Life In The Developing World As A Foreign Medical Student

In September 2010 I was dismayed to find out it would be at least 18 months until I could be accepted into and start medical school in Australia. I could be almost half way through my degree in that time. Worse still, what if I was not feeling so well on the day of the GAMSAT or the interview? I would then have to wait another 12 months to try again! What was I supposed to do for the next 18 to 30 months?

I soon discovered the little known secret that the Philippines offers an internationally recognised four year graduate MD degree taught in English at an affordable cost of only $1600 per semester. Add to that student accommodation at under $200 per month and each meal around $2, the total cost of studying and living was well under the cost of rent alone in Australia. Like Australia, the Philippines have a GAMSAT style entrance exam, but unlike Australia, it does not appear that many schools place such a significant emphasis on its weighting in their selection process. I was surprised when I saw offers made to other students despite their scores being in the bottom few percent. One school told me that this was because it was a government regulation that students sit the entrance exam but the schools had some independence about which students they accepted into their programs and on what basis. In general it seemed if you were genuinely interested in medicine and could pay for your tuition up-front you could find a school that would accept you into their program. Whilst it may have been a little less onerous to be accepted into a medical school program in the Philippines than in Australia, the ability to stay in the program was something different. Passing the first year was where the real selection of students happened.

Anyhow, I thought it would be good practice for the GAMSAT, so I set off for Manila on December 11 and sat the exam the next day. I received my results within two weeks and a few months later, after having sat the GAMSAT in Australia, I flew back to the Philippines to check out a number of the schools and have an exotic holiday before my life as a medical student began.

With a population of 95 million, the Philippines have 38 medical schools both private and public. The public schools do not accept foreign students and a number of private schools require foreigners to pay a non-refundable “deposit” of $10,000. I sent off applications to six schools as per the instructions on each school’s website. Many responded by saying to just ‘pop in’ whenever I happened to be in the neighbourhood and they’d arrange an interview at that time. So I went to the airport and flew to the first school on my list and true to their word, they summoned all the senior people from the school and within 30 minutes I was having my first medical school panel interview. Another school was so excited to see me that once I had paid their $40 application fee they gave me an official offer of acceptance – no interview required. This made the process fairly stress free, but was also a little disappointing because I wanted to practice answering the “Tell us about yourself,” and “Why do you want to be a doctor?” kind of questions for my interviews later in the year back in Australia. In hindsight, I can now see the fact I had turned up from a foreign land was evidence enough for them of my desire and willingness to become a doctor. Furthermore, I realised after my interviews in Australia that I really did not need to practice answering these questions. The fact I was prepared to study medicine in the third world proved to be strong evidence that I had many of the qualities they were looking for. As it turned out, my fresh and relevant experiences in the Philippines provided me with plenty of examples to demonstrate my passion for medicine when I was asked the humanistic questions. Without these I’m sure I would have struggled to distinguish myself from the other candidates. So, in many ways, my idea to study in the Philippines as a back-up plan in case I was not accepted into school in Australia helped me secure my place in a school in Australia.

After being accepted into a number of schools in the Philippines, I decided to relax and ponder which school I liked the most. I spent a lot of this time in a small country town, where I was able to stay with people who were living close to, or in, poverty. Along with this poverty came suffering and tragedy but also what I thought was a strong sense of community – neither of which is so evident in Australia. I saw men and women taking on ‘traditional’ roles that, while restricted, seemed to bring them some comfort in knowing their role in their community. It was a powerful reminder of how we can get caught up in our own small world and forget how satisfying it can be to be a part of a community and to make a meaningful contribution to it. I was humbled by my experiences there. One experience in particular stands out:

