Live Below The Line Fundraising Challenge 2014

Next week I will be taking part in the Live Below The Line Fundraising Challenge again and I will be living off £1 a day for 5 days to help raise awareness about people around the world living in extreme poverty. This is what I did last year:

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I will also be trying to raise money again for my chosen charity, Malaria No More, to try to get more bed nets in places like this hospital in Malawi below:

When I lived in Malawi and visited people in hospital there it was very rare to see any mosquito nets, even in the maternity wards. My brother caught malaria while we were living in Malawi, but fortunately he recovered after being given the right treatment. I’m doing this challenge so that other children can also receive life-saving treatment for malaria. No parent should lose their child to a disease that is easy to prevent and only costs £1 to treat.

Malaria is a leading cause of child deaths and poverty in Africa, but together we can make malaria no more. If you would like to donate and help prevent malaria, please visit my Live Below the Line page here.


Government publishes ‘blueprint for trustworthy’ NHS

Today Jeremy Hunt outlined the measures that the government are going to take following the Francis Report into the Mid-Staffs scandal at Stafford Hospital. You can read about them here.

Some of them are outlined below:

• Hospitals will have to publish details of whether they have enough nurses on wards. From April, patients will be able to see the numbers on a new national safety website.

• Hospitals will have to produce quarterly reports on how they are handling complaints and clearly set out how patients can raise them.

• There should be a legal duty of candour on organisations to be open and honest about mistakes.

• A criminal offence of wilful neglect to hold staff to account.

• A “fit and proper person’s test” so managers who have failed in past will be barred from taking up posts.

• A care certificate to ensure healthcare assistants and social care workers have the right skills and training.

• Every patient should have the names of a responsible consultant and nurse listed above their bed.

However, some people do not think the government has done enough and that the legal duty of candour should include all errors – at the moment the government has only said it will apply to mistakes that cause death or severe harm although it is going to consider whether to extend that to include moderate harm. Also, the inquiry wanted the duty of candour to apply to individuals not just organisations.

The Francis Inquiry made 290 recommendations in total. The government has claimed it has accepted all but nine of them. However, of the 281 recommendations the government says have been met, one in four have not been accepted in full. For example, the inquiry called for a system of registration for healthcare assistants, but the care certificate being introduced falls short of that.

However, Robert Francis QC said he was happy that the government’s response was a “comprehensive collection of measures”.


Work experience in Nephrology and Anaesthetics

This morning I was back at Y Hospital in a living donor clinic with a specialist nurse who was talking to a lady who wanted to donate a kidney to her son. It was really interesting to learn about how the mother and son’s care has to be completely separate and they have different doctors to ensure confidentiality and the best care for both patients. The nurse had to first make sure that the lady wanted to donate her kidney for the right reasons and that she wasn’t being pressured into it by her son or anyone else. She explained how everything had to be done legally in the UK because in some countries people are paid to donate their organs and there have even been some cases where people have been divorced and demanded their organ back from their partner. The nurse also assured the lady that she could change her mind at any point if she decided she no longer wanted to donate her kidney, and the doctors could always find a medical reason for her not to go ahead if she didn’t want to tell her son that she had opted out. The lady had to answer lots of questions about her health and previous operations or illnesses, which could affect whether or not she was able to donate her kidney. The nurse explained what would happen and all the different types of tests that she would have before the operation. She also explained how the operation would be carried out and all of the risks. She would also have a separate team of surgeons to her son so they were focused completely on her. I found it really fascinating to listen to especially when the nurse asked what the lady would like to do with the kidney if it was not able to be implanted into her son; she could have it put back inside her, donate it to a different patient on the national donor list, she could donate it for medical research or have it disposed of. I learnt how important living donors are; they help to save so many lives and improve people’s health as well as saving the NHS money, because patients with successful transplants no longer have to be treated with dialysis.

