the patient in a longer-term setting, although some of the patients were quite ill. The island had many cases of Zika when I was there, and there is Dengue and Chikungunya, although I did not see much at the hospital, as these patients are often asked to stay at home so as not to spread these diseases further. Other rare diseases were present, particularly certain complications of HIV infection.

I was able to clerk patients and examine them, and students have the opportunity to present patients at the weekly MDT meetings. Students sometimes have the opportunity to perform procedures such as LPs, although I did not have this chance when I was there.

The Emergency Department was more active and there was thus more to do as a student. The day began at 0800 with an MDT and then students would spend the day with an Intern. Typically, I would be clerking patients and presenting them to the intern or senior doctor. There was also the opportunity to spend time in the resus which, although it only had three beds, would see its fair share of trauma from RTCs and stabbings, which are unfortunately all too common on the island. I was able to be involved with these resus calls and could help with tasks from suturing to examination.

 Description of the destination:

Guadeloupe is a beautiful country. Located in the Caribbean, there is a clear melange of French and Caribbean cultures. With a population of around 400,000 it is not a large country, but certainly larger than some of the nearby islands. It very much has the feel of a tropical island, with hot and sunny weather, mountainous terrain and an incredibly diverse range of wildlife, including iguanas (always highly entertaining) pelicans and an array of sea-life.

 Were the local people friendly?

The locals were certainly a friendly bunch. We were lucky in that our hostess introduced us to lots of her family, meaning we got to know lots of people whilst we were there. The staff (albeit most of them visiting from mainland France) at the hospital were always friendly and very welcoming.

Did you feel safe and if not why not?

Yes, I generally felt very safe. Having a car definitely helped, as did being male as some of the ladies did receive some unwanted attention. In general, however, the island is one of the safer ones in the Caribbean.

 What did you do in your spare time? Is there anything that you would particularly recommend others to do?

Six weeks was a good amount of time to spend on the island as there was much to do there. The volcano is certainly one unmissable attraction; it takes two hours to climb from the starting point and if you are lucky, there is an incredibly view from the top. Alas, I was not lucky, but it is definitely worth the climb anyway. The beaches in Guadeloupe are brilliant too, many of which are better than others. My favourite ones were around Deshaies, but there are also good ones in the Gosier region (where most tourists stay) and elsewhere. Watersports are easy to get involved in, even if a little expensive – there is excellent scuba diving off the west coast and often good surfing on some parts of the island.

There are a variety of beautiful islands just off the Guadeloupe mainland to visit, and if you’re feeling more adventurous, Guadeloupe has exceptionally good links to other Caribbean islands including St Lucia, Martinique and Dominica, all accessible by boat or plane. If you choose the former option, be warned – it is cheaper, but not for those who get sea-sick!

 What time of the year were you there? What was the climate like?

April to June. The climate is tropical – many days it would rain, but rarely for more than 30 minutes overall. It was usually quite humid, with highs of 33 and lows of 23 degrees. Most days it was sunny, but there was almost always a few clouds in the sky.

 What was your accommodation like?

We were very lucky in that we stayed with a friend of a friend of a friend (of a friend) and she was incredible. Her place was very pleasant and she was exceptionally kind, cooking for us at least once per day by the end of our stay! We were based to the east of the Gosier region (where most tourists stay) which is a good place to be.

 Was it provided?

No. The hospital does rarely have accommodation, but it was not available for us.

 If not who arranged it?

My friend of a friend of a friend (of a friend). There is lots of Airbnb / apartment availability however.

 How much did it cost?

Approx £400

 Did you enjoy your visit? 

Very much so – it was certainly some of the best weeks of medical school. We found a good balance between spending time in the hospital and enjoying the country. I would highly recommend this is an elective destination if you want to improve your French.

 Did you find the visit useful medically? – in what way?

Absolutely – good exposure to some rarer diseases, excellent opportunities to practise clerking and many of the doctors took time to teach us.

 Has it improved your French? .

Immensely. The main reason for choosing to spend my elective in Guadeloupe was to improve my French, and this certainly happened. I had studied A2 French, and had kept it up a little throughout medical school, but these 6 weeks really helped improve my confidence. Many of the locals speak Creole, but most of them speak French too, and it was rarely the case that we could not see patients due to them not speaking French. All the doctors spoke French and were thankfully reluctant to speak English which was certainly a good thing as we felt fully immersed. I would say the experience is almost just as good as being in France for your French.

