Tuesday, 28 September 2010
Au revoir medicine...bonjour vagina squad
The halfway point has been and gone and thankfully I don't have to do any more on the general medicine wards! Last week I was rounding by myself meaning that all the patients were getting treated by me ACK! It was definitely a good idea to go to medicine first as the system works so differently here and the conditions people get are really different so its given me a good basis to start obs and gynae on. Last week I also confirmed my first death...win.
So now I'm headed to the new wing of the hospital (opened by President Bingu himself a few short weeks ago) to help save some babies and heal some ladybits! I'm very excited apart from the fact that this week I have to spend my time on the gynae HDU with our supervisor (who we're managing to build a pretty good case for the fact that we don't think he's a doctor - latest rumour is that his degree is from Belize haha!). I stuck a needle in someones groin for the first time ever today though so not all bad!
This weekend I went to the lake again but as my housemate had the car it had to be by public transport...ack! So off me and the 3 finnish nurses set at 7.30 on Saturday morning to get a bus (where I sat next to a chicken), then sit on the back of a pick up truck (only to get off it about 1km early resulting in a 4km walk in the midday sun in the wrong direction...standard chat!). We made it to Senga Bay eventually and spent the afternoon being watched by about 25 black kids who thought we were hilarious in our bikinis and chilling out to the max. Sunday we tried to get a big bus home but we had missed it so we had to get a minibus. In the UK this would not be an issue but here the minibuses have moveable seats, people standing, crazy drivers and the goats and people on bicycles here have more right of way than the cars.Luckily we made it back to Lilongwe and yet again I turned up for classy jazz in the park looking like a scarecrow.
This week is a sad week as Zareena, my roomate and partner in crime is headed off to other foreign climes .....I'm trying to convince her not to go but I don't think bribing her with a pair of scrubs is going to work! I don't know what I'm going to do once she goes as I will be the only female medical student in the hospital although I might get some more sleep after all our late night chats haha!
Tan update - my arms are now not the same colour as when I left home, I would say they are about beige rather than white! Have added to the sunburn round my bellybutton and the top of my chest though. I'm a veritable patchwork quilt.
6 days my birthday so I hope people have already started sending diamonds and money...fedex can get them here in 5 days ;)
Monday, 20 September 2010
Halfway point approaching...
Another week has passed here in Malawi and time is actually flying by! I don't think I've ever had so much to drink or been so relaxed in my entire life! This meant that when yet ANOTHER mishap occured with the car during ANOTHER trip to Cape Mclear I managed to retain a level head whilst being guided through a really dodgy part of town clinging to one of my Malawian friends in search of petrol (cause spacko here forgot to fill up before leaving!). This also resulted in us having to stay another night there and we had to leave at 4 in the morning to get back to the hospital. On the upside was another banging weekend at the Lake including highlights such as a boat trip and eating freshly killed duck (plus I managed to add to my sunburn only on my shoulders....WIN!).
Unfortunately I was slightly premature in my gloating that none of my patients had died as 2 have decided to do it right infront of me this week, one which was understandable but one that would have been completely preventable in the UK which is really frustrating. Other things that are frustrating about Kamuzu Central Hospital (and Malawian health care in general) are the doctors are so lazy, nothing gets done when it gets asked for, lack of resources are used as an excuse for people to not do their job properly and there is a general lack of organisation to the extent that some patients can go for days without being seen by a doctor. However, I felt very smug with myself when I managed to diagnose a case of appendicitis that all the other staff members had missed...1-0 to me!
Unfortunately I was slightly premature in my gloating that none of my patients had died as 2 have decided to do it right infront of me this week, one which was understandable but one that would have been completely preventable in the UK which is really frustrating. Other things that are frustrating about Kamuzu Central Hospital (and Malawian health care in general) are the doctors are so lazy, nothing gets done when it gets asked for, lack of resources are used as an excuse for people to not do their job properly and there is a general lack of organisation to the extent that some patients can go for days without being seen by a doctor. However, I felt very smug with myself when I managed to diagnose a case of appendicitis that all the other staff members had missed...1-0 to me!
Monday, 13 September 2010
A truly african weekend....
So this weekend I decided to visit Cape McLear (a gorgeous cape at the bottom of Lake Malawi) with Katie and Anna (2 students from Edinburgh who are doing their elective in Blantyre - the other big city). Off I set in my Toyota Corolla rental car to meet them in Monkey Bay which is about 20km away from the Cape and all was going well until the minute we turned onto the road to get to the cape. Cue a dirt track with constant divets the whole way along it...not the most comfortable road but bareable......until we nearly died.
