Children’s play space

The Royal London Hospital’s children’s ward has just had a makeover.

You can read more about the project in Oliver Wainwright’s blog.

He says that ‘the play space has only been open for two days, but let’s hope it holds true to Florence Nightingale’s assertion … that “variety of form and brilliancy of colour in objects presented to patients are an actual means of recovery.” ‘

If laughter is the best form of medicine, then this new playspace will go a long way to helping children recover, or at least forget about their illnesses for a while. It looks amazing! 

 

Interview with Professor Neil Kennedy

Professor Neil Kennedy is Professor of Paediatric medicine at Queen Elizabeth Central Hospital and Malawi College of Medicine in Blantyre, Malawi. He and his family lived over the road from me and my family for 4 years, and he has very kindly answered my questions for this blog.

Me: What’s a typical day like for you?

Professor Kennedy: Long!

0700 – 0800: Office and emails.

0800 – 0900: department handover meeting. We hear what’s gone on the night before, discuss difficult cases

0900 – 1200: ward rounds or clinic work. Here, that means seeing perhaps 40-50 children some mornings. We always have students with us when we work on the wards, so I do a lot of teaching – medical education is an apprenticeship. Most of my clinical work is in general paediatrics, but I have a specialist interest in paediatric cardiology (I run the only kids’ heart clinic in Malawi) and in child protection work.

1200 -1330: lunch (on occasions) or more usually some sort of meeting – a journal club or a university committee

1330 – going home time: varies a lot between teaching, working on research, administrative duties (I’m head of the dept), writing grant proposals or seeing specific sick children.

Me: What’s the biggest challenge that you face at the moment?

Professor Kennedy: Lack of time to do all that needs doing. Government is often out of cash for basic treatments.

Me: What is the most rewarding part of your work?

Professor Kennedy: The amazing variety and the opportunity to make a difference in the lives of the children we see and the wider community. Last week, I met the President as she opened our new centre for abused children. I got a phone call from a mum in Northern Malawi to thank me for getting her child sent to India for life-changing heart surgery. I worked with a donor to gain funds to train another 8 specialist paediatricians for Malawi (we only have 16 now – just over one per 500,000 children!)

I would like to thank Professor Kennedy for his interesting answers to my questions. I hope he inspires you as much as he has inspired me to become a doctor.

Comparing work experience in Malawi to work experience in England

 I have written this article, for the doctors who kindly allowed me to shadow them last week, comparing my work experience there with my work experience in Malawi. 

Comparing work experience in Malawi to work experience in England

I am in the sixth form, and I’m hoping to study medicine after my A levels. I was first inspired to become a doctor, after my younger brother caught malaria, in Malawi, where I lived with my family for 5 years. Even though Malawi is a very poor and underdeveloped country, he was quickly diagnosed and treated, and soon recovered. I really admire the doctors and nurses who work in Malawi, in spite of many difficulties, so after my IGCSEs, I spent a few days working in a diabetes foot clinic in a city government hospital there. More recently, I was also lucky enough to spend a week in England shadowing Dr Dhrubo Rakhit, a consultant cardiologist, and other doctors. I thought it would be interesting to compare what I learnt there with my experiences in Malawi.

It was an early start on my first day in England; at 8:00am I went on a surgical ward round, seeing patients who had come in over the weekend. The variety of patients with such different illnesses was fascinating, and I was interested to see how the doctors explained what was going on to them. All the nurses and patients were very friendly and eager to chat, and I tried to make myself useful by changing bed sheets and cleaning.

It was a different world from the hospital in Malawi, where the wards are much more crowded and many patients have to lie on the floor between beds, and even out in the corridor because there aren’t enough beds for them all. Each patient also has to bring a relative to stay with them to do all their cooking, washing and cleaning, as there aren’t enough nurses to cope with all the work.

In England, the hardest part of the first day was towards the end when I went with the consultant surgeon to talk to the wife of a patient in Intensive Care. The consultant explained that the patient was likely to die quite soon, because all his organs were failing. He said that the patient was very sick and had only about a 1% chance of recovery. It was heart-breaking to see the patient’s wife cry, and I’m sure that these conversations are the hardest part of being a doctor, and will never become easier. The consultant taught me that it’s important to be clear and honest with the relatives, but sensitive too. 