After the clinic I went over to the gastrointestinal department to shadow an anaesthetist, which I really enjoyed. I had to change into scrubs and put on an x-ray clip to measure the amount of radiation I was exposed to and a protective apron, which was very heavy. Before going into theatre, I went with the anaesthetist to talk to the next patient. I realised that you have to have really good communication skills as an anaesthetist, because you have only a short amount of time before the procedure to get information from the patient and also gain their confidence and trust. It was interesting to see how all of the nurses, surgeons and anaesthetists prepared for the operation by cleaning, opening new equipment and measuring out drugs. When the patient came in the anaesthetist reassured them and checked that he had the patient’s consent before injecting a general anaesthetic, which put them to sleep. He had to put a tube down into the patient’s throat to control their breathing, and the patient was given extra oxygen because the anaesthetic had slowed down the their heart rate. It was fascinating to watch and I was able to look right down inside their throat at their epiglottis. The surgeon was then able to start operating and although he was using an endoscope which wasn’t too invasive, the patient was elderly and there could have been complications so a general anaesthetic was used. The doctors and nurses explained to me a bit about the anatomy of the intestines and I could watch on the screen as the endoscope reached the bile duct. The path became a lot narrower, so the camera couldn’t get through and instead a needle was used to inject dye and it showed that there were some cysts blocking the duct. The surgeon removed the cysts using the endoscope and the bile came out. Fortunately the operation went very well and the anaesthetist was able to give the patient a drug which woke them up again after about ten minutes. Another anaesthetist was in the recovery ward to look after the patients who’d just come out of the theatres, explain how the operation went and make sure that there were no complications. I really enjoyed shadowing the anaesthetist, I thought that it was really fascinating and varied, because they see so many different patients of different ages and with different illnesses, and they have to work out how best to treat them individually. They have a position of responsibility, because they are in charge of monitoring and looking after the patient during the operation.

Work experience in Nephrology

I spent two days of my work experience in nephrology at X, which I found fascinating because I was able to compare the department to the one at Y. Although X is a large teaching hospital, there is not an adult dialysis unit so very ill patients who need dialysis are sent to the intensive care unit for blood filtration, or transported to Y.

Both mornings I spent at X started off with long ward rounds and many of the patients we saw were the same, so it was interesting to see the continuity of patient care.

One of the patients we saw was in a side room, because they’d had an infection, which had affected their kidneys. Although the patient’s kidneys had recovered they had picked up a hospital-acquired infection and it had made them very confused causing them to attack one of the doctors. I saw the patient a couple of days later and they were much better and they apologised to the doctor. This made me realise some of the difficulties of a career in medicine and highlighted the importance of keeping everything clean to prevent hospital-acquired infections.

One of the patients we saw needed to have a catheter put in to their kidneys for the doctor to measure how much water they passed, however they had refused. The doctor couldn’t go against the patient’s wishes because everyone has a right to autonomy so the doctor had to do their best for the patient with the information they had, even though it wasn’t entirely accurate. It was interesting to watch how the doctor interacted with the patient, explaining to them why having a catheter would be beneficial and asking them again if they would consider having one put in, after explaining that they couldn’t work out exactly what to do with recordings that weren’t accurate. The doctor explained later that the patient would probably be in hospital for a while because they wouldn’t get out of bed and move around, which was essential for their recovery, so they would need rehab.

Another patient was memorable, because they were quite elderly and had kidney problems as well as bladder cancer, which couldn’t be treated. The doctor had to have a difficult conversation with them about the likelihood of their heart stopping in hospital and whether they would want resuscitation. It’s a sensitive topic and the doctor was really empathetic. The patient hadn’t ever thought about what they would want so they were going to think about it and talk to their family. The doctor explained that if they were resuscitated they could survive, or they could end up on a ventilator with a poor quality of life. This made me think about ethical issues and what to do when a patient is dying. If the patient hadn’t expressed clear wishes then the doctors would act in their best interests and follow the correct path.

There was one patient who had become blind almost overnight after a kidney infection and dehydration. Many of the doctors were surprised because the patient had completely lost their vision and they hadn’t seen a case like it before. Although the patient had recovered from their infection, they would have to remain in hospital for a while longer until they had the right support and rehabilitation to adjust and return home. They were being cared for not only by the doctors and nurses but also occupational therapists, who had to assess their flat and make sure it was safe. This made me realise that while many patients in hospital have recovered from their illness, many require rehabilitation and after-care before they are able to leave.

Another patient we saw on the ward round had just come into hospital and when the doctor tried to ask them questions they seemed confused and didn’t reply. When a medical student spent some more time talking to them she found that the patient was more responsive if she talked loudly and they thought the patient could be a bit deaf. The doctors found it hard to get a history from the patient who still didn’t move or talk much at all so they tried to contact a relative who’d brought in the patient. The relative was able to give a history to one of the junior doctors, describing how the patient was an alcoholic and visited the pub everyday. 