A cow decided it was time for itself to walk into the middle of the road and I thought "OK I'll just brake now" but my foot went straight to the floor... there were no brakes. Luckily I managed to swerve and pull off some sort of emergency stop so the cow and the three of us escaped intact (thank goodness cause if you hit an animal here then you have to pay for it!). Unfortunately the brakes did not come off so well so we had to crawl the rest of the road (which at this point we thought would only take a couple of minutes) to get to Cape Mclear. An hour and a half later with cramp in my hands from gripping the steering wheel I had managed to coax the car to the cape with absolutely no brakes (it turned out we were absolutely miles away from the Cape when the brakes stopped working!). Once we arrived we stayed at a place called Mufasa's where they said that they would check the car out the next day (they thought it just needed some new brake fluid).
That night we went for a nice meal to a place called Gecko Lodge and met up with Anna (another student who's from York and quite possibly has the same brain as me is doing her elective at the same hospital as me - she got annoyed that I hadn't mentioned her so here it is Anna!!).
On Saturday we chillaxed most of the day, I went in for a swim in Lake Malawi (I'm on the look out for signs of schistosomiasis as I type) and managed to burn the back of one leg and not the other. Standard. During the course of the day my new Malawian friends text me asking what I was up to and I mentioned the fact that my brakes were non existent anymore. After going for dinner that night got a phonecall saying that my 3 knights in shining armour were outside where I was staying! They were further up the Lake and had driven down so that I could get back to Lilongwe the next day! So obviously I had to go out and buy them a drink to say thank you......this turned into a lot of beers and some tequila, singing Westlife at the tops of my lungs and not getting back until 4.30 in the morning.
Now had I not done tequila I think the next part of the story would not have happened. I woke up at 7.30 (on a Sunday - its a crime!) to find that I had managed to misplace my wallet at some point the night before. So the next 2 hours were spent frantically trying to find it, bribing locals and eventually giving in to the fact that i wasn't going to find it. At the same time I managed to convince myself that I had lost the car keys to the damn broken car but thankfully this was just a slight hungover mishap as they turned up in the bottom of my bag.
One of my knights decided he was going to drive my car back (he used to be a trucker) so he went back with the 2 Finnish nursing students that I had offered a lift to (forgetting that the car was broken) and we went back in the car with Blessing (coolest name ever lol!). En route we stopped to fix the car a bit better (when I say we the girls stood about in the sun and the guys were underneath the car!) and stopped to take a look at the scenery (which was totally stunning!). Katie and Anna flagged down a bus once we were back on the main road (the M1, could not be more different to the M1 in Britain, lots of goats and people on bicycles) and I went back to Lilongwe with the Malawians and the Fins thinking "yes I can get to my bed now" but nope!
I was dragged to watch jazz outside a posh pub where everyone was dressed up really nicely...I hadn't washed and hadn't slept so curled up in a deck chair and tried to look inconspicuous. After that I had the best BBQ steak ever in a place I'm pretty sure I'll never be able to find again then eventually got home!!!!
I think I might stay at home next weekend...
A cow decided it was time for itself to walk into the middle of the road and I thought "OK I'll just brake now" but my foot went straight to the floor... there were no brakes. Luckily I managed to swerve and pull off some sort of emergency stop so the cow and the three of us escaped intact (thank goodness cause if you hit an animal here then you have to pay for it!). Unfortunately the brakes did not come off so well so we had to crawl the rest of the road (which at this point we thought would only take a couple of minutes) to get to Cape Mclear. An hour and a half later with cramp in my hands from gripping the steering wheel I had managed to coax the car to the cape with absolutely no brakes (it turned out we were absolutely miles away from the Cape when the brakes stopped working!). Once we arrived we stayed at a place called Mufasa's where they said that they would check the car out the next day (they thought it just needed some new brake fluid).
That night we went for a nice meal to a place called Gecko Lodge and met up with Anna (another student who's from York and quite possibly has the same brain as me is doing her elective at the same hospital as me - she got annoyed that I hadn't mentioned her so here it is Anna!!).