On my second day of work experience, I was in Cardiology, where most of the patients I saw had been admitted to the coronary care ward during the night. It made me realise how rapidly patients are treated, and I was surprised at the number of patients seen each day. After the ward round, I watched a patient having an ultrasound scan of the heart, to look at how it was functioning. It was fascinating to look at the images of the heart, and to learn about all the different things that can be seen on the scan. The Cath Labs were also very interesting as I could see the patient’s heart on the screen and the doctors explained to me what was happening and where the narrowing in the arteries were. I watched a few patients have angiograms, during the afternoon, but one patient had so many blockages in their arteries that the doctors couldn’t put in any stents.

meg southampton 3

I thought that the angiograms were very clever and useful, because the doctors could look at, and operate on, the heart, without being too invasive or causing the patient much discomfort, which really benefits the patient. The doctors told me about open-heart surgery, which has higher risks because they take veins from the leg to put in the heart, so that blood can bypass the damaged artery.

I was impressed with the technology used in England, which was much more sophisticated than any of the equipment available in Malawi, where the doctors have to rely much more on their clinical skills to diagnose patients. Although they have an MRI machine in Malawi, the power sometimes goes off for up to a week, and although the hospital has generators, there are often huge fuel shortages, so the generators don’t work either. It also takes a long time to import spare parts, so if a machine breaks down it can’t be fixed for a long time, sometimes years. 

On my third day, I went to listen to Dr Armstrong give a lecture about chronic kidney disease. The lecture was very interesting and I was pleased to find that I could understand a lot of it.  It was a really valuable experience, because not only was I able to see the university, but I could imagine what it would be like to be a student there. After the lecture, I returned to hospital where I spent the morning in an Adult Congenital Cardiology Clinic. I shadowed a registrar, who kindly explained to me about some congenital heart defects.

The next day Dr Rakhit took me on a 3-hour ward round, followed by a cardiology meeting where the doctors presented and discussed unusual case studies. Although it was the same coronary care ward, all of the patients we saw were different to those we had seen before, as it is run so efficiently. I found these ward rounds really interesting, because there is so much to learn and discuss, including the history of the patients, their diagnoses, and plans for tests and treatments, and it is all done so quickly.

I was also lucky enough to meet some medical students and chat with them about their time at the Medical School and their experience in the hospital. They are all enjoying the medical course, which they say is very integrated. One of the students told me that she thought the best doctors are also excellent teachers. I think that this is very true, because doctors not only have to teach other doctors and students by giving presentations, but they also have to explain their diagnosis and treatment clearly to their patients.

This is much harder in Malawi, where the language barrier can be a problem. Many patients only speak Chichewa, the local language, and the British doctor I shadowed needed a translator. It’s so much easier to gain a history and diagnosis if the patient can speak good English, which is a more developed language than Chichewa; for example, there are more words in English to describe different types of pain. It’s also difficult to describe to the patients how and when to take their medication, as some patients don’t have clocks, so the doctor has to tell them to take their medicine when they wake up or go to sleep.

In England, I especially enjoyed watching the transesophageal echocardiograms (TOEs). The doctors sedate the patient, then they put a probe down the patient’s oesophagus, to get a very clear ultrasound scan of the heart. Most of the patients’ hearts were normal; however, one patient had a serious bacterial infection in their aortic valve, which had been replaced, and the infection had spread into their blood, which could cause serious complications.

meg southampton 2

After watching the TOEs, and learning more about the echo tests and structure of the heart, I saw a stress echo test. The patient had to stress their heart by exercising on a treadmill, and then get off and have an ultrasound scan of the heart straight after. This was then compared to an ultrasound scan of their heart at rest, so the doctor could find out whether the heart could function under stress.

Finally, I spent some time in a Cardiovascular Outpatients Clinic, with a doctor and a specialist nurse. The clinics are different to the ward rounds, because the doctor has more time to see each individual patient and treat them. The patients who came in had many different heart problems; a couple of them had prosthetic valves. I listened to their hearts and I could hear their metal valves, which made clicking sounds. Quite a few patients had been referred to the clinic, because of chest pain, but their ECGs showed normal heart rhythms and their echo tests were normal. However, some of the patients were diagnosed with heart problems, after being tested and were given treatment.

In Malawi, I also spent time in an outpatient’s clinic. Most of the patients came into the diabetes foot clinic with foot ulcers, which can be dangerous as they can become infected easily. Many of the patients had walked miles to get to the hospital, in broken flip-flops, which didn’t help their feet at all, and it would take them hours to get to the clinic to get their dressings changed, or be checked up on. Quite a lot of the patients needed to have amputations because their ulcers had become badly infected. I went onto one of the wards to see a diabetic man who had just had his leg amputated, and I checked his blood sugar levels.