I really enjoyed going on the ward rounds and seeing lots of patients who were so different and who each had individual needs. 

Work Experience in Nephrology

This morning I started my week of work experience in Nephrology at Y. When I arrived at about 9:00, I went to a multidisciplinary team meeting where doctors, surgeons and nurses were discussing some of their patients and planning their care. It was interesting to see how they worked together to organise treatments. I went on a ward round with a consultant nephrologist, registrar, junior doctor and a medical student from X. It was really interesting to see all the different patients and to learn that most of them had other illnesses as well as renal problems, such as diabetes. The first patient was friendly and I went back in the afternoon to chat with them. They were diabetic and had just had their leg amputated, but they said that it was a relief because they felt a lot better immediately after the amputation. I felt their arm, and I could feel where they’d had a fistula put in and they explained more about preparing for dialysis. After lunch I went to the dialysis unit where there were lots of patients who all had dialysis treatment for about 4 hours 3 days a week. I talked to a lot of the patients who were really friendly and eager to chat – they told me that dialysis took up so much of their time and energy. Some were waiting for a transplant, but others had already had transplants, which had been rejected. The patients had to limit their fluid intake, but one patient hadn’t and so they felt really unwell and breathless. Earlier I had seen a patient who needed to start dialysis and had got quite upset because it’s such a big change and it really affects your lifestyle. Later I went to the outpatient’s clinic and saw different types of patients. One patient had previously had cancer treatment, which had caused the ureters to become blocked so they needed stents put in to the ureters and medication. Some patients had chronic kidney disease and had to think about going on dialysis in the future. One patient wasn’t English and needed some tests but it was difficult for them to understand what to do because of the language barrier. The doctor had very effective communication skills and used actions to help the patient to understand.

Stafford Hospital – Day 4

This morning I arrived at the hospital early so that I could get to theatre and change into scrubs. I had to wear special shoes and tie my hair up inside a hat. When we went into theatre I had to make sure my hands were thoroughly clean and I wasn’t allowed to touch anything to prevent the spread of infection. There was a patient having open surgery so they had to be put to sleep with a general anaesthetic. The surgeon explained to us what he was doing, as he opened up the abdomen and looked at the large intestine. There was a lot of smoke produced as the surgeon cut into the patient’s abdomen and it didn’t smell very pleasant, but I was really lucky to be able to stand so close and see right down inside the patient. The surgeon had to remove part of the patient’s bowel because it was badly infected and the surgeon said this could either be due to diverticulitis or cancer but he found that the patient had severe diverticulitis. Once he had removed the diseased part of the bowel and reattached it, he had to make sure that it was completely sealed. They filled the abdomen with water and pumped air through the intestine; there were no bubbles, which meant that the bowel had been stitched together and there were no gaps. The surgeon was then able to put in a drain, and then two other surgeons stitched the patient back up. The whole operation took about three hours and it was really fascinating to watch and I was glad that I got through it without feeling queasy. I was surprised at how many people were involved in the operation. There were a few nurses, two anaesthetists monitoring the patient and giving them medication throughout the procedure as well as the consultant surgeon and two other surgeons who helped him operate. It was really exciting to watch how they all worked together efficiently and to see how they worked as a team with the consultant surgeon and the anaesthetist in charge. 

After lunch I went to an occupational therapist outpatient clinic, which was really interesting. They specialised in hands, and many of the patients had sprained or fractured part of their hand and needed to rebuild the strength by doing special exercises and they also had to bathe their hand in hot and cold water. I was able to try out some of the exercises and have a go with some of the weights used to build up strength in your hands. It was really good fun and I got a good insight into another healthcare profession with a lot of patient contact. 

Stafford Hospital – Day 3

I started the day in Endoscopy with a gastroenterologist who did two colonoscopies, while we observed. It was really fascinating to watch as it was like surgery but less invasive and the patient didn’t have to be anaesthetised. It was like playing on an x-box or playstation as the doctor had to have very good hand-eye coordination to navigate the endoscope through the large intestine. I watched as the doctor stopped some bleeding in the bowel of a man who had had radiotherapy, and then watched the doctor remove three polyps from a man’s bowel.

