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Elective in Cambodia – Paediatrics And The Not-So-Smooth Ending

I’ve been back home for nearly two weeks now, and I’ve been mostly sleeping and reading and watching TV, but I thought it was about time I concluded my recounting of my elective journey.

So the final two weeks of my time in Cambodia were spent at the National Paediatric Hospital in Phnom Penh, and it was quite different from the Friendship hospital. During our induction tour, we learnt that they receive a lot of funding from NGOs and international charities, which helped explain how much more modern and up to date the equipment they had was.

We also got told that all treatment at the hospital was free, which was also funded by the generous grants the hospital receives.  One sad thing we learnt from the tour though, was that the number of doctors in Cambodia went from about 4000 to just over 100 during the Khmer Rouge regime, which is just heartbreaking.

My first week at the Paediatric hospital was spent in General Medicine, where I saw a lot of dengue fever. So. Much. Dengue. Fever. I was quite lucky again to be with a team of doctors who spoke great English and were keen to get me involved. My days started with a ward round with the doctor, and she assigned me patients to take histories from and examine, before reporting back to her with a differential diagnosis, suggested investigations, and proposed management.

I was sent off to see these patients with medical students who acted as translators for me, and I really appreciated this because it made history taking much easier. The children and their parents were all so fascinated by and distracted by my hair, even though I tried to hide it with surgical caps. So my history taking and examinations had quite an audience, as they just HAD to take photos of me to show to their families.

My second week was spent in the surgical department, and it confirmed for me that I am definitely not interested in surgery in the future, as not even paeds could make it more exciting for me. Lowest point was suddenly crying during an achilles tenotomy and casting for clubfoot, because it reminded me of own casting and how sad I was that day. Ahh, I really need to get better at dealing with that, but it’ll take time I guess.

Overall I enjoyed my time at the paediatric hospital, and it was really great for me to do a paediatric placement on two feet, as my paeds placement in the UK last year was spent on crutches. How time flies!

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And just like that, my time in Cambodia was at an end. It had been a rollercoaster of an experience, but one thing I’ll take away from my time there is the importance of not underestimating how significant a language barrier can be. I was really humbled by how accommodating the doctors and midwives were, as they took time out of their busy days and 24 hour shifts to explain things and translate patient histories. If I’m to be honest, I was more in the way than I was helpful, so I really appreciated the chance to be part of the team.

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I also really enjoyed staying in the Work the World house in Phnom Penh – the food was delicious, the staff were helpful and friendly, and it was great getting to know other students from around the world; I now have friends from Australia, Belgium and the Netherlands, so looking forward to going to visit them at some point 🙂

Anyways, as for the not-so-smooth ending, OFCOURSE my journey home wasn’t without difficulty. Just my luck, eh? Long story short: I was supposed to be flying from Cambodia –> Kuala Lumpur –> London, but my lay over in Kuala Lumpur was extended, resulting in me having a 19 HOUR WAIT. To make things worse, the airline couldn’t find the hotel reservation they had promised, so yet again I had been screwed over.

But yet again, Abs a.k.a my mother came to the rescue, and after about an hour of phone calls back and forth between the help desk in Kuala Lumpur, and the airline back in the UK, she got them to give me a room in a 5 star hotel, with dinner and breakfast provided, as well as transport there and back from the airport. My mother is an absolute BOSS and I can’t say it enough, but I would be so so lost without her.

So yeah, that concludes my elective journey! Thanks for coming along on this cray cray adventure with me, it really has been quite something. Looking forward to relaxing at home over the next couple of weeks before heading back to university for FINAL YEAR ahhhhhhhh.

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Module 10 Placement: Weeks 3 & 4

Paeds OSCE is over, hallelujah!

Overall it wasn’t too bad but as always, I made silly mistakes, so it’s in God’s hands now! The OSCE was at the hospital I did my module 2 placement in, so it was good to see my PBL tutor from first year again. No matter what my results turn out to be, I’m just glad that I was allowed to do the OSCE on crutches; they even made adjustments to make things easier for me, so that was much appreciated.