A major problem with diabetes, in Malawi, is the lack of awareness. In England, there is a lot of education about health, so most people know about diabetes and it’s easy to look it up on the internet, but in Malawi it’s a lot harder for people living in rural villages. Many people don’t know that they have diabetes because hospitals are few and hard to get to. A lot of the work that they do at the diabetes clinic is raising awareness about diabetes and educating the patients about how to look after their feet and keep them clean to prevent infection. They advise about what shoes to wear; preferably ones that have thick soles and don’t rub, although many patients just can’t afford them, so they end up having to have an amputation. However, people are generally very positive and the patients often sing and dance to show their appreciation to the doctors and nurses, who have to make the best out of what resources they have, and just get on and do the best they can. It certainly made me appreciate how lucky we are here, to have free access to excellent health care, and one day maybe I’ll return to Africa, as a qualified doctor myself so that I can help to make a difference in the hospitals there.

I enjoyed every minute of my work experience; it has strengthened my ambition to become a doctor, and made me more passionate about following a career in medicine. Before my work experience, I wasn’t sure what it was like to work as a doctor under the NHS, but now I feel that I have a realistic insight into what the job involves at different stages in the profession. All of the doctors, nurses and staff were so friendly and made a real effort to make sure that I was enjoying my work experience and understood everything.

I would especially like to thank Dr Rakhit & Dr Armstrong, for arranging my work experience and for looking after me so well.  I would definitely recommend it to anyone thinking of going into medicine, and I’m looking forward to returning in the summer.

Work experience – Day 5

This morning started with a cardiology meeting, where the doctors were discussing a case study of a patient who had Brugada  Syndrome. I had met the patient earlier this week and she had been really happy to talk about her experience in hospital; I had also met her parents, who told me about their family history of the genetic heart condition. 

It was interesting to see how doctors present and discuss unusual case studies. I asked a medical student what she thought makes a good doctor; she said that she thought the best doctors are really good teachers. I think that this is very true, because doctors have to explain to the patients their diagnosis and their treatment clearly, so that they are able to understand, and they also have to teach other doctors and medical students. 

After the meeting, I spoke to  a medical student who told me about the curriculum used at the medical school. It was useful to hear about the course, and she told me it’s important to look closely at the curriculums, because some medical schools teach certain topics, but not others.

I then found my way back to Cardiology, and went to a Cardiovascular  Outpatients Clinic, with a doctor and a specialist nurse. The clinics I’ve been to are quite different to the ward rounds, because the doctor has more time to see the patients and treat them. The patients who came in had many different heart problems. A couple of patients had prosthetic valves. I was able to listen to their hearts and I heard their metal valves which made clicking sounds. I learnt even more about different heart problems and about the NHS, by talking to the doctor and the specialist cardiac nurse.

There were quite a few patients who had been referred to the clinic, because of chest pain, but usually it wasn’t caused by a heart problem. Their ECGs showed normal heart rhythms and their echo tests were normal. Some of the patients however were diagnosed with heart problems, after being tested.

There was one patient who I found fascinating. She had recovered from bowel and liver cancer, but unfortunately had a small cancer growth in her lung, which had developed over 4 years. The surgeons wanted to remove the tumour with an operation which would require general anaesthetic, so the patient had to be assessed to see whether she was fit enough to survive the anaesthetic. It had recently been discovered that the patient had severe narrowing of the aortic valve, and so to undergo the operation she would first need bypass surgery on the heart, to replace her valve. To be told that you need urgent open heart surgery, in order to survive more than two years or so must be very shocking, and it is a lot for a patient to take in. Being a doctor, I think you need to be sensitive and empathetic, and use the right approach when giving a patient shocking news.

It has been interesting to see how doctors deal with situations like this, and how they cope with different reactions from patients and their relatives. 

I have enjoyed every minute of my work experience, I think it has strengthened my ambition to become a doctor, and made me more passionate about following a career in medicine. Before my work experience, I wasn’t sure what it was like to work as a doctor under the NHS, but now I feel that I have a realistic insight into what the job involves at different stages in the profession. All of the doctors, nurses and staff at the hospital were so friendly and made a real effort to make sure that I was enjoying my work experience and understood everything.

I would like to thank especially Dr Rakhit & Dr Armstrong for arranging my work experience and for looking after me.  

Work experience – Day 4

My week of work experience has flown by so quickly, it’s hard to believe that tomorrow will be my last day! I feel like I’ve learnt so much about different medical conditions, being a medical student and being a doctor, and I’ve really experienced what it’s like to work in a hospital.

This morning we started like Tuesday, with a 3 hour ward round. Although it was the same Coronary Care ward, all of the patients we saw were different to those on Tuesday, which shows how rapidly patients are seen. I find the ward rounds really interesting, because the history of the patient, their diagnosis, and a plan for tests and treatment are all discussed, and each patient that you see is different.

