Reporter: Maria Lobo
Year of visit: 2015
Region: North Benin
Institution: Hopital de St Jean de Dieu
Department: Medecine generale
Work / Study undertaken: I spent 7 weeks at the hospital, on ward rounds, in A&E and in clinic. As my French improved I was able to clerk patients and write in their notes, and hold consultations in clinic in my own room.Medical students are able to order investigations and write out prescriptions for patients leaving hospital so that was a great experience.I also spent one day with the hospital psychologist who works with patients with HIV- very moving.
Description of the service and department:The hospital is one of the largest and best in Northern Benin, run by the Catholic order of St John of God (though the staff and patients are of all religions and none). Patients travelled from Togo, Burkina Faso and Nigeria to use its services.Healthcare is subsidised by the charity and many patients are very poor. Ward rounds take place in the morning and in the afternoon there is clinic or can go to A&E. I had a lot of free time and often finished around 2pm, though Surgery was much busier. Having been used to busy London hospitals, the turnover of patients in A&E was much less- the medics would see on average around 6 patients there in a 24h period. The doctors are very passionate about what they do and it was inspiring to hear them talk about their work and what they thought needed to be done to improve healthcare in Benin.Some cases were very sad so just be prepared for this- several deaths on the ward of young patients.
Description of the destination: Tanguieta is a small town but with several bars, a large market and local attractions nearby such as waterfalls.
Were the local people friendly? You do stick out as a Yovo (white person), so just be prepared for lots of stares and children shouting and pointing at you. And just be aware that annoyingly as a tourist you may have to pay bribes eg at airport customs or to police officers on the road.However, it was the people that made my trip! The staff at the hospital were so welcoming and there is a wonderful community there. It would often take half an hour to walk from one side of the hospital to the other just because of all the lovely people you would bump into and chat to.Get to know Sister Immacule, the cook, she is very funny and friendly and did an impression of a goat to explain what we were having for dinner when I didn’t understand the French word! In the North there are less tourists so the friendly locals that you meet are likely to be genuine.
Did you feel safe and if not why not? Yes. I chose Benin as (according to Wikipedia at least!) it is one of the safest and stablest African countries. Of course take sensible precautions that you would anywhere, but I had no problems during my 9 weeks in West Africa.The hospital arranged for their representative to meet me at the airport in Cotonou and as the accommodation was on-site everything was very easy for me.I travelled around Togo afterwards with my partner who joined me after my elective. In hindsight I could have travelled everywhere by myself and would have been unlikely to encounter any problems.
Is there anything that you would particularly recommend others to do? I did have a lot of spare time so take a lot of books etc with you. I made a lot of progress in my French grammar book! There are bars in Tanguieta and can go to the market.Excursions near Tanguieta for weekends-Pendjari national park- Safari! Best part of my trip- saw antelopes, hippos and came very close to a herd of elephants at sunset. End of April (end of dry season) is one of the best times of year to go when the roads are ok and the animals gather around watering holes. (Whole weekend including park entry, hotel, meals, driver cost £70 each in a group of 4).
Cascades de Tanougou- can swim in pool and jump from rocks. Near pendjari park so see them on your way back.
Natitingou- Hotel Kaba in the mountains has a swimming pool you can use that overlooks the mountains
Could also visit Tata Somba.
These weekend excursions were organised through Malik (the nuns have his contact details), our lovely Senegalese tourist guide who is so friendly and will invite you to his house for tea with his wife (a brilliant seamstress if you want to have an African dress made) and daughter. Also look out for Mohammed who works at the market selling art and will also invite you round for tea.After my elective I travelled around Togo (crossed the border at the south via bush taxi, ie 8 people crammed into a 5 seater car!) visiting Lome, Kpalime and Lac Togo.
What time of the year were you there? What was the climate like? April-May. I was there just when the rainy season was about to start. Very hot- 40 degrees Celsius, takes a few days to get used to. When it rains it’s an absolute downpour!
What was your accommodation like? Was it provided? If not who arranged it? How much did it cost?
