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.

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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 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. 

Vegetarians ‘cut heart risk by 32%’

Today I read this article about how vegetarians can cut their risk of heart disease by 32%. I found it interesting, as I am vegetarian and recently I went to a medical society lecture at school, about Cardiovascular Disease.

We were lucky enough to listen to a cardiologist from Stafford Hospital, who talked about heart disease and its causes. Some risk factors are being overweight, having an unhealthy diet and high cholesterol levels, which can all be reduced by becoming vegetarian.

I became vegetarian last year, and still manage to enjoy a varied and tasty diet. I think it’s healthy and beneficial for everyone to enjoy some meals without meat occasionally. It’s better for the environment too!

image from http://michelinrecipes.files.wordpress.com/2012/09/vegetarian-recipes3.jpg

I hope to find out more about heart disease when I spend time in the Coronary Care Unit at Southampton Hospital soon.