Today there was a patient on the ward who had come in with a heart problem, but he also had problems with his kidney function, so I was able to watch him do self-dialysis, which was fascinating. He explained how important it was to keep clean; he had to scrub his hands for 3 minutes before carrying it out, and if he touched the tap or anything, then he would have to wash again, to prevent any contamination and infection. He has to do self-dialysis several times a day.  The patient was extremely chatty and interesting. I talked to him for about half an hour, and he told me that he had spent two years in hospital, as a young boy in the 1940s. He was admitted with TB, and at that time, there were no drugs to treat TB. He described sleeping on a balcony in a large ward, and told me how the snow used to fall on his bed which was freezing. He told me that he was the first patient to be treated with a special operation, and he was an experiment to see whether it worked or not, and luckily it did. They used weights to pull apart his joints to get rid of the infection. The conditions he endured for 2 years sounded horrific.

After listening to the patient’s fascinating story, I was able to talk to some medical students about their time at Medical School and their experience in the hospital. They said that they were enjoying the course, and that it’s very integrated. It was interesting to talk to them about being in the hospital, and they told me that they felt a really good doctor is one that is a good teacher too.

I went over to the Echo department and watched an echo test being carried out. After a ten minute lunch, I went to a cardiology meeting, which was interesting, because it gave me an insight into what a typical doctor would do.

Later, I went to watch some transesophageal echocardiograms (TOEs). I found these scans really interesting. The doctors sedate the patient, then they put a probe down the patient’s oesophagus, to get a very clear ultrasound scan of the heart. Most of the patients’  hearts were normal; however, one patient had a serious bacterial infection in their aortic valve, which had been replaced, and the infection had spread into their blood.

After watching the TOEs, and learning more about the echo tests and structure of the heart, I went to see a stress echo test. The patient had to stress their heart by exercising on a treadmill, and then get off and have an ultrasound scan of the heart straight after. This was then compared to their ultrasound scan of their heart at rest, so the doctor could find out whether the heart could function under stress.

I really enjoyed the day, and I feel that I have learnt a lot by asking questions. Both the patients and the doctors were very good at explaining everything to me and making sure that I understood what they were talking about. I am looking forward to learning more tomorrow!

Work experience – Day 3

I started off today by going to Medical School, to listen to a lecture about chronic kidney disease. The lecture was very interesting and I managed to understand most of it.  I found that it was a really valuable experience, because I was able to see a part of the university, and also appreciate what the medical lectures are actually like. I realised you have to be very organised, because there is so much more information to learn every day, at a much quicker pace and you have to keep on top of all the work.  After the lecture, I spent the morning in Cardiology, in an Adult Congenital Clinic, shadowing a registrar. She explained to me about some congenital heart defects. The first patient we saw had had a mustard procedure as a baby, because their pulmonary artery and her aorta were attached to the wrong chambers of the heart, and so their body hadn’t been supplied with enough oxygen. The mustard procedure helps by using tubes to direct the blood into a double circuit. I was able to listen to some of the patients’ hearts, look at their echo tests and watch their examinations which I found really fascinating and informative.  I found learning about congenital heart conditions fascinating, and it was also interesting to hear the doctor talk with the patients about the possibility of future pregnancies which could be risky because during pregnancy the heart has to work much harder. It is a sensitive issue which showed me that doctors need to be empathetic and good at communicating with their patients.  There were a couple of patients we saw in the afternoon who had Downs Syndrome. Children with Downs Syndrome have a much higher risk of congenital heart disease. One of the patients had come in to have a stent put in and was quite nervous. The patient needed to have some blood taken and so the doctors used numbing cream, so that it wouldn’t hurt the patient, who was very anxious. I had a chance to talk to one of the specialist nurses, who told me some of the ways they prepare children with Downs Syndrome for their time in hospital and make sure that they are really comfortable.   It was a fascinating day, and I learnt a lot about congenital heart disease, and was able to speak to patients with a variety of different conditions. 

Work experience – Day 2

This morning I started off by going on a ward round with a consultant cardiologist. The first patient we saw was very ill and had developed other problems apart from cardiac problems, so they had to be transferred to the Intensive Care Unit. 

We went round seeing other patients, who were mainly new on the ward and had been admitted during the night. It made me realise how rapidly patients are seen and treated, and the number of patients seen each day. There is a lot of managing and organising of tests to be carried out. 