Then in the afternoon I went to Cardiology and watched a transesophageal echocardiogram – it was interesting to watch how the doctor gained the trust of the patient before giving them an anaesthetic to put them to sleep. Afterwards I attended the Angina Clinic, where patients were doing exercise tests to see if they suffered chest pain when their heart was stressed. I enjoyed the clinic as the doctor had time to chat to the patient and gain a history before examining them and then working out a plan for treatment if needed. 

In the afternoon a nurse showed us around a cardiovascular ward, telling us about some of the different patients. She told us how the patients who were violent, or at a high risk of falling due to a stroke were in beds opposite the nurses’ station so there would always be someone watching them to make sure they were OK. She taught us how to take blood pressure and measure temperature and oxygen levels of patients, which I really enjoyed because I had to use practical and communication skills. We were also able to talk to a junior doctor about applying to medical school and about what life is like in a medical career, which I found really useful and informative.

Stafford Hospital – Day 2

In the morning, we went to see Diagnostic Imaging. First I looked at x-ray pictures of different parts of the body and saw how the image diagnoses illnesses, such as secondary lung cancer, because the tumours show up as small black marks in the lungs. I saw collapsed lungs, joints and fractures and saw how the image can tell you how a patient broke a bone because they fell in a certain way.

Then we had a talk from a nurse about the importance of hand washing and keeping clean in the hospital, to stop people suffering as a result of illness picked up at the hospital. She also showed us the radio substances containing barium or iodine, that patients drink so that images can be taken inside their body, and she showed us catheters and instruments used when operating, such as stents.

Afterwards I went to the general x-ray area where all of the x-rays are done. The nurse showed me how they receive a request form for an x-ray which tells them the area to x-ray; why they need to x-ray that area; and some information to justify why an x-ray will be beneficial to the patient, because there is a risk when an x-ray is taken as it is radioactive and can cause mutations.

She showed us the x-ray rooms and explained how they worked. The nurses told us that if a patient is at risk because they have had a lot of x-rays, a warning flashes up on the screen and they have to question whether an x-ray is actually beneficial or not. We also saw a CT scan which was really interesting to observe.

In the afternoon we went to Critical Care and saw the amazing facilities for the critically ill patients there. There were lots of dialysis machines and ventilators, which most of the patients there relied on. There were trollies ready for emergencies – e.g. one patient’s tube in his trachea came out and he couldn’t breathe so it had to be put back in immediately.  There were also rooms for families to sleep and live in if their relative was critically ill, so they could stay near them in their final days. I also learnt that all of the doctors in Critical Care were anaesthetists, because the patients there were so ill and relied on drugs to keep them alive. There were some alcoholic patients who were suffering withdrawal symptoms and needed full time care and supervision because they could be violent. Lastly, we had an interesting talk from a doctor there who told us about some different specialities and medicine in general.


Stafford Hospital – Day 1

Today I started my week on the Aspiring Doctors Programme at Stafford Hospital.


I met up with the six other work experience students in the Postgraduate Centre and we had an introduction to the Programme from a surgeon. Then I went to the Acute Medical Unit (AMU) with four of the other work experience students and we split into two groups to go on ward rounds with the consultants. The first patient we saw had quite severe dementia and she was confused and was attacking the nurses who were cleaning her. When the doctor examined her she appeared quite reluctant to be seen and didn’t really seem to understand what was happening. She had also refused to eat or drink anything and had spat out the medication she’d been given at her care home. The doctor said afterwards that patients with such severe dementia probably wouldn’t be resuscitated if they suffered from a cardiac arrest.

We also saw another elderly patient who started crying when I asked her how long she’d been in hospital. She said she’d been having hallucinations and could see people around her, calling her names. First the doctor asked her some simple questions, which either she couldn’t answer or made her confused and then he examined her movements, which weren’t very good, so he decided to refer her to the mental health ward, and said she was probably developing dementia.

Many of the patients in the AMU ward were elderly (from 85 to 90+) and there were also a lot of patients who were alcoholics, which meant that some were quite violent and difficult to treat. The consultant examined all of the patients before making a list of possible causes (differential diagnosis). Then he arranged for tests such as CT scans to find out the diagnosis so that a plan for treatment could be made. He said that it was usually a very simple test, such as a urine dipstick test, that would diagnose a patient.