On Saturday we chillaxed most of the day, I went in for a swim in Lake Malawi (I'm on the look out for signs of schistosomiasis as I type) and managed to burn the back of one leg and not the other. Standard. During the course of the day my new Malawian friends text me asking what I was up to and I mentioned the fact that my brakes were non existent anymore. After going for dinner that night got a phonecall saying that my 3 knights in shining armour were outside where I was staying! They were further up the Lake and had driven down so that I could get back to Lilongwe the next day! So obviously I had to go out and buy them a drink to say thank you......this turned into a lot of beers and some tequila, singing Westlife at the tops of my lungs and not getting back until 4.30 in the morning.
Now had I not done tequila I think the next part of the story would not have happened. I woke up at 7.30 (on a Sunday - its a crime!) to find that I had managed to misplace my wallet at some point the night before. So the next 2 hours were spent frantically trying to find it, bribing locals and eventually giving in to the fact that i wasn't going to find it. At the same time I managed to convince myself that I had lost the car keys to the damn broken car but thankfully this was just a slight hungover mishap as they turned up in the bottom of my bag.
One of my knights decided he was going to drive my car back (he used to be a trucker) so he went back with the 2 Finnish nursing students that I had offered a lift to (forgetting that the car was broken) and we went back in the car with Blessing (coolest name ever lol!). En route we stopped to fix the car a bit better (when I say we the girls stood about in the sun and the guys were underneath the car!) and stopped to take a look at the scenery (which was totally stunning!). Katie and Anna flagged down a bus once we were back on the main road (the M1, could not be more different to the M1 in Britain, lots of goats and people on bicycles) and I went back to Lilongwe with the Malawians and the Fins thinking "yes I can get to my bed now" but nope!
I was dragged to watch jazz outside a posh pub where everyone was dressed up really nicely...I hadn't washed and hadn't slept so curled up in a deck chair and tried to look inconspicuous. After that I had the best BBQ steak ever in a place I'm pretty sure I'll never be able to find again then eventually got home!!!!
I think I might stay at home next weekend...
Thursday, 9 September 2010
A week and a day at the hospital
I've now been at the hospital for a week and a day and it has now sunk in that the healthcare here is absolutely awful! Every morning there is a handover meeting and each day there are at least 2 deaths to report in the previous 24 hours....Tuesday morning there was 6 deaths from a ward of 90 patients which is just a ridiculous amount. Thankfully this week none of my patients have decided to die although one tried her best today (very annoying case, I thought it was acute renal failure on Monday- doctor didnt - started getting more ill today and then the doctor was like "I think its acute renal failure"......shock!). I'm v proud of myself this week as managed to put in my first catheters...except one of the student nurses opened the urine collecting bag and piss went all over the floor...but also have been having a mare of butchering peoples veins trying to take blood but thankfully because of the black skin you can't see the bruises :D!
One of the biggest annoyances here is the work ethic of the Malawian clinicians. There are lots of what is called a "clinical officer" who are the equivalent of junior doctors (FYs) in the UK. However, these guys just turn up when they want and absolutely disappear in the afternoons leaving the medical students running the ward (ack!!!!). Several patients have not been seen for days meaning that they are either better and can go home...or that they are about to die when someone does see them!
On the up side there is now a crack team of medics on the ward including Dr Allan Martin MD, Family Medicine from Arkansas who used to be a military man but has now had the "call from god" to come to Malawi (I hope I get the call too...but preferably to the Seychelles!), Australian medical student Damien (Damo to those who have ever watched neighbours) whose main aim in his time here is to slap a hippo on the ass and Mike and myself. Between us we've not had a single death all week....WIN!!
In other news I ventured out into Lilongwe nightlife last night with our lunchtime crew of medical students to a place called "the shack." Pretty good description of the place but it has cheap food and cheap malawi gin (which apparently is just gin flavoured ethanol?!) and its where all the cool Mzungus (white people) go on a Wednesday! I'm off up to the lake this weekend so hopefully will be as red as as postbox when I come back!
One of the biggest annoyances here is the work ethic of the Malawian clinicians. There are lots of what is called a "clinical officer" who are the equivalent of junior doctors (FYs) in the UK. However, these guys just turn up when they want and absolutely disappear in the afternoons leaving the medical students running the ward (ack!!!!). Several patients have not been seen for days meaning that they are either better and can go home...or that they are about to die when someone does see them!
On the up side there is now a crack team of medics on the ward including Dr Allan Martin MD, Family Medicine from Arkansas who used to be a military man but has now had the "call from god" to come to Malawi (I hope I get the call too...but preferably to the Seychelles!), Australian medical student Damien (Damo to those who have ever watched neighbours) whose main aim in his time here is to slap a hippo on the ass and Mike and myself. Between us we've not had a single death all week....WIN!!