After the ward round, I talked to a medical student about medical school. We also talked to a couple of  patients who were having  ultrasound scans of their hearts, to look at how they were functioning. It was interesting to look at the images of the heart, and learn about all the different things that can be seen on the scan. 

Later, I chatted to a patient who had been flown to the hospital by air ambulance, from one of the Channel Islands, as it doesn’t have a large cardiac unit. It was interesting chatting with the patient; They had had a small heart attack, but couldn’t have a stent put in on the island, so was given medication. I went with the patient to the Cath Labs to watch their angiogram.

I spent most of the afternoon in the Cath Labs which I found very interesting. I could see the patients’ hearts on the screen and the doctors explained to me what was happening and where the narrowing in the arteries were. One patient had so many blockages in the arteries that they couldn’t put in any stents, and they would need bypass heart surgery. I watched the doctors try to put a stent into a different patient’s artery, but the narrowing was too thin for the wire to pass through and so they couldn’t put the stent in.

I thought that the angiograms were very clever and useful, because the doctors could look at and operate on the heart without being too invasive or causing the patient much discomfort, which really benefits the patient. The doctors told me about open heart surgery which has higher risks because they take veins from the leg to put in the heart, so that blood can bypass the damaged artery. 

‘Malaria No More’ News

This morning I was asked to share this news from Malaria No More, as I’m supporting their work to combat malaria. Thank you to all who have donated on my Just Giving page.

Dear Megan,

The results are just in from work we helped support in Namibia to increase malaria testing and we wanted to share the great news with you!

Namibia’s amazing progress against malaria has seen rates slashed by over 95% in the last decade, making accurate diagnosis before treatment is given even more important. With your help, we supported development and testing of a new health worker training programme focused on improving diagnosis, including the use of rapid diagnostic tests for malaria.

THE RESULTS
Over 100 health workers were trained in Kavango, the region with the highest reported malaria illness. The results of the programme showed a significant rise in the number of patients tested for malaria and an increase in correct prescriptions of malaria treatment.

The strongest improvement was seen when training was followed up by mentoring, resulting in the number of patients tested rising from 27% to a whopping 90%. Almost 8,000 people benefited from malaria testing in the six months following the training and the work continues.

It is extremely encouraging that the increased testing also showed much lower levels of malaria in the region than previously thought. This is really positive news for Namibia’s efforts to become malaria free and helps the Ministry of Health to plan for the future.

Angelika, one of the malaria mentors, told us “This training has helped us frame the way we look at cases… we have proof that we are fighting malaria and getting to zero local transmission. It is something I can already see, the training changed our mindset. We are not vulnerable. We can combat malaria.”

CONTINUING THE WORK
Excitingly, efforts now are underway to roll out the new training and mentorship programme across the country with support from The Global Fund.

We are also continuing our work in Namibia with a new programme helping health clinics and communities identify and target responses in the country’s remaining malaria hotspots; aiming to maximise impact towards Namibia’s goal to become malaria free by 2020.

SHARE THE NEWS
It’s wonderful to be able to share this step towards making malaria no more with you – we’d love it if you wanted to share the good news too!

Interview with Dr Sue Heyes

Dr Sue Heyes is a British doctor, who spent a year working in the diabetes clinic in Queen Elizabeth Central Hospital, Blantyre, Malawi. I was lucky enough to spend time shadowing her last summer, and she has kindly allowed me to interview her for my blog.

Me: What was the biggest challenge that you faced working in Malawi?

Dr Heyes: The biggest challenge that I faced working in Malawi was two fold really. One was having so few reliable clinical tests available to help in diagnosing patients.  The other was not having enough basic drugs available to treat the commonest illnesses.

Regarding the clinical tests available, the hospital had lots of fairly up-to-date machines for performing tests, but they often didn’t work because they needed a new part which was unavailable, or the reagents were out of stock for the blood and microbiology testing.  For example, for a few weeks there were no tests available for diagnosing HIV so that meant that patients could not be started on their HIV drugs because it was essential to have a positive test result before starting treatment.  Also, we not infrequently ran out of processing chemicals so that X rays could not be developed so no X rays.  Most of the time there were not the reagents for the machine which checked for electrolytes (a test of kidney function) so there were no results or more commonly they just could not be relied on…  The test results for TB often got lost and had to be repeated several times before a result was available…… Getting lymph node biopsies done and getting a result,  to distinguish between TB and lymphoma, was so difficult to organise….The MRI scanner needed a spare part so was not in use for a few weeks while they waited for the part to arrive and the machine to be repaired… I could go on and on, but you can imagine how difficult this made things.  In the UK, we rely on test results so much in making our diagnoses, so in Malawi I had to relearn my clincical skills and start to rely on them for diagnosis.

