Obamacare

I’m interested, reading in the BBC news here, about the new Affordable Care Act (ACA) that President Obama has just introduced in America.

Mr Obama said the ACA would be “life changing for the 15% of Americans who don’t have health insurance. Tens of thousands of Americans die each year just because they don’t have health insurance. Millions more live with the fear that they’ll go broke if they get sick. And today, we begin to free millions of our fellow Americans from that fear.

There’s another interesting article about it here, which gives the view of a young American woman.

I find it hard to believe that until now seven million Americans couldn’t afford health insurance and many died instead of getting access to life-changing care. 

It makes me really appreciate our NHS which is free for everyone at the point of delivery.

Lessons From Auschwitz Project Certificate and Accreditation

Today I was really pleased to receive my certificate and 3 ASDAN credits for my work on the Lessons from Auschwitz project as an ambassador for the Holocaust Education Trust

This is what the examiner wrote about my project:

Megan demonstrates a good understanding of the concentration and extermination camps as the outcome of Nazi racist policies. She stresses the need to emphasise the experiences of individuals to audiences rather than dwell exclusively on the statistics of death, horrifying as they are. Megan makes reference to contemporary examples of discrimination against homosexuals and how such prejudices should be challenged. In association with her colleague she has organised a number of methods of teaching audiences through a newspaper article, blogs on the internet, an album for the school library and planned talks within school.’

You can read about my project and see my photo album here.

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Fall in hip replacement death rates news

It was interesting to read this article today about recovery after hip replacement operations. 

According to a study of more than 400,000 patients, in The Lancet recently, death rates after hip replacement surgery have fallen by half in England and Wales between 2003 and 2011. This is mostly due to elderly patients being fitter now and also because there is better physiotherapy after the operation, with patients encouraged to start walking the day after surgery. Other reasons include the use of a spinal anaesthetic which is likely to lead to fewer complications and specific treatments to stop blood clots after surgery.

The patients most at risk after hip replacement surgery are those with severe liver disease or people who have had a heart attack, have diabetes or renal disease. Surprisingly overweight people tend to have a lower risk of death than those who are not overweight.

I think this article shows how important post-operative care is, and also the importance of a good multi-disciplinary team. The role of physiotherapists is just as important as the role of surgeons and anaesthetists in ensuring good recovery.

 

Great news which will save a life every 3 seconds

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I was really excited to read in the news here that Justine Greening, the international development secretary, has announced that the UK will support the Global Fund to Fight Aids, Tuberculosis and Malaria over the next three years with a pledge of £1 billion, if the overall target of $15 billion is met from other governments and donors. Barack Obama has promised $1.65 billion for 2014 and Sweden, Norway, Finland, Denmark and Iceland have each pledged $750 million. Now, other governments like Australia, Canada and Germany will hopefully follow suit and match the UK’s offer.

If they do, it means that the UK will be able to deliver 32 million mosquito nets with the potential to protect over 64 million people (equivalent to the entire UK population) and save a life every 3 seconds. They will also be able to fund lifesaving anti-retroviral therapy for 750,000 people living with HIV and TB treatment for more than a million people. The Global Fund is estimated to have saved more than 8.7 million lives since it was set up.

I am particularly happy about this announcement as I feel I have played a small part in it myself. Back in March this year, I wrote to my MP asking him to ask Justine Greening to increase Britain’s support for the Global Fund. You can read my letter to him here.

I received a reply here and also an invitation from Jeremy Lefroy to go to Westminster to make a presentation to the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG), which you can read about here.

I am really proud of the part I have played in this news today, and I hope that one day soon there will be no more malaria in the world.

 

Prize Giving

I’m really happy because I found out today that I have been awarded the Nowell History Cup and the Governor’s Award for academic achievement, as well as the Old Edwardian’s Plate for Community Service. The community service award was for all the charity work I’ve been doing for Malaria No More and for my volunteering in childcare and at Katharine House Hospice. It’s really encouraging and has motivated me to carry on doing more.

UK CAT Test

Yesterday I took my UKCAT test, and was very pleased with my result, which was better than I had expected. These are some of the books I used to practice with. 

image from http://media.johnwiley.com.au/product_data/coverImage/45/11199658/1119965845.jpg

This book was useful for practice mock tests, but I used it less than the others.

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This book was probably the most useful with very similar questions to the real test.

Now I just have to decide where to apply….

Kidney checks could save lives

I was really interested in the news here  and here about kidney checks saving around 12,000 lives a year, as I just spent a week at Southampton and Portsmouth hospitals shadowing consultant nephrologist, Kirsty Armstrong. Lydia Spilner’s life could have been saved if her acute kidney injury (AKI) had been prevented through the provision of basic clinical care, such as hydration. You can read more about her case here.

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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.

DFID investment to save millions of lives from malaria and other diseases

Today the UK Government announced an investment into pioneering partnerships to save millions of lives from the world’s most deadly but preventable diseases including malaria.

The Department for International Development (DFID) is investing £138 million over the next five years into nine public-private partnerships to support the development of new drugs, vaccines, insecticides and diagnostic tools to prevent, diagnose and treat malaria, HIV, TB, diarrhoea and other neglected tropical diseases.

image from https://www.concern.net/sites/www.concern.net/files/media/event/dfid-logo.jpg

You can read more about it in a DFID press release here and in Malaria No More’s policy section here. I think it’s really important to continue to develop new technologies to fight these deadly but avoidable diseases. You can support my fundraising for Malaria No More at my Just Giving page here.

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.

Katharine House Hospice Voluntary Work

Volunteering at my local hospice has taught me a lot about patient care, for instance I now realise how many different people are involved in providing support and treatment for the patients. Throughout the day, nurses, physiotherapists, doctors, nutritionists and volunteers work together as a multidisciplinary team to make sure that the patients are comfortable. I was surprised at how much there was available to do at the hospice – we put on craft activities, talks or patients can have a massage or have their hair done. 

Although many of the patients have similar illnesses or symptoms, each person is unique and we treat everyone as an individual – many people like to have their own particular arm chair that they like to sit in, or a particular biscuit or cup for their tea. Everyone chooses their own meal from a menu and they can request special food or treats. It’s so important to keep the hospice sterile and we make sure to keep clean and wear gloves when preparing food or tea, but take them off when we serve the patients, to be less clinical. I’ve noticed how small things like these make the hospice such a comfortable and homey environment to spend time in, helping the patients to feel at ease. 

I’ve also seen how much the patients gain from their time at the hospice. They are able to talk to each other and relate to each other about what they are going through. Many of the patients told me how they get annoyed when people say “I know how you feel” because they don’t, but having the support and reassurance of others going through the same or similar conditions can be really beneficial. The hospice is a place where people aren’t afraid to talk about how they feel and they can say that actually, they’re not feeling fine when asked how they are. 

I’m really enjoying my time volunteering at the hospice. It’s improving my communication skills; talking to the patients about their families or outings or jewellery is really fascinating and I’ve been lucky enough to meet some lovely interesting people. I’ve also greatly improved my domino skills after playing so many games with the patients there! 

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.

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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.

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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.