So how were the final two weeks of placement?

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The snow/ice definitely made getting around on crutches a bit trickier, but massive thanks to York Girl for being such a babe and driving me in, so nice!

I got to sit in and observe some great clinics – particular highlights were Gastro and Neonatal Outpatients, where one of the doctors said that I had the “makings of a great paediatrician” after I did some accurate developmental assessments; that really made my day!

Paediatric BLS was pretty fun; I got a lot of time to work out the logistics of getting down to the floor from my crutches to do compressions, and our tutor was very patient and understanding. BLS ended up being one of my smoothest stations in the OSCE, so hopefully the examiner thought so too.

I started neonatal week with a Baby Check Clinic, which involved head to toe assessments of new born babies, and it was the cutest morning of my life to date OMG. So. Many. Babies. It really was adorable and I almost couldn’t cope.

During a SCBU (Special Care Baby Unit) ward round, I learned so much about the complexities of balancing family dramas with social care intervention, and ofcourse, managing the patients’ conditions. So. Much. Drama. I was just in awe of the patience of the healthcare workers in dealing with it all, because boy oh boy, if I could write up some of the stuff I’ve heard…

Being on SCBU was quite something for me because The Keen One a.k.a. Kenny and I spent the first weeks on our lives in SCBU, as we were born quite early, so seeing little twins there made me think, “I was one of you!”

The neonatal unit was soooo cute though! (Yes, I know I’m massively overusing the word ‘cute’ but IT REALLY WAS). The ward gets quite a lot of knitted things given to them, so the extra toys are put out for anyone to take, as long as they give a donation. So ofcourse I had to get some:

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Cute toy

During my neonatal nursing session, I got to feed and carry some of the babies, and it was just everything. They were so small and I got so broody and it was the best. I have no pictures of myself with the babies (professionalism and all that), so here I am with a bae(by):

Me and bae(by)

Placement ended with a mock OSCE that was really helpful, and made me feel less worried about the real thing, so again, praying I’ve done okay!

Overall, Module 10 was great – I enjoyed placement so much, and I was really blown away by everyone’s kindness. I’m positive that I want to do paeds in the future, so I’m glad that after years of wanting to get to 4th year to see if it was for me, it really lived up to my expectations. YAY 🙂

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Module 10 Placement: Week 1

I’ll start with the less cheerful stuff, because I might as well get it out of the way.

The lowest point of this week was crying in the doctors office. I was aching all over from hobbling from our clinical skills building to the ward for an impromptu ward round, which I was 20 minutes late to. I absolutely hate being late to things so that made me feel crap, I’d just had an IV drug session that didn’t go too well, and I was just so frustrated by my immobility, because I’d thought that having the cast off would give me more freedom. I’m still on crutches, so yeah, that sucked.

And now, on to the good things.

I LOVE PAEDS.

This is definitely what I want to do because I’m really enjoying it so far, and for the first time ever, I’ve wanted to stay longer in clinics. I just love how varied it is, because paediatrics covers such a wide age range, so I’ve seen different presentations and conditions on the ward and in clinics.

I just love kids so much! Paeds is definitely making me broody, but I’ve always enjoyed working with children. Having a younger brother and young cousins, as well as being a Sunday school teacher in the past, has given me a lot of experience with being around young children, so interacting with and examinining them comes a bit easier to me.

Being on crutches for the placement I’ve been looking forward to most sucks, yes, but I can start doing some toe touch weight bearing now, so less stress on my wrists on the crutches, yay!

I continue to be blown away by the thoughtfulness of people towards me; from York Girl’s car lifts (so blessed that we’re in the same group), to the patience and understanding of consultants when I arrive late, and the clinical skills staff putting out chairs with pillows on them for me in teaching sessions, everyone has been really kind.