Regarding drug supplies there did not seem to be a problem with supply of drugs for TB or HIV treatment.  However there were severe shortages of almost all other drugs.  Twice during my year in Malawi we had no long-acting Insulin  (the commonest treatment for Insulin treated diabetes ) available for several weeks.  There was no good alternative available.  Some people were given quick acting Insulin as an alternative but there is a much greater risk of low blood sugar levels with this and consequently, sometimes death.

In addition, we sometimes for a few weeks, did not have the antibiotics needed to treat the commonest bacterial infections, eg bacterial meningitis, pneumonia, non-typhoid salmonella and even malaria.  These are very common in patients with HIV and will often cause death in these patients whose immune systems are so damaged. 
One of the worst things, though, was the lack of available painkillers, both  mild and strong ones. Mostly the only painkiller available in the short term was paracetamol.  Good painkillers were available for patients who had a confirmed terminal illness through Tyanjane, but generally on the wards there were very few available.  I ended up having my own supply of painkillers which I gave out on the wards as necessary. To me it is bad enough that we did not have the right drugs to treat the patients with, but it seems unacceptable that we were not at least able to keep our patients comfortable and allow them to die as comfortable a death as possible.

Me: In the UK everyone thinks of AIDS or malaria when you mention Africa, do you think diabetes gets forgotten about, and how could awareness be improved?

Dr Heyes: I do think that Diabetes gets forgotten about when thinking about Africa. I believe that over the next 20 years, it is going to become a huge public health issue, as an increasing cause of illness and death.  It is obviously important to raise awareness of diabetes, both its prevention,diagnosis  and treatment available, in Malawi.  However, having seen the scourge of HIV at first hand, I can completely understand the priority given to HIV awareness in Malawi at the moment when health care resources are so scarce.  HIV predominantly affects young adults in the age 20 to 40 age group who tend to have young children and families to look after where as most people with Diabetes tend to be in an older age group, so again, much as I, as a diabetes specialist, would love to see Diabetes having a higher profile, I can understand why HIV takes priority.

Interestingly, it is now known that some of the drugs used to treat HIV increase the risk of  developing  Diabetes, so therefore actually increasing education about the prevention of HIV, would also impact to some degree, the incidence of diabetes in the developing world in the future!

Me: What was your most rewarding experience working in Malawi?

Dr Heyes: Regarding rewarding experiences in Malawi, there are two which stand out in my mind.

One was looking after a young man with HIV and paraplegia (loss of any power and sensation in his legs and lower back).  He and his 2 younger brothers had been orphans for many years (probably due to HIV) and R was the breadwinner while his brothers finished their schooling.  They were all very bright boys and the youngest brother wanted to go to medical school to train as a doctor.  R was looked after in hospital by his middle brother M who had left school but was unable to get a job because he was caring for R.  Over a few weeks it became apparent that there was no hope that R would ever recover from the dreadful pressure sores he had developed on his bottom and hips (because he had no feeling below the waist).  I was able to help M to come to accept that his brother could not get better and was going to die and I was responsible for his care when he died peacefully in hospital, with his family understanding that this was  inevitable.

Subsequently, I was very pleased to learn that M had been successful in getting a job as a translator at QECH (the hospital where I was working) which hopefully will be his first step on the employment ladder and means that M is now able to financially support his family.

The other rewarding thing about my time at QECH (Queen Elizabeth’s Central Hospital, Blantyre) was the development of a diabetes foot clinic which had open access for any diabetic patients with foot problems, in the out patient department which ran weekly .  This is the only diabetic foot clinic in Malawi and had not existed before 2012.  We were able to offer education regarding the prevention of foot ulcers in diabetics, as well as providing good  multi -disciplinary treatment for pateints with ulcers, to help the ulcers to heal and to prevent subsequent amputation which is an all too common consequence of foot ulcers in sub-saharan Africa.  During my time there, the Orthotics department made their first pressure-relieving insoles to be worn in shoes, to off-load pressure areas in a patient who had had recurrent foot ulcers over many years.  And it was wonderful to see some of the ulcers that I had treated actually heal and not need those amputations (from which there is such a high mortality in Sub saharan Africa).

I would like to thank Dr Heyes for taking the time to answer my questions in such depth.

Work experience – Day 1

Yesterday I started my week of work experience, shadowing a consultant surgeon. It was quite daunting when I first arrived because the hospital is so large, and it’s easy to get lost! 

It was an early start and at 8:00am we went on a ward round, seeing patients who had come in over the weekend. It was fascinating to see such a variety of patients with different illnesses, and to see how the doctors talked with the patients to explain what was going on. 