I was playing a game of pool set up on the street by a family to make a little income when, at around 10pm, I heard a strange scream coming from a nearby house. Within a minute, dozens of people had appeared, broken down a security gate and carried a man on to the street and commenced CPR. The man had hanged himself and the screaming woman was his wife who had woken up in the night to find him hanging from the ceiling. The man together with the wife and two young sons were quickly rushed off to a nearby health-care centre, only for the wife and sons to come back 30 minutes later, alone. The wife was escorted into the house by the women from the community, but the kids refused to go back into the house. I went over and talked to them. The youngest said it was his fault that his father hanged himself because it was his birthday. Of course, I told him it wasn’t and that his father had gone to heaven, but he quickly replied saying he knew his dad was now in hell “because people who kill themselves go to hell.” It was shocking to hear that a child so young could have such a strong opinion and sad to think these children would probably carry this burden for the rest of their lives. When I told my Filipino friend that these children should probably have some counselling, she said they would not be able to afford it. I immediately felt a sense of duty to offer to pay – at $40 for a one hour session with a fully qualified psychiatrist I had the means to do so. She quickly added though that they would be reluctant to accept such an offer because of the stigma attached to admitting you have a psychological issue. This made me think about the campaigns on mental illness at home which were aimed at promoting its awareness and treatment and destigmatising it. I realised just how vital it is to do this otherwise other children in need may not get access to the care they need.

Over the coming months I realised this was not such an isolated event as my friends and fellow medical school classmates told me of their own personal accounts of rape, armed assault and murder. This tainted my initial impression of the positive effects of poverty. I began to feel guilty that my country was possibly contributing to this by not sharing its wealth and not providing equal opportunities to people in other parts of the world. I was taught and believed that discrimination was wrong, but here I could see first-hand that these people did not have the same rights that I had as an Australian. But what could I do as an individual? I do not have the resources or influence to make much of a direct impact. So I hope in sharing these experiences that I can make a difference by helping others appreciate the personal benefit and insights that can be gained by stepping out of our comfort zone and starting a journey into the lives of other people. And I hope they can also encourage others to do the same, thereby resulting in a greater awareness of where we, as individuals and Australians, want to fit into this world.

I eventually decided to study at the Cebu Institute of Medicine. It is ranked as the best private school in the country (based on a 100% medical board pass rate by graduates over the past ten years) and is on the “friendly, safe and beautiful” island of Cebu. The island is famous for being the place where Magellan was killed 500 years earlier for trying to bring Catholicism to the area. The warrior who killed him is a national hero, which I found ironic since the vast majority of people in the Philippines are practicing Catholics and many have some Portuguese or Spanish ancestry. Paradoxes liked these seemed to be everywhere in the Philippines and I often found myself asking people how they could reconcile such disparities in their heads. That was until someone asked me about Gallipoli, Ned Kelly and convicts.

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June 6 was the first day of school. There were a few Filipino-Americans in the class, but I was the only Caucasian – providing me with another experience of living as the odd one out. School got underway pretty quickly after the first week of orientation (Figure 1). The school I had chosen was almost entirely based on PBL. We were expected to read and understand several chapters on new topics every day and be prepared to present them from memory to other students the following morning. On top of this we were given one to five formal exams each week and would be tested on the most obscure details. My life had gone from an exotic holiday to an 80 hour per week study nightmare! My 98% score on the Filipino “GAMSAT” and a PhD published in the journal, Science, meant nothing! In the first semester, we had memorised a dozen biochemistry pathways; memorised all the bones and muscles of the body with the help of a street person-turned-cadaver that we had dissected using a few photocopied notes as a guide; completed the physiology of the respiratory, cardiology and gastrointestinal systems; written a research proposal; submitted weekly entries from our reflection journal; and had begun clinical training on Saturday mornings. I was reading every spare minute I had. I remember once thinking I should give myself a moment to think about what I was actually doing. I looked around at other people going about their lives and smiled. I felt so glad that I had the courage to be in this place that was different to what I was accustomed and to have been given the opportunity by the people of this land to not just learn medical science, but to learn about the human condition. I had never felt this feeling of purpose before and I would have never imagined I would find it so far from my comfort zone. Soon after this I received an offer to study at ANU and I knew I would return to Australia but not as the same person. I had a new perspective and better understanding on what is required to truly study medicine. It is not just about learning the science but to understand what it is to be human with all its complexities.

I am now in my second year studying medicine at one of the best universities in the world, yet in many ways I learnt so much more from my short eight months in the Philippines. It was an experience that I believe everyone who wants to understand more about what it means to be human should do. My experiences from living with people who have been dealt a different set of cards and observing how they have adapted to them made me question assumptions that I had never before even thought to challenge. I went to the Philippines to start my study in medicine thinking it was about learning how the body works. I came away understanding that medicine is much more about humanity.

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