Report 1
Reporter: Hannah Rowley
Contact at destination: Nathalie KALUZNY (Nathalie.Kaluzny@cht.nc)
Year of visit: 2019
Country: New Caledonia
Region: Nouméa
Institution: Médipôle de Koutio
Department: A&E / Neurology
Work / Study undertaken
During the 4 weeks I spent in A&E, I shadowed a junior doctor for the first week while I got to know the departmental processes and tried to take in as much medical French as I could! After that, I mostly saw patients on my own and reported back to a senior doctor, although there was another medical student in the department and we would often see patients together when things were quieter. I also got to go out with the ambulance crews, both in the van and the air ambulance. Flying over the lagoon with the mountains on one side of me and open ocean on the other, looking down at schools of sharks, rays and turtles was a definite highlight! The day would start with the morning handover at 8am, and I would usually leave at 6pm or slightly earlier. I wasn’t expected to come in at the weekends, and they were relaxed about me taking days off here and there so I could have long weekends to go on trips.
My 4 weeks in the neurology department were less busy by comparison but still very interesting. I would come in for 9-9.30am and leave at 5pm or earlier. I attended ward rounds on the neurology ward and neurovascular intensive care unit, attended clinics, accompanied the on-call neurologists to A&E referrals, and observed patient assessments by allied health professionals including the neuropsychiatrist, physiotherapists and SALT team.
Description of the service and department
New Caledonia is part of France and the healthcare provision follows the same system of reimbursing costs through social security. The Médipôle de Koutio is the largest hospital in the country and the only organisation offering certain services, which makes it interesting from a learning point of view as all acutely unwell patients or people needing specialist care end up there.
Description of the destination
New Caledonia is an unusual place. The capital city of Nouméa feels quite familiarly Western, with its French restaurants, fast-food joints, supermarkets and bars. Once you leave the capital, the population becomes sparse and tribally based. The country has some of the most beautiful scenery I’ve ever seen, both the inland mountains and jungles, and the coastal areas, islands and lagoon. The Iles de Loyauté are as close to paradise as I’ve ever been.
Were the local people friendly?
The population of Nouméa is quite transient, so there are lots of young people there looking to make new friends. I joined a football team which was a great way to meet locals. The rural people I came across were very friendly, but there are certain customs that must be followed when entering a tribe. The metropolitan French population and the locals don’t seem to mix much, which I found slightly strange and unfortunate. There’s isn’t much open hostility between the two populations, they just carry on alongside each other.
Did you feel safe and if not why not?
There were only 2 circumstances where I felt vulnerable. The first was while driving at night, as I had been told that the locals drive very recklessly and drink-driving is common. The second was when waiting in the dark for a bus back from football training in one of the slightly dodgier areas of Nouméa. At no point did danger feel imminent and I never came to any harm, but I’d be lying if I said I felt completely safe.
What did you do in your spare time?
In the evenings I often had football training, and would then come home and hang out with my flatmates or chill on my own, reading, watching TV or catching up with friends and family back home. At the weekends I would often go out to local events or bars with my flatmates or junior doctors and other students from the hospital. A couple of times I hired a car to go on trips out to the countryside by myself. I was fortunate enough to have 2 sets of visitors while I was out there, as I have friends and family in Australia.
Is there anything that you would particularly recommend others to do?
I’m glad that I lived in a flat share as it forced me to speak French all the time, and also meant that I had people my own age to hang out with and find out about things to do. Exploring outside Nouméa is absolutely essential; as cities go it’s pretty nice, but New Caledonia’s real value is in its nature. On that note, learning to scuba dive was the best thing I did there; the lagoon is known as being one of the best diving spots in the whole.
What time of the year were you there? What was the climate like?
I was there June and July, which is wintertime. The weather was always fairly warm (low 20s) but it was quite cloudy and drizzly when I first arrived. The weather improved as time went on and by the end of my time there it was very warm and sunny most days.
What was your accommodation like?
I stayed in a rented “colocation” with 2 boys and a couple, in a nice (but slightly filthy) apartment halfway between the city centre and the beaches on the south side of Nouméa. It meant I had to walk about 30 minutes and then get a bus to the hospital, but it was worth it to be nearer to the action in the city.
Was it provided? No.
How much did it cost? About £550 per month.
Did you enjoy your visit?
Yes, I learnt lots of medicine and French, and had some incredible experiences. There were aspects that were difficult though, particularly getting around without a car and the astronomically high cost of living.
Did you find it useful medically? If so, in what way?
The patients I saw in A&E were very varied: strokes and infections were some of the most common things, the latter ranging from more familiar pneumonias and wound infections to dengue fever and fulminant leptospirosis. There were some fairly typical injuries which give some insight into life in New Caledonia: flip-flop related slips and trips, alcohol-related accidents, diving accidents and fishing hooks lodged in various body parts. I got to be quite hands-on dealing with the minor trauma cases, and did a lot of suturing, removal of fishing hooks and applying plaster casts, as well as venepuncture and cannulation. There were occasional major trauma cases such as car accidents or more serious altercations.
Strokes were the most common reason that patients ended up on the neurology ward. Unfortunately, the health of the local population is quite poor, and the combination of rampant diabetes, smoking, limited education and lack of access to healthcare means that it is not uncommon for patients to have catastrophic strokes in their early forties. Another common issue was traumatic brain injuries, usually following road accidents due to reckless and/or drunken driving. I also encountered some more unusual pathologies, such as myasthenia gravis (in the context of a thymoma), Guillan-Barré syndrome, lateral medullary syndrome, reversible cerebral vasoconstriction syndrome, neurosarcoidosis and sciatica secondary to leprosy infection.
Has it improved your French?
Absolutely. Although many of the local people living outside Nouméa speak tribal languages, French is the common language, so that’s what I spoke all the time in the hospital. Very few people I met spoke much English, so I had to try and get by in French all the time. Living with French people forced me to speak French 24/7, which was tiring at times but definitely paid dividends.
How has it increased your knowledge of French culture?
I knew very little about New Caledonia before going, so it was really interesting learning about its colonial past and tribal customs.
If you went back would you do anything differently?
I would try to save more money and apply for more bursaries before going, as the cost of living there is very high.
How did you get there?
I flew via Hong Kong and Auckland.
What was the approximate total cost? Around £3000.
Is there any other information that you think may be useful?
I think the main thing is to be aware of the cost, I hadn’t looked into it a great deal, so it came as an unpleasant surprise. Getting around Nouméa without a car can be tricky but is definitely doable, but if you want to explore further afield you will need to hire one (which is actually quite reasonable). It’s definitely worth trying to keep money aside to scuba dive and take trips to some of the Iles de Loyauté.