Then I spent some time with a junior doctor, seeing some of the patients who had been on the ward round. It was interesting to see all the tests carried out to diagnose patients and how efficient it is to start their treatment. 

I talked with some of the nurses and patients who were all very friendly and eager to chat, which was really nice. I helped to change some bed sheets and do a bit of cleaning, which  made me feel useful.

Later on, we continued with the ward round, when the consultant had finished in theatre. We went into the Intensive Care Unit, which was different from the wards as all the patients had lots of different machines attached to them, and many of the patients had several different problems. 

The hardest part of the day was towards the end. I went with the consultant and another doctor to talk to the wife of a patient in Intensive Care. The consultant had to explain to her that her husband was very likely to die quite soon, because all of his organs were failing. At first it was hard for her to accept that he most probably wouldn’t recover this time, because he had been in and out of hospital so often. The consultant surgeon told her that her husband was one of the sickest patients he’d ever seen and had only a 1% chance of recovery. It was very sad to see her cry, and explain to her young children on the phone how unwell their father was.  I think that these conversations are the hardest part of being a doctor, and will never become easier. The consultant surgeon said that it’s important to be clear and honest with the relatives, but sensitive too. 

I spent the rest of the day in Cardiology talking to a patient with a genetic heart disease, who had spent a lot of time in hospital. She told me about her history and experiences, about what it felt like to find out that she had the condition and come to terms with it. She was lovely and I enjoyed talking to her, and finding out about her heart condition. It was a nice way to end the day, which I really enjoyed overall. 

Off to Auschwitz…..

3.25am…wake up…..

4.05am…pick up my friend, Lydia, and go to Birmingham Airport…

7.00am…fly to Krakow in Poland with 200 other sixth formers from all over the West           Midlands…

Today I’m going to visit Auschwitz with The Holocaust Educational Trust as part of my History A Level syllabus. I’m not sure what to expect, but I shall try to share my experience with you later…

This is a breakdown of the day:

05.00 – 10.45

Check-in at UK airport and fly to Kraków

10.45 – 12.15
Flight lands in Kraków
Transfer through immigration and customs to allocated coaches
Coach journey from Kraków Airport to Oświęcim

12.15 – 13.10
Visit a site of pre-war Jewish life in Oświęcim
Re-board the coaches for the journey to Auschwitz I

13.10 – 15.15
Tour of Auschwitz I
Re-board the coaches for the journey to Birkenau

15.15 – 18.30
Tour of Birkenau
Memorial service at the ruins of Crematoria II, Birkenau

18.30 – 22.30/23.00 
Re-board the coaches for the journey to Kraków Airport
Arrive Kraków Airport and fly back to the UK

So you want to be a doctor?

image from http://cache0.bdcdn.net/assets/images/book/medium/9780/1995/9780199573325.jpg
Today I got the book ‘So you want to be a doctor?’ It looks like a really interesting and useful book, with lots of information about the process of getting into medical school. It talks about: how much medical school costs; what work experience is best, and how to get it; completing the UCAS form; surviving the UKCAT and BMAT admission tests and getting through the interview. It’s all laid out nicely and looks easy to read! I’ll let you know what it’s like…

‘From The Heart’ – organ donation week

image from http://news.images.itv.com/image/file/160093/article_update_61987b5c7d7008b1_1360356434_9j-4aaqsk.jpeg

All this week, ITV are raising awareness of organ donation, through a new campaign called ‘From The Heart’. There will be several programmes on ITV which will highlight the shortage of donated organs in the UK. They will be following the heart transplant team at Papworth Hospital, which is the UK’s largest specialist cardiothoracic hospital and the leading adult heart and lung transplantation centre. There will also be real-life stories about people who have benefited from organ donation and whose lives have been transformed. Viewers will be encouraged to join the organ donation register and be advised to talk to their loved ones about their wishes, as this helps to increase the chance of organ donation happening.

image from http://news.images.itv.com/image/file/159481/article_3787df2a0faebce3_1360254109_9j-4aaqsk.jpeg
On Wednesday night at 9pm there will be a special one hour entertainment show with music and comedy from celebrities who want to raise awareness of organ donation. The idea is that this Valentine’s Day everyone will have the chance to give a gift that could potentially transform and save the lives of others.

I think that this is a great campaign, and I am especially interested in it as I shall be spending next week in the Coronary Care Unit at Southampton Hospital, shadowing Dr Dhrubo Rakhit, a cardiology consultant.

