Healthcare Disparity in East African Island Hospital, A Neurological Perspective
Soroush Kakawand1
1University of Oklahoma Health Sciences Center
Objective:
To report on an International Medical Elective in East Africa, a disastrous capsized ferry accident, and the ensuing medical management with a focus on neurological care. 
Background:

Medical student elective is an excellent opportunity to gain valuable cross-cultural experience and become familiar with different healthcare systems around the world. 
My experience was in Mnazi Mmoja hospital, a small referral hospital in Zanzibar. I participated in several services, including Paediatrics, Obstetrics, and Surgery. Lack of sufficient funding, deviation from standards of practice, and paternalistic mode of practice were especially evident during this international experience.
Students who elect to spend time learning in developing countries must remain cognisant of their limitations and competencies. 
There is a need in developing countries for a more structured exchange program that would be mutually beneficial, with a particular focus on neurology exchange programs 

Design/Methods:
Field report 
Results:

During this elective time, I was witness to a capsized ferry accident where hundreds of people lost their lives. We were a group of medical students on an elective during this disaster. We were called upon to assist in the search and rescue mission and to provide immediate life support. Patients with traumatic brain injuries, convulsions, and other neurological presentations often did not receive adequate care due to insufficient personnel and equipment. 

A portion of the elective was spent on obstetrics service, during which we assisted with deliveries. Often there were several women on separate birthing tables; at times, there was a lack of adequate analgesia and aseptic procedures, contributing to both infant and maternal mortality.  

Conclusions:

Medical electives in developing countries are an excellent opportunity to learn and gain exposure to the diverse, multicultural health system, which will be an asset in reducing unconscious biases in healthcare. To gain maximum benefits, a student must remain open-minded, vigilant, and professional throughout the experience. 

10.1212/WNL.0000000000204013