My medical French improved enormously. I would, however, very much recommend attending an Anglo-French Medical Soc medical French weekend, which was really beneficial.

 How has it increased your knowledge of French culture?

Although Guadeloupe is very different to mainland France, there are many similarities due to it being an overseas territory of France. They have all the Géant / Casino / Super U supermarkets as in France, and their pain-au-chocolats and baguettes are second to none!

 If you went back would you do anything differently? 

Probably not stand on a sea urchin – I would not recommend that.

 How did you get there?

Eurostar to Paris, and fly from Paris – almost always the cheapest route.

 What was the approximate total cost?

£1800 (and my dignity, when mispronouncing various French words)

 Is there any other information that you think may be useful? 

A car is absolutely essential for the island – I would go as far to say that if you do not have one or have someone who can give you lifts there, it’s not a great place to be. Everyone drives (beware of rogue traffic jams, almost always occurring for absolutely not reason whatsoever) and the public transport is about as good as an iguana is intelligent (not very, in case you are wondering). Car hire, however, is incredibly cheap.

The country uses euros, meaning it’s a little more expensive than most Caribbean islands, but not too much so – you can definitely get by on a student budget.

 

Report 2

Reporter: Marianne Phillips

Contacts at Destination: Dr Serge Ferracci (head of Accident and Emergency) and Dr Eric Saillard (head of Hepato-gastroenterology) and Marie-Line de la Reberdiere (for admin/terms of elective) Centre Hospital Universitaire, Pointe-à-Pitre

Year of Visit: March-May 2016

Country: Guadeloupe

Region: Pointe-à-Pitre – capital city of Guadeloupe

Institution: Centre Hospital Universitaire (CHU), Pointe-à-Pitre

Departments: A&E and Hepato-gastroenterology

Work/Study Undertaken:

My elective consisted of 4 weeks in A&E and 2 weeks in hepato-gastroenterology.

 

Although I am bilingual and fluent in the social French I speak with my family, I soon realised that there were many Medical terms I did not necessarily know – Medical Language is arguably a whole new dictionary in itself. For this reason, I think working in A&E was one of the best ways to learn as much Medical French as possible, as it exposes you to all body systems and examinations from the start.

 

In A&E, early mornings tended to be quieter, but later in the day the department was often heaving with patients. The Medicine was good and there were ample supplies of necessary equipment, but the department itself definitely looked dated, smaller and much more basic compared to the huge and pristine A&E I was used to at UCLH. The set up was otherwise the same – Minors, Majors and Resus. In minors I got a lot of suturing practice, which is something I felt I wanted to develop more confidence in, so this was particularly useful.

 

Having only 2 main hospitals on the island meant I saw a huge variety of conditions, including some I had not yet come across in the UK, such as a case of pneumococcal septicaemia (with pneumonia and meningitis). I got to perform my first CPR on a patient and also helped in the management of a haemothorax in a patient who had a gunshot wound to the chest. The latter was one of many trauma cases I saw entering the A&E department secondary to gang-related crime, which seemed to be prevalent in Pointe-à-Pitre. In fact, one of the weekly junior doctor teaching sessions, was by a pathologist who explained more about this issue, as well as her own fascinating work on homicide/post-mortem cases between the French Outremer departments. I also came across some conditions that are more specific to French (‘Spasmophilie’) and Antillais populations (early repolarisation (ST segment differences) and dolichocolon).

 

Moving on to a department with more continuous/chronic care, in hepato-gastroenterology, was definitely worthwhile. This part of my elective allowed me to feel part of a team, in seeing the same doctors each day. I felt more useful too, as I was given the role of clerking new patients every morning, during the ward round. This gave me time to take full histories, examine all the systems, then present to the lead doctor, with discussions of investigation and treatment plans afterwards.

 

 

Description of Destination:

Guadeloupe is known as l’île papillon (‘butterfly island’) because of its shape, but this is fitting with its natural beauty. Christopher Columbus named it the ‘island of beautiful waters’ and it truly is the most exotic and paradisiacal place I have visited. From its warm and calm turquoise waters, to its volcano and innumerable palm trees to its iguanas, pelicans, turtles and unending birdsong, to its flowers, fruit and spice markets – it is a traveller’s feast leaving the senses in awe.

 

Whilst the CHU location in Pointe- à -Pitre isn’t the most exciting of places, breath-taking beaches, interesting walks and stunning views are only short drives away.