 

Lessons from Auschwitz Orientation Seminar…

Today I travelled to Birmingham for the Lessons from Auschwitz Orientation Seminar. I listened to a Holocaust survivor, Kitty Hart-Moxon, who was at Auschwitz for two years when she was only 16 years old. Her story was both moving and inspirational. I feel honoured to hear such a personal account of the Holocaust and conditions at Auschwitz. I think it’s really important to remember, that everyone who suffered during the Holocaust was an individual person, not just a faceless statistic.  

image from http://newsimg.bbc.co.uk/media/images/47795000/jpg/_47795540_learningfromevil013.jpg

                           Kitty Hart-Moxon talking about her experience at Auschwitz

Read more about her here.

Teamwork and keeping fit…

Yesterday I played in the senior house netball competition, as wing defence. I’m not very tall, so it was quite difficult to mark girls who were towering over me! I haven’t played netball in a while, but I’ve just been voted senior sports captain, so I have to take part in competitions in sports that I wouldn’t normally choose to do.   

I’m really happy that I was a part of our netball team, because it was much more fun than I had anticipated, and although I was freezing at first, I warmed up quickly after running up and down the court. It was a close match, and I really enjoyed playing, even though we lost in the end. 

Netball is a great team sport, and I enjoyed playing together with girls from our house. I think that being able to work and co-operate with others is a vital skill for doctors, and team sports like netball, are a really good way to improve teamwork skills. Plus, it’s a good way to keep fit and healthy! 

 

How tweeting can stop the spread of flu

I read a really fascinating article the other day, about how activity on Twitter, Google and social media sites can now be used to discover information about hospitals, or flu epidemics very quickly, and help to save lives.

It’s amazing that lots of tweets about the smell of ‘urine’ might be able to alert people to failing hospitals way before anyone dies from malpractice. In the same way tweets that talk about staff like ‘angels’ will be able to point people to good hospitals.

Felix Greaves is a young doctor who has developed a computer programme which searches social media posts to spot good and bad hospitals, just by recognising common key words. Unfortunately, when ‘cup of tea’ is mentioned, the computer can’t tell whether the situation is good or bad as the words are used in both positive and negative ways! His study of “sentiment analysis”, was published in the February issue of the online journal BMJ Quality and Safety, and is an example of the way that social media is becoming more important in medicine.

Another way this programme can be used, is to recognise when flu outbreaks are occurring as they unfold. People who feel unwell often type ‘flu remedy’ into a search engine, so epidemics can be discovered sooner than if doctors had to report them. This way public health crises can be predicted and hopefully avoided. 

Max Pemberton (‘Trust me, I’m a junior doctor’) wrote in his blog a couple of days ago that perhaps the government should recruit celebrities to tweet health tips after 1D’s Harry Styles has been educating his thousands of Twitter followers about Greek philosophy. But I’m not sure if that’s such a good idea!

If a friend or family member was having a heart attack or was choking, would you know how to help them?

Today I received a downloadable app from the British Red Cross, which they asked me to share.

The free app features simple, easy advice on 18 everyday first aid scenarios, as well as tips on how to prepare for emergencies, from severe winter weather to road traffic accidents.

With videos, interactive quizzes and simple step-by-step advice, it’s never been easier to learn first aid.

image from http://upload.wikimedia.org/wikipedia/commons/6/62/British_Red_Cross_First_Aid_Kits.jpg

The information you need is all hosted on the app itself, meaning no internet connection is needed, making it fast and easy to access. Best of all, it’s free. Get this essential app on your smartphone now.”

You can download it here

image from http://www.modelscotland.co.uk/resources/BRC%20logo.jpg

 


Diphtheria, Tetanus and Polio Vaccination (ouch…)

Today I had a booster vaccination for Tetanus, Diphtheria, and Polio.

Although it hurt quite a bit, I’m lucky to be immunised against these diseases, which can be fatal, and have caused many deaths worldwide.

image from http://topnews.in/health/files/cervical-cancer01.jpg

I read these articles about Tetanus, Diphtheria and Polio, to learn more about the causes and treatments of these diseases.

Immunisation programmes for Polio were started in the UK from the 1950s, when there was a Polio epidemic. Now the virus is eliminated in the UK and many other countries.

However, Polio is still endemic in the countries Nigeria, Pakistan and Afghanistan. I read an article in the news yesterday, about Polio vaccinators working to stop the endemic in Nigeria, who were shot by terrorists. Sadly, this is not the first time that Polio vaccinators have been killed. In Pakistan the Taliban accused health workers of being US spies and alleged that the vaccine causes infertility.  

It is a shame that Polio cannot be eradicated completely, because of a handful of people who are against the anti-Polio movement.