Great. On the hospital site (arranged as part of the elective) so very convenient. Had a twin room (though no one else was sharing it with me) with en-suite bathroom, mosquito nets provided and there was even air-con! Frequent mini power-cuts and water shortages though.Cost £9 per day (they ask you to pay in advance through bank transfer- I used azimo.com) and includes all meals. Food is delicious!You stay with all the international staff and elective students which makes it a great way to meet people from around the world.
Did you enjoy your visit? Yes! Was difficult at times as my rusty French made it hard to follow conversations, especially initially. But the staff are so welcoming and people are so much friendlier than I am used to in London.
Did you find it useful medically? If so, in what way?Yes. Cases on the ward cases were very different to the UK- lots of TB, malaria, severe infections, organomegaly and sadly advanced cancers as patients sought medical attention late.Cases in clinic were often similar to what I had seen before- peptic ulcers, hypertension and diabetes so it was a useful setting to practice my management of these cases.Encountered different health beliefs- some A&E attendances were due to side effects of traditional medicines.
Has it improved your French? Definitely. I went on elective with pretty poor French, having done it for GCSE many years ago. But I improved quickly and was proud to be able to hold whole consultations by the end. Elective is a great opportunity to challenge yourself so if you are unsure I would just say go for it! African French is spoken much slower than in Europe which makes it a great place to learn. I would recommend being the only English-speaking student like me as then it forces you to be immersed in the new language. I bought ‘Lexique Medicale’ off Amazon before my trip which was a very useful pocket-sized French-English medical dictionary.
How did you get there? Flight to Cotonou with Ethiopian Airways (via Addis Ababa, long route, in hindsight would probably be better to fly via Paris).Stayed one night at Cotonou in AMCES (organised by hospital). The next day had 14h coach journey to Tanguieta, quite uncomfortable with no proper toilets on the route so just be prepared for this! The hospital is very close to the coach station in Tanguieta.
What was the approximate total cost?
Flights- £600 (returned from Togo).Visa- £90- obtained in advance from Beninese consulate in N.W. London.
Antimalarials (atorvaquone)- £100 (travelpharm.com)Accommodation- £5002 weeks holiday in Togo afterwards- £250
Is there any other information that you think may be useful? Euros are easy to change while you are there and you can take your bank card as well (Visa worked everywhere for me).https://www.thomasexchange.co.uk/ The oxford street branch had CFA franc available.
Reporter: Donald Waters
Contact at destination: Dr Andrew Potter
Year of visit: 2014
Institution: Hôpital St André de Tinré
Work / Study undertaken One month attachment at the biggest specialist eye hospital in Western Africa. Clinical placement a bit limited in terms of variety and what I was able to do, basically spent an awful lot of time watching cataract operations! However also gained experience of using the slit lamp and managed to arrange a week transfer to Benbereke hospital which is a general hospital run by the same Christian mission. Here I was able to see a lot more variety including paediatric and obstetric cases and also spent a day assisting in theatre on a general surgery list.
Description of destination Parakou is the second town of Benin and is big enough to have everything you need and more: supermarket, bank, post office, internet café… even a tennis court! It is by no means a pretty place and has the constant hustle and bustle that seems to characterise most large African conurbations, however it is much quieter than Cotonou (the biggest city in Benin) and a manageable size in that you can get anywhere by motorcycle taxi within 10-20 minutes. Also a big university town so has quite a lot of alternative stuff going on (I went to several really cool reggae gigs) and lots of young people looking to practice their English!
Were the local people friendly? Exceedingly, there are still so few people with white skin in Benin that I felt like a bit of a novelty a lot of the time and people were continually coming up to talk to me. Although this can be a bit wearing, as long as you are willing to play along with it it can also be a lot of fun! I had so many silly conversations about how Scottish people can’t handle the heat and what the point in sun cream is with just random people I met in the street or on public transport!
Did you feel safe and if not why not? I felt entirely safe in Parakou and never had any trouble even walking around at night. The only source of danger which worried me was the public transport, especially the motorcycle taxis which have numerous accidents every day. I’m absolutely not saying don’t use them, as they are by far the best way to get around. Just strongly consider wearing a helmet, no matter how much the locals laugh at you.
