It seems almost impossible to put into words the many different experiences I have had in The Gambia.
I started my stay in The Gambia at the Fatou Gaye Clinic (that’s the name of the clinic in the community, I’ll explain why later) right after my specialist exam as “Gynecologist and Obstetrician”. However, I quickly realized that my western-style specialist knowledge is hardly helpful.
On the one hand, the resources are completely different, both in terms of diagnostics and treatment options. On the other hand, completely different risks have to be considered, which do not play a role in our everyday medical life. To give one example: do I induce labor in a premature baby because of severe maternal hypertension when neonatal care is almost non-existent? In this case, as well as in many others, the German guideline I learned by heart was of little help.
Some diseases either do not occur in Germany in the same frequency or rarely in this severe manifestation which forced me to widen my differential diagnoses and it was quite satisfying to see that a lot of knowledge from the general medical studies has stuck. In low resource environments the old “hands-on” medicine, visual diagnosis and the trust in a thorough physical examination without further equipment really still applies. Laboratory tests are limited at the clinic, but fortunately there is a well-functioning ultrasound machine, which is valuable especially for prenatal care.
The number and severity of burns and other chronic or infected wounds I saw was impressive. With extremely limited resources but an inexhaustible patience, these wounds are cared for by the nurses until they are properly healed.
Overall, the number of patients was split about 50/50 between obstetrics and general medicine. Especially for the cases I was not used to treat in Germany it was very helpful to have internet access through my Gambian SIM card, so that I could double check some informations I was unsure about.
The staff of the clinic forms a community into which I was very warmly welcomed. At the beginning I was told several times that they are “one big family”. At first, this may be dismissed as an empty phrase, but in the course of time I realized that it was actually true. In addition to working together, we ate together, joked, discussed and took care of each other. At the head of this large family sits Fatou, the head midwife, from whom everyone can certainly learn a lot, both professionally and personally. Even though the clinic is actually named after an Islamic leader, the name Fatou Gaye Clinic has quite rightly become established in everyday life, because she shapes and enriches the community beyond the clinic and the Darra.
During my whole stay it has given me, and I hope most of the staff, a lot of pleasure to teach a little when there was time. Depending on the situation, I passed on practical or theoretical knowledge (e.g. ultrasound, surgical wound care, the female menstrual cycle, anatomy) individually or in groups and was always pleased when it was then applied.
In addition to the work, of course, one should not forget to travel around The Gambia and see other parts and aspects of the country. Even for people with travel experience like me, it is sometimes not easy to figure out how to get from A to B in the beginning. However, you will always find someone who is happy to help and with time you will gain more insight and independence. I recommend a stay of at least 3 months to be able to pass the period of many many questions at the beginning to then have time to fully experience this beautiful place.
Just two days after my arrival the Ramadan began. This is a very special time that is exhausting but also very exciting. It has made me very humble to experience it and also to fast along with my collegues, at least in part. I now have a very different understanding of this phase of the year, which is celebrated by so many people all over the world.
I received a very warm welcome and an even warmer farewell and hope that many more will have such an experience. It changes the view of the world both on a professional, but also on a personal level and for that I am very grateful.