 

Are the local people friendly?

Locals were generally friendly, although I learnt early on that they do not like photos aimed in their direction. For example, I was told off twice by market sellers who seemed angry when I tried to take general photos of stalls/produce seen.

 

In contrast, some local men were ‘a bit too friendly’. I think Katie Percival mentioned this in her 2014 report and I also found that being a girl travelling around alone attracted a lot of male attention – offers of lifts if I was walking, giving me their phone numbers when I was in shops or on the buses etc. I never felt threatened though and remained polite usually just laughing it off and thanking them for their offers of lifts and explaining that I enjoyed walking.

 

I also met a very friendly ‘externe’ (medical student), who has become a good friend. During our stay on the island, she kindly invited my friends and I out on daytrips and for evening events/meals with her and her boyfriend.

 

Did you feel safe and if not why not?

I walked to and from the CHU to my accommodation and had pavements for 90% of my journey. I always made sure I got back before nightfall (~18:20) and I would not recommend going out/walking alone at night. In the evenings there is often some form of organised or indoor entertainment to be found, from sports competitions to concerts to dance shows. Whilst I was there the annual Guadeloupian basketball finals were being played; so I got to see my first ever live basketball matches. It also allowed me to see more of the local culture, from half-time Bokits/Aglougous (local sandwich specialties) to the drumming and singing of fans supporting their teams.

 

Spare time activities:

The beaches are breath-taking and I went to them at least twice a week, whilst on the working part of my elective, then everyday once on holiday. The best ones I found were in Port-Louis (the sea is a like an enormous swimming pool here – not one wave!) La Caravelle, in Sainte-Anne, and Plage de Grande-Anse (if calm), in Deshaies.

 

Visiting the botanical garden in Deshaies was a great day out – Guadeloupe has such a variety of flowers, trees and animals. Over my time on the island, I came across pelicans, iguanas, mongooses, turtles, cockerels, cattle and – rather less pleasant – one or two centipedes! Although I had no luck at Pointe de La Vigie, dolphin and whale sightings have often been reported there. Another impressive place to drive down to is Pointe des Chateaux where the Atlantic Ocean and the Caribbean Sea meet.

 

Climbing the Soufriere Volcano and visiting Les Chutes du Carbet and the local ‘Paradis’ freshwater waterfall and lake was one of the best days of my life. The power of the wind at the summit was exhilarating and the climb and descent were a perfect challenge (not too long or too difficult). The ‘paradis’ was a little difficult to access on the descent, but 100% worth it! I have never come out of water feeling as cleansed as I did on that afternoon. It is an absolute must!!

Diving in Basse Terre (Bouillante) is another activity I highly recommend. My friends and I all went for our ‘Bapteme’ (‘baptism’) dives and the beautiful fish and corals were breath-taking, whilst the pure silence experienced was incredible.

 

Other things to do are day trips to the surrounding islands. Les Saintes are beautiful and it was such a clear day when I went that I got views of Guadeloupe, La Desirade, Marie-Galante Dominica and even La Martinique!

 

Climate:

In March and early April it rained heavily most nights, so the morning air was quite fresh and it warmed up again during the day, as humidity increased. Occasionally, the humidity was particularly high and those days were stuffy, but the hospital has air conditioning so working conditions were fine – and if it was the weekend, swimming in the sea was the perfect way to cool down! The daily temperature was around 26-30°C and never fell below 24°C at night.

 

Accommodation:

I stayed in Air Bnb accommodation in Le Gosier Campagne. The studio was brand new, fully equipped and had a wonderful terrace (with a hammock!). I was a 40 minute walk away from the CHU, so some people may have preferred a car to drive in each day, but I enjoyed taking in the beautiful green surroundings each day – including coconut, papaya and palm trees…

 

My hosts were incredible – I really don’t think I could have been any luckier. On my first few days they showed me around practically all of Grande Terre – in particular they introduced me to what became my favourite beach in Port Louis – so calm that it is like an enormous swimming pool! They also gave me useful local information and tips.

 

Was it provided?

No. Some previous elective students seem to have been able to secure hospital accommodation, but none was available during my elective. It was a great experience to have lived a bit further out though, in Le Gosier.

 

How much did the accommodation cost?

£1,540

 

Did you enjoy your visit?

It has been the best experience of my life to date. I kept on finding myself thinking both how happy and how lucky I was to be in such an idyllic place. Guadeloupe was the perfect medicine to recharge my batteries after the stress of revision and Finals. It is a place I will never forget!