Scrubs and Crutches

We’ve had quite a lot of teaching on Safeguarding Children and Non-Accidental Injury this week, which has been pretty heavy and harrowing, but ofcourse, very important.

Another low part of this week was getting told off and asked to leave theatre, as the Sister nurse said me being there on crutches was a health and safety hazard, and that it was wrong of me to come. I tried to explain to her that the medical school and surgeon I was following had okayed it, but she wouldn’t budge and kept telling me to leave.

As you can imagine, this made me quite upset, and I got teary again because I don’t take well to being shouted at unfairly. It was particularly frustrating because I’d arrived just before 7am to follow a patient through their journey before and after surgery, so I was missing him being put under anaesthetic.

I was found by the consultants in my teary state, and they got really annoyed at the Sister’s dismissal of me. So they called a meeting with her team and fought my corner, arguing that it was unfair for me to miss out on important teaching when I was in no one’s way in theatre. They took full responsibility for any repercussions that might come about from me being in there, and even provided a stool for me to sit on, so that I could be comfortable as I watched the procedure.

I was just speechless and blown away by kindness again, how nice of them, right?

I was super proud of myself for managing to fit into scrubs- my first time wearing trousers in over a month. Can you tell that these are extra extra large bottoms that I’m wearing to fit my boot??

Scrubs and Crutches 2

Overall week 1 of paeds has been quite eventful; can’t wait to see what next week will bring!

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First Month of 4th Year

I LOVE PAEDS.

This is the module I’ve been looking forward to most since foundation year, and so far it hasn’t disappointed. The last couple of weeks of lectures and primary care placement have been great, and I’m really hoping that secondary care doesn’t put me off.

By the end of this year, I’ll definitely know if paediatrics is for me because I’m the module rep for paeds, and I was also allocated paeds for audit as well, so YAY PAEDS.

What else have I been up to in the past month? An update:

Performed at the gala dinner for the UIMC (International Union of Railway Medical Services) Conference in York. Shoutout to York Girl and her family for their hospitality; I had such a great time! The Yorkshire pudding wrap was one of the best things I’ve ever had OMG.

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Nigerian Independence Day Celebrations 2017 were a lot of fun- Starbucks Girl, Bangledeshi Bae, and The Keen One a.k.a Kenny came down for the weekend! Having them here was so great; division of labour made all the cooking much easier, and it was the first time we’ve all been here together since 2015!

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I have so much more to post about because boy oh boy, it’s been quite the term so far. Stay tuned…

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Module 7 Placement: Ophthalmology

A summary of ophthalmology in three words? Death by clinic.

So. Many. Clinics.

I had no idea that ophthalmology had so many sub-specialties within it, as a lot of our teaching sessions were in different clinics. From eyelid disorders, to corneal disease, to glaucoma and strabismus (squints), we saw a wide range of patients, so that was really good.

My favourite clinic was the paediatric one, where I was with a consultant that specialises in squints seen in children, and this is when the eyes point in different directions. The consultant really grilled me, but he wasn’t mean about it, so I learned quite a lot in his clinic. The best part was he asked me to help distract the children, so I had to keep them focused by playing games that ensured they were looking behind the consultant, in order for him to examine their eyes properly. Such fun! It made me even more determined to go into paeds when I qualify.

Anyway, you know how I said otoscopy was hard when I did ENT? Yeah, it’s a walk in the park compared to fundoscopy. FUNDOSCOPY IS SO HARD.

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It involves the use of an ophthalmoscope to look into the back of eyes, and I really struggled with it. The hardest thing about it is that when you’re looking into someone’s left eye, you have to use your own left eye, and that’s difficult for me because I struggle with closing just my right eye. So I’ve been practising winking with that eye, and it’s helped, sort of? I guess this is another one of those things that will get better with time, I hope!

