Planning your elective - Western Samoa

Western Samoa is a young developing nation, which gained its independence from Britain and New Zealand in 1962. Neighbouring American Samoa is still under American government. Samoa consists of nine volcanic islands, the most densely populated of which is Upolu, which has a population of 115 000. The National Hospital of Samoa (also known locally as the Tupua Tamasese Meaole Hospital after the first head of state) is on the outskirts of the capital, Apia.

This hospital provides the bulk of medical care to Samoans, although there are five small peripheral hospitals, each with one doctor: three on Upolu and two on the largest island in Samoa, Savai'i. Only two other islands are populated: Manono (with a population of 1500) and Apolima (with a population of 150). There are no doctors on these islands and people have to travel by ferry to Upolu. In addition to the government hospitals there are a few private general practitioners and one private hospital used almost exclusively by the "palagi," or white foreigners. The remainder of the islands are small and uninhabited.

The majority of people earn a living by growing and harvesting crops, such as banana, coffee, copra, coconut, and taro for home consumption and export. There is relatively little poverty in Samoa since the majority of Samoans follow a strict code of conduct known as the "fa'a Samoa," where resources are pooled and shared between members of a village. However, there are a few wealthy entrepreneurs living in Apia who have rejected the traditional Samoan way of life and are keen to imitate the American or New Zealand cultures that are becoming more prevalent here.

What can you expect from an elective in Samoa?

Samoa has a safe environment where there is little aggression or violence, no political instability, and HIV is virtually unknown (there have been only six cases of HIV in Samoa, all of which were imported from Los Angeles). As there are no government employed GPs in Samoa all minor complaints are dealt with in accident and emergency departments or paediatric clinics. However, there is a lot of chronic disease in Samoa and the women who come in with a cold may well have diabetic retinopathy or cardiomegaly.

Most Samoans are very large and food plays an important part in their lives. As a consequence, the hospital is full of Western style disease: diabetes, hypertension, more hypertension, heart disease, and obesity. There is an abundance of signs and symptoms for those doing their elective close to finals. There are also conditions that we almost never see now in Britain. We all ask about a history of rheumatic fever but very few of us ever see it. In Samoa, a large proportion of the adults (10%) have had rheumatic fever and now have cardiomegaly and heart failure as a result. In the paediatric clinics, acute rheumatic fever is seen almost daily and you can become proficient in detecting heart murmurs.

If your interest is surgery there is plenty for you to do: a small core of general surgeons deal with just about every surgical condition. Only patients who need complicated cardiac surgery are sent to New Zealand for their operations. The skill of the surgeons is variable but some of them are excellent and enjoy teaching and providing practical experience. There are regular visits from volunteer teams from around the world. During my time a team of plastic surgeons arrived and I was able to help with skin grafting and observe cleft palate operations and such rarities as the repair of a ruptured levator palpabrae superioris.

Those students doing obstetrics and gynaecology seemed to have the most fun and worthwhile experience. Those who opted for anaesthetics were feeling competent at handling a case from clerking, through the operation, and all the way to postoperative recovery after only a few weeks here. However, anaesthetics in Samoa varies from practice in Britain: there are no ventilators. If the anaesthetist forgets to squeeze the bag the patient does not breathe.

Visas and travel

British citizens will need a student visa if they plan to stay for more than 30 days. This needs to be organised well in advance as it has to be obtained by writing to the nearest Samoan Embassy, which is in Brussels, with payment in Belgian francs.

Health and safety

Despite the mass of vicious mosquitoes, there is no malaria in Samoa. There is, however, dengue fever, so normal precautions against mosquito bites are advisable. There are occasional outbreaks of typhoid fever. It is advisable to include betadine ointment and a couple of courses of antibiotics in your first aid kit as small wounds quickly become infected in the climate and the hospitals regularly run out of antibiotics. In virtually crime free Samoa the main danger from walking alone at night is from the stray dogs. "Who let the dogs out?" written and recorded by a Samoan band was inspired by these dogs. While placid by day, these dogs become aggressive as the sun sets and have been known to attack lone medical students and doctors walking to and from the hospital at night. There is some rabies so anti rabies jabs would be a wise precaution. Hepatitis B and C are widespread because of the tradition of tattooing. No matter how tempting, getting a traditional tattoo is best avoided.

Jo Bramall, final year medical student, University of Wales College of Medicine


studentBMJ 2001;09:129-170 May ISSN 0966-6494