 

Did you find it useful medically?

Very – I feel I grew in confidence in my diagnostic skills and in communicating my ideas and queries with other medics. I also saw some conditions that I had not yet come across in the UK.

Something I found particularly useful was seeing a few patients with the Zika infection. This is good to be able to recognise, as the prevalence and spread of this virus are currently threatening to increase.

 

Has it improved your French and how has it increased your knowledge of French culture?

I learnt a huge amount of Medical French and by the end was presenting cases in the main weekly handover meeting and having interesting discussions with the doctors on the ward.

One of the most striking things was the contrast between the paternalistic relationship doctors have with their patients compared to the ‘shared-decision making’ model found in the UK. For example, I saw quite a few cases of doctors literally telling patients off. One such case was related to a common problem I came across in Guadeloupe – non-compliance to medications.

Something that impressed me at the start of my placement was that access to imaging seemed easier and faster than in the UK. However I soon realised that there was a greater dependence on imaging and biochemical results before treating/decision making, compared to in the UK, resulting in more frequent patient exposure to radiation.

 

I also noticed less strict ‘bare below the elbow/hygiene’ policies, for example the white blouses were not washed daily and some looked quite dirty and most doctors/nurses wore a bracelet or watch too.

 

An additional challenge I came across was that, in the French system, medications are discussed using trade, rather than scientific, names e.g. Lasilix = Furosemide!

 

Beyond the medical aspect, I enjoyed going to the Catholic masses in Guadeloupe. They definitely differed from masses in France or England, with much more singing and often being longer. I found them to be very celebratory and the homilies always had very interesting, but clear messages. I was very lucky to have been able to go to the Easter Vigil too – it lasted 3 hours – with half of the mass carried out in candlelight. It is an evening I will never forget.

 

Approximate total cost:

£2,500

 

Other information that may be useful:

Feel free to contact me for any further information/questions.

Report 3

Reporter: Katie Percival
Contact at destination: Professor Bruno Hoen, head of Infectious and Tropical Medicine & Dermatology Department, Centre Hospitalier Universitaire, Pointe-à-Pitre
Year of visit: 2014
Country: Guadeloupe
Region: Pointe-à-Pitre, Grande-Terre
Institution: Centre Hospitalier Universitaire (University Hospital of) Pointe-à-Pitre
Department: Infectious and Tropical Medicine & Dermatology, Intensive Care

Work / Study undertaken: Two four-week clinical attachments where I was encouraged to clerk and review patients, do examinations and discuss management, and perform some interventions under supervision as well as attend teaching and journal clubs.

Description of destination: The hospital is situated on the outskirts of the capital city of Guadeloupe. The city itself is not very big and I was told it could be dangerous at night; this was reflected in the early finish of many of the festivals that took part in the capital while I was there (and there were several – the French love a Bank Holiday!). My accommodation was in a residential area called Le Gosier to the east of the city. Lots of the medical staff lived close by and the area had a lovely town centre with an incredible local market held every Friday on the park by the coast. Guadeloupe is an island of incredible diversity: while Le Gosier and other towns on the south coast of Grande-Terre are famed for their beautiful beaches and great surfing, the quieter north of Grande-Terre has a rockier coastline and endless swathes of sugar plantations inland. You can kayak through mangrove swamps to the north-west where the sea is calmer. Basse-Terre is the wilder of the two islands, surrounded by a coral reef to the north and west coasts, and with a huge national park of lush rainforest and active volcanoes making up most of the inland territory. The two Terres (the ‘wings’ of the butterfly shape of the island) are adjoined by a built-up commercial area called Baie-Mahault where the larger bars and clubs, and the island’s shopping mall Destreland are situated.

Were the local people friendly?

Many inhabitants of Guadeloupe, particularly medical staff at the hospital, were from mainland France, and all were friendly and supportive. The indigenous people are much more approachable, and will approach you and chat to you much more often than I am used to in the UK, and most were intrigued to meet an English person, as I don’t think they come across many! Some of the men I came across were quite forward and there were a few unwanted advances – prepare yourself for a culture shock if you’re a female travelling alone as I got the impression it’s not considered unusual for a man in Guadeloupe to see more than one woman, and to see women who are much younger than them. A few times men seemed not to take no for an answer and that was quite frustrating.

Did you feel safe and if not why not?