Examining the eyes is very #longforman in general to be honest; there are so many steps to remember! I was taught ‘AFRO’ as a good way to ensure you don’t miss things out, and it’s been really helpful:

A – acuity (Snellen chart, Ishihara plates)
F – fields (as well as inattention and blindspot)
R – reflexes (direct, consensual, RAPD, and accommodation)
O – ophthalmoscopy

So good! Again, practise practise PRACTISE.

Finally, the week in ophthalmology taught me that I’m really not my best when I haven’t had much sleep. As it was our final week at this hospital, we still had to get the 8am bus from campus, so it was early starts all week. The smart thing to do would have been to go to bed early to ensure proper rest, but I’m more productive at night, you see, and that’s why I end up going to bed late.

The lack of sleep definitely showed every day, because I was crankier, more impatient, and got irritated more easily. Apologies to anyone I was snappy with- it’s not you, it’s me. I really need to start sleeping earlier because the more sleep you get, the more energy you have for the next day. Who knew?

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Module 5 Placement: Week 3

Considering the fact that our module lead had to take sudden emergency leave, meaning that a lot of our teaching sessions had to be rearranged or cancelled in some cases, this week hasn’t actually been that bad!

The teaching we did have- pleural effusions and case histories, were really good, and I learnt a lot. Our clinical skills session with SimMan was a lot of fun, as we were given patient simulation scenarios and had to diagnose then manage the patient. Using SimMan is pretty cool and makes teaching more realistic, but I do have to say how creepy I find it when he(?) blinks…

On Monday I went down to the Paediatric ward to find younger respiratory patients, as we’re quite limited in our base ward because most people have COPD. In Paeds I got to speak to the mum of a 7 month old baby with bronchiolitis, and he was just the cutest thing! It was nice to get a paediatric history for a change; so much less complicated with no comorbidities, a very straightforward logbook case 🙂

Thursday’s ward round was very intense- got drilled on chest xray and ABG interpretations, but it was good practise for the OSCE. Got a chance to take an ABG sample from a patient, and it didn’t go very well, unfortunately. I was unable to get any blood, and it was painful for the patient because I kept moving the syringe around. I was just really nervous, and it definitely showed! The patient and doctor supervising me were very nice, which made me feel even worse, but oh welllll. You live and learn, I guess, and practise makes perfect, so I plan to go back to the ward next week and have another go, and it will (hopefully) be fine.

One week of placement to go… Never thought I would say this, but I will be so relieved when we have 9am starts again; this waking-up-at-6am-life is most definitely not for me…

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Module 2 Placement: Weeks 3 & 4

So we’ve come to the end of our secondary care placement, and I’m actually a bit sad. Today was our last day together as a PBL group, as we change groups next year, so goodbye, group M! I’ve been really blessed to be in such a chilled group, with people who didn’t take things too seriously, but still produced great work. Not going to lie, it’s not all been smooth sailing sometimes, but overall it’s been great.

The last two weeks have involved a lot of teaching sessions, which have all been quite good, but draining. A highlight was being drilled in a rheumatology clinic by the consultant, whose disappointed face when I got questions wrong will always remain with me. Seriously if I need motivation to revise, that’s what I will picture in my head…

I really enjoyed visiting the Children’s Physiotherapy Clinic, which only fuelled my wish to specialise in Paediatrics in the future. The kids were so cute! Taking histories from children is more challenging, especially when their parents get involved, so that was good for revision.

Another highlight was getting to clerk patients before they saw the consultants in fracture and pain clinics. I felt like a “proper” doctor, as we then had to examine the patients, present our findings to the consultant, and then come up with a diagnosis and management plan. So much fun!

In other news, our end of module OSCE in 2 days, ahhhhhhh, time has really flown by! At the moment I’m calm and doing my best not to panic, so that’s a good thing. The OSCE will consist of 6 stations, and we’re not told what they are beforehand, so it could range from joint examinations, to prescribing and giving injections, as well as consultation skills and data interpretation. Exciting times!

So I guess I should probably get back to revision then…