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Case Study: VSO work - returning to the UK


Dr Jamie Rylance shares the many ways in which a stint for Voluntary Services Overseas has brought him great benefit.


Q: What kind of work did you undertake and where?

A: I worked as a general medical doctor in a small town in south-west Tanzania. My time was divided into service provision (seeing patients on ward rounds and in my own clinic) and teaching. The latter was usually informally organised, although later in my placement, I devised teaching programmes for 'clinical officers' and nurses. I also spent considerable time 'on the job' training a small group of nurses on our more intensive monitoring ward; called ICU but very different from any technologically advanced concept of intensive care.


Q:What skills and experience do you have that you would not have achieved otherwise?

A: I have gained a great deal of clinical experience in a setting where diagnostic testing is flawed or not available. This has greatly enhanced my clinical skills, and made me more confident when managing uncertainty. With less clinical supervision, I've become a more independent and questioning doctor.

I've had personal experience of the barriers and problems relating to language and communication. These experiences have given me a fresh and useful insight into medical practice in the UK. In a wider sense, many of the problems relating to poverty and access to heathcare have direct parallels in the UK, and my time in Tanzania has opened my eyes to these at home - definitely an appreciation I would otherwise not have had.

While trying to improve service structures, I've gained a lot of skills relating to management; needs assessments; persuasion of colleagues of the need for change; rationing services; maximising efficiency where resources are severely limited. Some of these are far more a part of UK practice than I wanted to believe!

Relating to teaching, I had more time to design, deliver and evaluate my own practice. This has made me a more confident and flexible educator.


Q:How has the experience changed your outlook and interests, including outside of your medical career?

A: I've always been interested in medicine overseas, and my time with VSO has consolidated this. My perspective on personal priorities has changed; I've had to evaluate what I really want out of life. More widely, I'm far more engaged in debate about 'development' and global ethics; I really feel I have a grounded perspective and sensible insight into things that previously might have been too big to contemplate.


Q:How has your time abroad helped or hindered your medical career since returning to the UK?

A: Immediately on returning I was thrown into the disorganised and highly restrictive MMC restructuring. Despite the difficulties with all this, I always felt I had something more to offer to employers than the pre-VSO me. Generally, colleagues both junior and senior have been highly supportive, if a little bemused at my enthusiam for living and working in a developing country. In the long run, I can't imagine any negative impact on my medical career.


Q: Are there any specialties or employers with particular regard for doctors offering experience of overseas development work?

A: Sensible recruiters want enthusiasm, new perspective and broad experience. Overseas development work can offer all these, but you have to spin this the right way to NHS employers. You may often encounter a 'Why on earth...?' attitude until you can explain yourself. I'm not sure any specialties are more forward-looking than others from this perspective.


Q:Have you made friends and connections and keep in touch with these? Would you ever go back to international development work?

A: Yes. I have made friends who I expect to stay in touch with for a long time - they are an important part of my life. Connections with organisations are more difficult and less personal, but I will maintain strong links with VSO in whatever way I can. I am planning on further international development work, albeit with a more medical slant - I am after all a doctor with interest in development rather than a development worker dabbling in medicine.


Q:Overall, what are the pros and cons of volunteering?

A: My experiences from Tanzania alter how I approach things every day; I've been extremely privileged to have had the opportunity to work in such a challenging and interesting environment. I can't imagine my life without the extra perspective, the friends and the personal confidence that living in Tanzania gave me. On bad days, volunteering can be dull, stressful, lonely and down-heartening. On good days, I've been more uplifted and 'buzzing' that I've ever been. Volunteering seemed to exaggerate all these pros and cons; at least the contrast never left me feeling stuck in a rut. Leaving family and friends behind was one of the most difficult aspects, but integration into a different community is one of the most fulfilling things I've done.


Q:What's the one piece of advice you would give to other doctors considering something similar?

A: Don't expect any deanery to be overjoyed at temporarily losing a trainee - to them it is nothing but hassle! So don't let an off-the-cuff 'you can't do that' response put you off. Canvas support from your educational supervisor and programme director. And know that the gains for most VSO doctors have far outweighed the difficulties either before going or after returning.


Dr Rylance is a respiratory physician in specialist training. He has recently temporarily left NHS training to undertake research relevant to medicine in the developing world, funded by the Wellcome Trust.


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