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Rob Marshall, final year medical student and president of the Australian Medical Students' Association, won this year's Alan Charters Prize for his presentation following his elective in Haiti earlier this year.

Rob had taken a year off from his medical studies to spend a year in France and, on the way home in early 2010, he read about the earthquake that had devastated the French-speaking island. He organised his elective over the next 12 months. This is an edited version of his report.

How could this happen? How could one of the world's most neglected and impoverished countries be the victim of magnitude seven Earthquake?

What would happen to a country with no infrastructure and no health system to speak of when the thousands of injured and dying Earthquake victims need medical help?

I decided to find out for myself.

As I started organising my elective, the situation in Haiti went from bad to worse. The death toll rose to a staggering 230,000. The disaster hit again. Flooding caused by the hurricane season resulted in mass homelessness, reaching the 1.6 million mark and unemployment was up to 80 per cent.

On top of this, an epidemic of cholera broke out in October that killed nearly 5,000 people. In the context of these medical and environmental disasters, Haiti was also struck by a political crisis due to disputed Presidential election results. Mass rioting, road blockades and political unrest ensued.

It was amongst this political, medical and environmental chaos that I finally found myself landing in Port-au-Prince, ready to start work in a free volunteer-run primary care clinic 10 kilometres from Port-au-Prince.

The driver who picked me up on my arrival drew a succinct picture: ‘Haiti was a disaster zone, and then it was struck by an earthquake,' he said.

The next six weeks I spent working alongside nurses and doctors at the clinic seemed to confirm this fact. With system and a complete lack of basic infrastructure (running water, building codes, ambulances, electricity, roads), our clinic was overrun every day with complaints far beyond the scope of primary care.

At seven in the morning the gates open and patients from far and wide pile in and form lines depending on their complaint. We would see over 200 patients a day, ranging from minor complaints like coughs and colds, ulcers, skin infections, and reflux to the very serious complaints of malignant hypertension, malaria, cholera, typhoid, HIV and tuberculosis.

One of the most common presentations at the clinic didn't require complex investigations or management. Cholera, a devastating diarrhoeal disease has a simple and lifesaving treatment: sugar, salt and bicarbonate of soda dissolved into clean drinking water.

I remember one little girl who came in with a pink ribbon in her hair, so dehydrated from cholera that she looked like a skeleton: retracted eyelids and lips, dry skin clinging to her face, and limbs that were literally skin and bone. Oral rehydration wasn't enough in this case so we set up some IV fluids. A very short while later I asked the nurse what had happened to the little girl, and who this happy little girl was who had also been given an IV. The nurse said that it was the same girl. If it weren't for the pink ribbon in her hair I would not have believed the nurse, such was the incredible transformation that some simple rehydration had offered.

None of the reading I had done prepared me for the experiences that I had in Haiti. Being part of the relief effort was immensely rewarding. With an open mind, a value of culturally-appropriate and ethical healthcare delivery and a good mosquito net, a medical elective in a developing country can be an experience that is challenging, educational and might even change your view of the world.

I learned a lot in Haiti: about medicine, about disease, about poverty, about politics, about health care and importantly about myself. I learned that you miss resources in medicine when you don't have access to them. I learned that it is impossible to separate the medical conditions and the health needs of a person from their social, cultural, political and economic environment. And I learned that when you have literally nothing else, you can still have hope. And hope gives life.

Published in UWA News , 3 October 2011