Unfortunately, one of the work experience students then fainted, so she was given a bed and her blood pressure was checked. It was very low, so she was taken down to A & E for an echocardiogram.

At the end of the ward round all of the doctors and the head nurse came together to review all of the patients and discuss what needed to be done. It was really interesting to see a typical morning for a doctor in AMU, and to gain an insight into some of the challenges that doctors face; patients who don’t want to go home; patients with dementia who won’t comply because they’re not competent; and violent patients who have problems with drugs or alcohol.

After lunch we had some paediatric basic life support training, where we learnt how to resuscitate babies and young children, by doing mouth-to-mouth resuscitation and compressions on dummies. We also learnt what to do if a child or baby is choking and had a chance to ask a nurse about what it’s like working in paediatrics.


Later, we learnt some surgical skills from a surgeon who taught us how to tie together blood vessels and different ways to stitch up wounds, which I really enjoyed.

Katharine House Hospice Training Day

Yesterday afternoon I went to a training day at Katharine House Hospice, in preparation for starting work experience there. We had a few talks about what to do in a fire; safe handling; food and hygiene; and infection control, which were all informative, but quite long. I found the infection control talk the most interesting. We watched a short DVD about the importance of washing hands, and keeping the hospice clean, because the patients are especially vulnerable to infections. Then a couple of people put a special gel on their hands and shook hands with everyone else at the talk. We looked at our hands under UV light, and it was fascinating to see how the gel had spread to everyone. The germs on our hands showed up, and it highlighted how infection is spread so easily, and how infections are hard to get rid of, even after washing our hands thoroughly. I’m looking forward to starting volunteering at Katharine House after my exams. 
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Interview for the Aspiring Doctors Programme at Stafford Hospital

Today I was interviewed for a week’s work experience placement by Mr Gwynn MD, FRCS, FRCS(Edin), the director of the Postgraduate Centre at Stafford Hospital. He looked at my CV and asked about my grades, universities I’m looking at, and general questions about applying to medical school. He also asked me why I want to be a doctor, and what qualities I have which would make me a good doctor, as well as questions about other work experience I’ve had, and my time at Medlink. It was the first medical interview I’ve had and I thought it was a really valuable experience. I came out of it feeling very positive, especially as he offered me a place on their Aspiring Doctors Programme in July, which I’m really looking forward to. Over 5 days, I’ll be shadowing doctors in different clinical departments in the hospital, including the breast care unit, dietetics, nuclear medicine, therapy services, wards and x-ray. I shall also have the opportunity to go into surgery and learn some first aid skills. 

Stafford Hospital goes into administration

Today, Stafford Hospital will be the first foundation trust to go into administration, as it is ‘no longer clinically or financially sustainable’. Instead, it will be run by two specially appointed administrators to ‘safeguard the future of health services’. The health regulator, Monitor, has recommended the closure of the hospital’s maternity unit, intensive care unit and accident and emergency department. Instead, it suggests patients should go to Stoke, Wolverhampton or Walsall hospitals. 

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Stafford is my local hospital, where my sister and brothers were born. My brother went to A&E there just last week and had an x-ray and plaster cast put on his ankle, which was badly sprained. It would have been much harder for him if he’d had to travel further away for treatment, but unfortunately, patients are still suspicious of what sort of care they will receive there after the scandal, and I think it will be a long time before people can forget about its history.

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According to this BBC news article, ‘Monitor said the administrators would have 145 days to work with commissioners and other local healthcare organisations to produce a plan for patients that was “sustainable in the long term”.’

This Saturday, there will be a march in Stafford town centre by the Support Stafford campaign group, which is supported by our local MP, Jeremy Lefroy.

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I have applied for work experience at Stafford Hospital in July, and I’ve got an interview there this Friday. I think it will be really interesting to compare it with Southampton Hospital where I worked in February, and with Queen Elizabeth’s Hospital in Malawi, where I worked last summer. I’ll let you know how I get on.

Katharine House Hospice

On Tuesday evening after school, I had an interview and a tour of Katharine House Hospice, in Stafford. Soon I’ll be able to volunteer there regularly and gain valuable work experience. I was surprised at all of the facilities they offer patients, and I am looking forward to helping there after my exams. 

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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.

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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.