From Manchester to Manila: My Orthopaedics Elective at PGH

“My name is Salome, and I’ve been a Cowrie Foundation Scholar since my very first year of medical school. This summer, thanks to the Foundation’s support — which covered my tuition fee and helped with some of my visa requirements — I spent my medical elective in the orthopaedic department at Philippine General Hospital (PGH) in Manila. It was one of the most eye-opening months of my medical education so far, and I’m so glad I get to share it with you.

Why PGH?

At the University of Manchester, every fourth-year medical student has to complete an elective, and I knew straight away I wanted orthopaedics. What I didn’t know yet was where. I chose PGH because it’s one of the biggest tertiary referral hospitals in the Philippines — the kind of place that sees everything, from routine trauma to conditions I’d only ever read about in textbooks. I wanted to step outside the NHS bubble and see what orthopaedic care looks like when resources are tighter and the pathology is far more advanced by the time it reaches you. I got exactly that, and then some.

Four Weeks, Four Worlds

PGH split my time across four sub-specialties — tumour, sports, spine, and trauma — a week in each. One week I was in clinic discussing bone tumours, the next I was scrubbed in for sports injuries and seeing athletes on the university campus, then deep into spinal deformity, then straight into the chaos of trauma call. By the end, I’d built a genuinely well-rounded picture of the specialty, not just a narrow slice of it.

The Monday and Friday That Taught Me the Most

If you want to understand what really shaped my thinking during this elective, it’s not a single surgery — it’s the seminars. Every Monday, residents pitched the week’s planned surgeries to the consultants: here’s the patient, here’s the plan, here’s why it’s the right call — not just clinically, but for *this* patient’s life. Every Friday, we did the harder thing: sitting with any deaths recently and asking, honestly, could we have done something differently?

I’d never seen “is this surgery right for this patient” debated with such weight given to someone’s home situation, their ability to actually get through recovery and their finances. At PGH, even as a charity hospital, patients still pay a discounted rate for their care — which means affordability sits at the table for every single surgical decision in a way it simply doesn’t in the NHS. It completely reshaped how I think about what “patient-centred care” really means.

What Surgery Looks Like Without the Safety Net

I spent most of my days in theatre, in outpatient clinics, or on ward rounds, and I saw things I may never see again in the UK — spinal tuberculosis causing kyphosis and scoliosis being the standout example, a presentation that’s become rare at home thanks to low TB prevalence and the resources we have to catch things early.

But it was the operating room itself that really stuck with me. The air conditioning wasn’t working. Surgical gloves and gowns were sometimes repurposed as makeshift drapes when proper draping equipment wasn’t available. Staff often brought in their own scrubs because the hospital couldn’t provide them. And through all of it, the surgical team worked with a level of skill, calm, and dedication that honestly humbled me. Great surgery, it turns out, has very little to do with how well-stocked the cupboard is.

Thank You, Cowrie Foundation

None of this would have happened without The Cowrie Scholarship Foundation. You’ve backed me since my very first year of medical school, and this elective is one more chapter in that story.

I came home with a stronger sense of the surgeon I want to become, a deeper understanding of what resourcefulness really looks like, and memories I’ll carry through the rest of my training. Thank you for making it possible.”

Salome visiting the sights in Manila.