People I met who worked at the hospital warned me about walking alone by myself at night (it gets dark at around 18:30 all year round) but I never felt particularly under threat. Pointe-à-Pitre is best avoided at night – I never saw any incidents in the city itself but ‘arme-blanche’ (stabbings, which were often gang-related) were frequently witnessed coming into the A&E and intensive care departments. The driving is pretty wild out there too – pedestrian footpaths are often just lines drawn into the road which moped and motorcycle riders like to consider as their own lane sometimes, and you sit on the edge of your seat when you’re driving on the main road into Pointe-à-Pitre, so watch out for that. There’s quite a high incidence of road traffic accidents and people seem to have a more relaxed attitude towards drink-driving too.

What did you do in your spare time?

There’s so much to do in Guadeloupe as a tourist! Don’t fall into the trap that I did of thinking that because it’s a small island, you’ll see everything during your elective. I’d highly recommend scuba diving with one of the scuba clubs that operates out of Bouillante (we went with La Rand’Eau, www.larandeau.com), climbing La Soufrière, Guadeloupe’s active volcano, visiting the Pointe des Châteaux to the very east of Guadeloupe for incredible views and lovely beaches, and surfing at Plage des Gros Sables (we learned with Cyrill at Poyo Surf Club, poyosurfclub.com). Road cycling is a popular spectator sport in Guadeloupe so we managed to get involved with some of the Tour de la Guadeloupe as it came through the neighbourhood! I wouldn’t recommend cycling for any but the super-fit though – the humidity is suffocating and the roads undulate so much my car usually struggled!
Is there anything that you would particularly recommend others to do? You must try plenty of the local cuisine while you’re out there – fish and seafood is sold in abundance, often with rice and fried plantain. Try the local tipple, a Ti’Punch cocktail, at your peril! The local rhum agricole (agricultural rum, made from the sugar plantations) is pretty moonshine stuff, but it’s fairly ubiquitous in all the bars. If you’re a confident swimmer (and beware, the tides are quite strong!), swim from the beach at le Gosier to Ilet Gosier. That was probably my favourite thing that we did. Reward yourself with some churros or coconut sorbet from one of the street vendors at Le Gosier when you get back.

What was the climate like?

Almost 100% humidity. Mostly sunny and dry throughout June and July. In August the rainy season started, so much of the tourism and markets wound down a bit, along with the humidity, but the insects came out in abundance. Grande-Terre is usually sunny because the volcanoes at Basse-Terre catch all the clouds.

What was your accommodation like?

Accommodation was a clean apartment in good condition, loaned to me by the hospital during my stay.

Was it provided? Yes

How much did it cost? Nothing
Did you enjoy your visit? It was one of the things I am most proud of doing in my whole life!
Did you find it useful medically? The medical system in Guadeloupe is very similar to the UK, so I learned a lot about patient management which I can transfer back to the UK, as well as learning about some more tropical diseases.
Has it improved your french? Definitely.
How has it increased your knowledge of French culture? Yes – French patients seen to have a very different relationship with their doctors. It’s much more paternalistic in my experience. I’ve also picked up an incredible amount about Creole culture and the colourful history of Guadeloupe as an occupied Caribbean island. It wasn’t really evident in contemporary society as I saw it during my trip, but historically there has been a lot of resentment between the indigenous population, the French landowner race and the largely Afro-Caribbean migrants who were brought over as slaves to work on the sugar plantations. There’s a huge diversity of culture on the island.
If you went back would you do anything differently? I’d make sure I’d stocked up on mosquito repellent – there was a shortage while I was there because of an endemic of Chikungunya virus, a mosquito-borne virus similar to dengue.
How did you get there? I flew into Paris CDG airport from Manchester, then had a hectic two-hour transfer window to get between CDG and Orly for my connecting flight to Guadeloupe Le Raizet airport. If Air France give you two hours between flights on your itinerary, get in touch with them to change it!

What was the approximate total cost?

I dread to think. Probably in the region of £2,500, including all the fun activities we did. Car hire is essential in Guadeloupe, so definitely budget for it. The roads aren’t always safe to walk or ride a bicycle on, and the buses aren’t reliable enough to get you to and from hospital in a timely fashion.

Is there any other information that you think may be useful?

Make sure your French is up to scratch before you go – very few people spoke English well when I went! The Guadeloupe French accent is easier to understand than mainland French as they don’t tend to speak so fast, but try and pick up a little of the Creole language while you’re there too!