6 months in placement. 18 to go.

Am I able to say that this volunteering “fancy” of mine has been a good idea at all?

Without a doubt!

Will I change my mind at the end of the whole two years?

Extremely unlikely.

Why so? Well that, for me, is because of the very nature of volunteering. Every volunteer knows from the outset that things are going to be very different from the cosy security of ‘home’, wherever that may be. As a result, they are somewhat shielded from the shock of facing new cultures, new levels of (dis)comfort, new paces of life and new communication barriers. Furthermore, since these are the very new experiences that attract a lot of people to volunteering, they tend to see it more as a challenge... a goal. But then you hear a lot of people saying “I totally didn’t expect it to be SO different!”.

That may be so but also the majority of these people (who, remember, are only a small subset of all volunteers) don’t regret going away to do what they have done. Most of them are transformed by the experience and feel that they have, in some way or other, transformed other people’s lives. Those people are not just the villagers/school children etc they have worked with abroad, but very much closer too- people at home they’ve inspired or challenged preconceptions of. And then you hear quite a few volunteers responding negatively when asked if they would ever go back. I think that this answer does not reflect on their having acquired a distaste for volunteering, but merely reflects wider realities- work pressures, family commitments, a desire to do something else (maybe even volunteer somewhere else) rather than volunteer in the same place again. In any case, you won’t be able to help there being a small handful of volunteers who will adamantly reject volunteering completely after their own bitter experience.  So be it; just don’t let your views be tarnished by the minority. Their circumstances are likely to have been unique, albeit genuine.

So allow me to entice you to the beautiful, exciting, cocoon-shaking, yet sobering experience of volunteering in Africa. I had this urge gnawing at me for years to be honest. In fact, unlike most doctors, my urge for volunteering came before the urge to be a doctor and I chose medicine partly because it would provide me with that great platform for volunteering. (Alright I was a bit taken in by the whole glamour thing of MSF and all, but that was then!)

The last 6 months must have been the most surreal ones of my life, not least for the circumstances surrounding them. But then these circumstances also go to show that some apprehensions about volunteering aren’t always justified. How many times do you hear about people refraining from volunteering because of relationship issues? Well, if mine is not at the extreme end of the relationship issue spectrum, I don’t know what is! My wife and I got married after a 4 ½ year relationship literally 3 months before my departure to Malawi. Alone. That was not the original plan of course. We wanted to go together. But for the very sake of our family in a certain way, we thought it best to do things this way. She needs one more year to specialise (another medic!), after which she can come out to join me. I am at a stage in my career where I am really ready to volunteer rather than launch into a committing 4 to 5 years of higher surgical training. And we both want to have kids before our gametes become defective and immotile! So here you go. With a bit of dialogue and cool reasoning, it became possible to do the seemingly impossible. And 6 months on, I can safely say things are going stronger than ever before. We’ve met once already and had one of the most refreshing times we’ve ever had together. What this also demonstrates to me is that even though one can always find a reason they’ll think is strong enough to refrain from volunteering, one can also find a stronger reason for pursuing their passion if that’s what they want to do. In my case, I could have used popular deterrents like work (so many people called it “career suicide”), financial security (need to have a house etc before going away) or cynicism (“at the end of the day you’re not gonna change a thing, Ash”) to keep me grounded. If that was the case, then no one would volunteer at all and that’s definitely wrong. A lot of the times, these deterrents are other people’s ideas which have seeded themselves in your mind, and often these other people are completely different from you and never cared about volunteering in the first place. At the end of the day, most volunteers describe their experience as the most worthwhile thing they’ve achieved and whatever sacrifices they’ve made have been paid back.