In other news I ventured out into Lilongwe nightlife last night with our lunchtime crew of medical students to a place called "the shack." Pretty good description of the place but it has cheap food and cheap malawi gin (which apparently is just gin flavoured ethanol?!) and its where all the cool Mzungus (white people) go on a Wednesday! I'm off up to the lake this weekend so hopefully will be as red as as postbox when I come back!
Sunday, 5 September 2010
1 fake pregnancy, 1 killer pregnancy and an African Wedding!
So on Wednesday I started at the hospital thinking that I would have a few days following people around to get my bearings...I was wrong. That morning myself and the Dundee student that I'm with (Mike) were told to start rounds on our own. Whilst examining and trying not to inhale the smell of the ward on the first few patients I thought I had made a HUGE mistake in coming here! I don't like dirt, or smelly people...or beasties (a cockroach walked under the bed of a patient I was examining, but I managed to remain cool and maintain my professional integrity) but once I got used to it the medicine side of things is really interesting.
A lady we went to see was apparently pregnant according to the notes and suffering from meningitis. When I examined her abdomen it was tender but it felt like a pregnant tummy. As getting a pregnancy test done is nearly impossible we thought (foolishly) that we should carry out an ultrasound ourselves as we were pretty sure that we would be able to tell a baby from a bladder.....but we couldn't. So still unsure whether this woman was pregnant we thought that if we stuck a catheter in her it would show if it was just her bladder that was full and in 10 minutes over 2 litres of fluid had rushed out into the collecting bag (the very most a normal bladder can take is 1 litre and even that is pushing it!). So delighted with ourselves that we had solved this mystery we spent the next 2 days trying to get some fluid back into her but the nurses conspired against us - changing the bags or stopping drips when they were put up! On the upside this lady stands a chance of survival unlike most of the other women on the ward.
My first saved life was a lady with a rare condition called a molar pregnancy (basically a fetus that isn't made up right genetically so turns into an invasive cancer). None of the doctors on the ward knew what it was and assumed this lady had pneumonia and a bleed in her brain. What myself and Mike managed to figure out was that actually her cancer had spread and no one else had considered that a possibility. We managed to get a gynae referral almost immediately and withink 10 minutes she was taken down to the high dependency unit and was started on the treatment which has a high likelihood of success. Win for us!
The rest of my time in the hospital is spent guessing what people have (usually malaria) prescribing drugs (ack!!!) that I don't really know will have any effect. If a patient can walk and talk then they are considered well enough to be discharged so there is a fairly high turn around on the wards. The hospital stinks like nothing I have ever smelt before but apart from that it is not actually that bad.
On to lighter things...this weekend I went on a road trip with Mike and his girlfriend (third wheel much lol). I managed to see some elephants in Liwonde National Park (after a pretty hairy journey in the dark trying to avoid bikes that had no lights on them and getting slightly lost on the way to the hostel!). Also saw lots of monkeys and some hippos who snore about as loudly as I do!
Yesterday I also was lucky enough to attend an African wedding of one of Mike's girlfriends work colleagues. It was amaaaazing! Lots of dancing and loud music with alot of happy people! One tradition is that everyone goes up and dances with the bride and groom whilst giving them money....definitely going to bring that one back to Scotland! One of the most cringy moments of my life was being called up to dance and then having to receive money after the DJ told the crowd of people that I wasn't married....cue several African men getting photos with me and paying a considerable amount of money for my hand in marraige. Very cool experience and felt like I saw a bit of the real Africa.
Today I am going hill walking (shock horror I know) around the Zomba plateau - which is a lush mountain overlooking the town of Zomba in the south of Malawi. If I don't write again its probably because I have fallen off or had a small heart attack from all the exercise!
A lady we went to see was apparently pregnant according to the notes and suffering from meningitis. When I examined her abdomen it was tender but it felt like a pregnant tummy. As getting a pregnancy test done is nearly impossible we thought (foolishly) that we should carry out an ultrasound ourselves as we were pretty sure that we would be able to tell a baby from a bladder.....but we couldn't. So still unsure whether this woman was pregnant we thought that if we stuck a catheter in her it would show if it was just her bladder that was full and in 10 minutes over 2 litres of fluid had rushed out into the collecting bag (the very most a normal bladder can take is 1 litre and even that is pushing it!). So delighted with ourselves that we had solved this mystery we spent the next 2 days trying to get some fluid back into her but the nurses conspired against us - changing the bags or stopping drips when they were put up! On the upside this lady stands a chance of survival unlike most of the other women on the ward.