What did you do in your spare time? I spent a lot of time at Parakou University chatting to or playing football with local students, a really fascinating experience of just how different student life is in Sub Saharan Africa (we don’t often have to chase goats out of lecture theatres in Scotland!). There are bars in Parakou and a club or two, however I didn’t have a huge amount of involvement with these as the students I hung out with couldn’t really afford them. I also visited the Parakou market a lot and spent a couple of days before coming home seeing two of Benin’s three tourist sights: Ouidah the international home of the voodoo religion and Ganvié, the largest collections of lake dwellings in Africa. Both were very interesting although beware of locals claiming to be guides and trying to mug you off! The third main tourist attraction is the national park in the North West of the country, however doing this solo would have been way above my budget (£100+ per day).
Is there anything that you would particularly recommend others to do? As well as its links with voodoo, the town of Ouidah used to be a major slave port and has a really poignant reconstruction of “the gate of no return” looking out to sea, which slaves had to pass through before being put on a ship for the Americas. Apart from this and the things mentioned above, Benin really hasn’t become much of a tourist hotspot yet and so there are so many little bits to explore which really feel genuinely like uncharted territory. Just get on a motorcycle taxi and see where you end up!
What was the climate like? Very very hot, 35 degrees Celsius inside clinic with two rooftop fans on! I basically didn’t stop sweating for the entire duration of my stay, although Parakou was much more pleasant than Cotonou as the humidity was less. The air-conditioned operating theatre became a bit of a paradise for me and so I didn’t really mind spending all day watching cataracts being removed!
What was your accommodation like? I spent my first week in a room in the hospital which was free of charge, functional and had cooking facilities however was also really rather lonely as all of the other staff left the hospital at 2pm (the hospital is 12km out of town) and I was left to entertain myself in the sweltering heat, made worse by the frequent powercuts taking out the fan in the room. I therefore moved back into town after the first week and stayed in the accommodation of the Christian mission which runs the hospital. This was a very interesting experience for me as I am not religious myself, however this was not really an issue and as long as you are willing to abide by their rules and have quite a few talks about “le seigneur” then it is a really nice place to stay. Much better value also than any other commercial accommodation and benefits from being surrounded by beautiful mango trees which provide both a free breakfast every day and also a bit of shelter from the mad noise of the Parakou rush hour.
Was it provided? Both the hospital accommodation and then my move to the mission was a arranged by Dr Potter.
How much did it cost? 5,000 Communauté Financière Africaine francs a night (F CFA is fixed at F655=€1)
Did you enjoy your visit? Yes, very much.
Did you find it useful medically? Not hugely in terms of specific medical knowledge or experience, but gained a huge insight into the complexities of healthcare provision in a low resource setting and also the implications of a religious funding element to many hospitals in low- and middle-income countries.
Has it improved your French? Phenomenally few people spoke English (apart from uni students) and so I had to improve my French at speed! Many Beninois people I met claimed they speak better French than the French do, and although I’m not sure this is entirely true they certainly do speak clear French at a speed that isn’t too hard to comprehend. The accent is bizarre though and took me a good few days to get my head around!
How has it increased your knowledge of French culture? Obviously there are still many French cultural influences in Benin however I feel I learnt a lot more about Western African culture than I did about French. Gained a much deeper understanding of the problems of growing up and going to university in a low-income country, something I hadn’t really thought about before. Also an eye-opening insight into the religious fervor of some missions in Africa, not sure that part is something I would want to repeat however.
If you went back would you do anything differently? Probably try and go to a more general hospital without the religious facet.
How did you get there? Flew Edinburgh-Paris-Cotonou. No direct flights from the UK. Only providers are Air France and KLM (actually the same company)
What was the approximate total cost? Flights £690 then spent £400 in 4 weeks including 3 weeks of accommodation.
Is there any other information that you think may be useful? Go to Benin! It is an amazing little country that nobody has heard of and has so many bizarre quirky things that you will never have experienced anything like it before! More specifically to my placement I would strongly recommend trying to make a friend at Parakou university and then eat at the uni canteen some nights. Guaranteed huge quantities of carb and meat-of-unknown-origin for approx 25p a meal, much cheaper than the meals offered at the mission and a great opportunity to really feel part of local life. Benin is ot a place to go unless you are relatively confident conversationally in French as nobody speaks English, they are however more than happy to help you practice your French so you don’t need to be fluent by any means. When you’re bartering always smile, the second you get angry you’ve lost the game!