I have chosen to volunteer now, when I’m still young and full of energy and passion to change things. The more I delayed my decision to volunteer, the bitterer and the less dynamic I would likely become. I applied to go with VSO (voluntary service overseas) since they matched my ambitions the best. There are always a number of charities to choose from and I can’t say that one is necessarily better than the other lest I join each one in turn. So I started my planning with a thorough search through the available options. VSO prepared me somewhat for the placement prior to departure through some very useful training sessions in the UK. After a few months of profile matching, I got posted to work in the district hospital in Ntcheu in Malawi as a medical officer. This job description was left somewhat loose, given the anticipated need to adapt to the local settings once in placement. Given my background in Orthoapedic surgery, I naturally slipped into the role of Dokotalla Wa Mafupa (orthopaedic doctor) in the hospital, while also assisting in general surgery and occasionally in Obstetrics/ Gynaecology. The transition was truly fascinating, requiring a supervised period of induction at the central hospital to ensure that I meet the level of confidence to undertake these new procedures. What this has translated in for me is a formidable expansion and refinement of my surgical skills. On top of that, my orthopaedic experience has also been extended by the range of cases I am dealing here, which would be very uncommon in the UK: neglected congenital deformities; advanced sepsis; extreme trauma; burns and even snake bites. Being in the position where I’m making more senior decisions and managing pathology more independently is a priceless experience which every aspiring surgeon needs during their training. This, I couldn’t hope to acquire to such an extent back in the UK. Getting used to managing conditions in different, often more conservative ways, has also forced a more in-depth understanding of the basic science of injuries. So far, at least as far as the career-oriented deterrent goes, I am positive that volunteering here has been the right decision.

Even though I’m here as a health volunteer, the “work” I am doing does not stop with work as we know it back home. A lot of “work” involves working on oneself to facilitate adaptation into a new culture and work ethic. It requires one to understand the people we’re working with better. I also have to conduct teaching and supervision of staff on a daily basis. Unless that communication and culture gap can be bridged, then there’s little hope of ever making progress in the actual “work”. This I find to be an incredible challenge, incredibly more rewarding when the rapport is finally established. Daunting it may appear at the beginning, but one soon finds that the natural warmth of the people here is so infectious that the distance soon closes itself naturally. Never before has my understanding of people been so enlightened, and to now take that human skill and team-working ability back to the UK will no doubt equip me with something I can’t just get from a workshop.

Incredible, it has to be said, this volunteering experience is proving to be for me. I find myself everyday reflecting on its myriad aspects and finding new ones still. There is a part of me that is becoming more independent, more confident. Part of me that is becoming more cultured, more well-read, more educated by virtue of the time freed up to read in here and the different mix of more like-minded and inquisitive and critical people from the west I am meeting all the time. There is a part of me that is getting more respectful of the things I used to take for granted: food, sanitation, new fashionable clothes, healthcare, education, you name it. The relative insignificance of man faced with Nature becomes ever more awesomely humbling here. I can see, at first hand, the far removed effects of climate change and environmental degradation one hardly comes face to face with in a British city or town. The threat to starvation and natural destruction that it poses. Not least the innocent lives that are held to ransom.

Being away doesn’t mean you have to be serious about everything and compare all you do with the way things were back home. It can be unbelievably fun too. Local travelling, whichever means you use, is always accompanied by a sense of adventure. From the minibus to the back of a pickup truck to the long-distance bus seat for 30hours, you’ll accumulate crazy stories to wow your friends with. The natural wonders of this relatively unspoilt part of the world are there to be discovered and oh how great it is to go after them: Nyika Plateau, Mulanje Massif, Lake Malawi, game parks and even just the fields  right on your doorsteps filled with more species of birds and flowers one could bear to name.  You can do it all here on a wide range of budgets. You can certainly go into the chalets for a treat but as long as you’re happy with a tent and a sleeping bag (of course you can add an inflatable mattress), you can pretty much pitch up in most places and self cater. An even more off-the-beaten-track treat is to actually go and stay in a village with the indigenous people some time and observe their daily getting about. Absolutely fascinating and makes me wish I hadn’t traded so many of those survival skills for computer and financial skills as I have. I could easily fill up volumes just to describe the fun I’m having here as a volunteer but I guess I’m already doing so on my blog page (www.ashtinafrica.blogspot.com). I’ll simply close this section by adding that all the fun is complemented by a deep sense of satisfaction that I am at the same time contributing to the safeguard and welfare of some of the least priviledged people in this unjust world order; i.e. fun less the guilt.

Honestly, I’m having the time of my life so far and wouldn’t trade it for anything in the world. My eyes, my heart and my mind are being simultaneously open. I recommend it to each and every one on earth. As my brother once said to me: Minds are like parachutes, they function best when open...

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