My first saved life was a lady with a rare condition called a molar pregnancy (basically a fetus that isn't made up right genetically so turns into an invasive cancer). None of the doctors on the ward knew what it was and assumed this lady had pneumonia and a bleed in her brain. What myself and Mike managed to figure out was that actually her cancer had spread and no one else had considered that a possibility. We managed to get a gynae referral almost immediately and withink 10 minutes she was taken down to the high dependency unit and was started on the treatment which has a high likelihood of success. Win for us!
The rest of my time in the hospital is spent guessing what people have (usually malaria) prescribing drugs (ack!!!) that I don't really know will have any effect. If a patient can walk and talk then they are considered well enough to be discharged so there is a fairly high turn around on the wards. The hospital stinks like nothing I have ever smelt before but apart from that it is not actually that bad.
On to lighter things...this weekend I went on a road trip with Mike and his girlfriend (third wheel much lol). I managed to see some elephants in Liwonde National Park (after a pretty hairy journey in the dark trying to avoid bikes that had no lights on them and getting slightly lost on the way to the hostel!). Also saw lots of monkeys and some hippos who snore about as loudly as I do!
Yesterday I also was lucky enough to attend an African wedding of one of Mike's girlfriends work colleagues. It was amaaaazing! Lots of dancing and loud music with alot of happy people! One tradition is that everyone goes up and dances with the bride and groom whilst giving them money....definitely going to bring that one back to Scotland! One of the most cringy moments of my life was being called up to dance and then having to receive money after the DJ told the crowd of people that I wasn't married....cue several African men getting photos with me and paying a considerable amount of money for my hand in marraige. Very cool experience and felt like I saw a bit of the real Africa.
Today I am going hill walking (shock horror I know) around the Zomba plateau - which is a lush mountain overlooking the town of Zomba in the south of Malawi. If I don't write again its probably because I have fallen off or had a small heart attack from all the exercise!
Thursday, 2 September 2010
9 million hours and 3 planes later...
I'm here!!! After what seemed like an absolute age I arrived in Malawi 24 hours after I left the UK...things of note on this trip
1. I met a man who specialises in bees and travels all over the world looking at them/eating honey
2. I was proposed to by a security guard at Nairobi Airport
3. I nearly killed myself when my new walking boots decided to tie its laces together...in Edinburgh...before I even got through security!
But all that doesn't matter cause I'm here! I'm staying with another student from Dundee and his girlfriend (third wheel much!) but they're both lovely and the little house we have is so quaint and African its amazing! We have a car (happens to be an automatic so nearly killed everyone in it trying to change gear and stamping on the brake!) so getting around is pretty easy, even though there are not really any road priorities and the traffic lights are pretty much ignored! Malawi is a pretty cool country though and everyone is very polite and friendly, went to the market the first day I arrived and bought some fresh fruit and veg, then went to the town centre - had to give way to some goats on the pavement!
Yesterday was my first day at the hospital. It's called Kamuzu Central Hospital and it looks pretty much like the prison from Shawshank Redemption. I'll write about it next time as I need to get home before it gets dark...lets just say its an experience being at the hospital!!!!
1. I met a man who specialises in bees and travels all over the world looking at them/eating honey
2. I was proposed to by a security guard at Nairobi Airport
3. I nearly killed myself when my new walking boots decided to tie its laces together...in Edinburgh...before I even got through security!
But all that doesn't matter cause I'm here! I'm staying with another student from Dundee and his girlfriend (third wheel much!) but they're both lovely and the little house we have is so quaint and African its amazing! We have a car (happens to be an automatic so nearly killed everyone in it trying to change gear and stamping on the brake!) so getting around is pretty easy, even though there are not really any road priorities and the traffic lights are pretty much ignored! Malawi is a pretty cool country though and everyone is very polite and friendly, went to the market the first day I arrived and bought some fresh fruit and veg, then went to the town centre - had to give way to some goats on the pavement!
Yesterday was my first day at the hospital. It's called Kamuzu Central Hospital and it looks pretty much like the prison from Shawshank Redemption. I'll write about it next time as I need to get home before it gets dark...lets just say its an experience being at the hospital!!!!
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