Work Experience in India!

I have just come back from 2 weeks work experience in a hospital in India. I had an amazing time! I was in Vasundhara Hospital and fertility clinic in Jodhpur. At first I was shocked by the conditions and how different it was from the UK. The doctors would answer their phones during a surgery and people would constantly be walking in and out. The anaesthetist even fell asleep in one of the surgeries I saw. Also the cameras used in the endoscopies were usually faulty. However, I was allowed me to see much more than I would in the UK, such as a varicose vein being cut in a man’s testicle, ovarian cists being drained and many laparoscopic surgeries in which operations in the abdomen are performed through small incisions.

The most memorable thing that I saw would have to be natural childbirth. It was worse than I expected and they had to cut the woman’s vagina which made me cringe inwardly. However when the baby arrived I felt such a sense of happiness that I understood why women go through all that pain and continue to have more children after they know how much they will suffer. I also saw a caesarean birth and was again shocked by the brutality with which they cut open the tummy and all the layers and finally the amniotic sac.

Another thing which intrigued me was IVF treatment. A penis shaped metal instrument was inserted into the woman’s vagina and then opened up a bit. Then a tiny tube with a syringe attached was inserted very gently through and the embryos in the syringe inserted slowly so as not to be regurgitated. I also saw an intra uterine insemination (IUI) which was exactly the same process as IVF but with sperm in the syringe rather than embryos. I was also told that the plastic of the tube was different for the 2 different procedures. A reason for having IUI would be sperm immobility so the mobile sperm are individually selected and inserted (sperm washing).

I had never seen a surgery before going to India so I was worried that I would be squeamish, however I surprised myself by how calm I was in the surgeries. I was too engrossed in the procedures to be uneasy, so I could possibly have a career in surgery.

I also visited an orphanage for mentally and physically disabled children with some others. There was a woman who spoke English and she greeted us and showed us round. They had very basic facilities – cots, lockers etc.  We helped feed the kids, which was quite difficult because they don’t have normal reactions such as to chew when there is food in their mouth. It’s sad to think that these children will never have a normal life and will always need help in even the simplest of actions.

While in India I stayed in a house with about 20 other students my age doing work experience in the same and other hospitals. Living together and having next to no entertainment meant that we formed strong friendships fast and I really enjoyed my time at the house and exploring the towns with the others. I took a fancy to Indian tea and brought some of the masala tea spice back home with me. I can honestly say that I am going to miss the crazy Indian driving, haggling prices for rickshaw rides and seeing cows everywhere, even in the middle of the roads. It was one of the best experiences of my life.

 

Cystic Fibrosis

I went to a talk about cystic fibrosis (CF) and the CF  unit at Frimley Park Hospital a few weeks ago given by Dr. Timothy Ho. I hadn’t previously known much about cystic fibrosis and this talk inspired me to do some research and find out more about the disorder.

Cystic fibrosis is an inherited metabolic multi-system disorder. It is characterised by abnormality of chloride and sodium transport across an epithelium, leading to thick, tenacious secretions. It affects most critically the lungs, and also the pancreas, liver, and intestines.

 

CF was previously thought of as a children’s disease and 50 years ago CF patients wouldn’t live to the age of 9. It is the most common lethal inherited genetic disorder in the UK with approximately 7000 UK CF patients. It is also statistically more prevalent in males than in females. It is more common in Caucasians and less common in Asians and Orientals.

Cause

Cystic Fibrosis is caused by mutation in the gene, cystic fibrosis transmembrane conductance regulator (CFTR) in chromosome 7. It could be one of many mutations. This is a recessive gene so only people carrying 2 of these abnormal genes are affected by CF. The abnormality leads to sweat ducts being impermeable to chloride ions.

Also, 25% of CF patients develop diabetes. A little benefit for them is that they don’t have to pay for prescriptions and although that does not make it worth it, they save hundreds of pounds as they have to take many tablets everyday for the rest of their lives.

Symptoms

  • Symptoms often appear in infancy and childhood, such as bowel obstruction due to meconium ileus in newborn babies
  • Salty sweat
  • Poor growth and poor weight gain despite a normal food intake
  • Accumulation of thick, sticky mucus
  • Malabsorption – Abnormal stool
  • Rectal prolapse and constipation
  • Frequent chest infections and coughing or shortness of breath
  • Males can be infertile due to congenital absence of the vas deferens

 Diagnosis

  • Age of diagnosis:
    • 50% by 1 year
    • 90% by 10 years
    • 99% by 20 years
  • Methods:
    • Before birth or after by genetic testing – genotyping of patient, looking for known mutations
    • Immunoreactive trypsinogen (IRT) testing in newborns – a high level of IRT suggests possible CF and requires further testing.
    • Sweat test in early childhood – sweating is induced by pilocarpine iontophoresis and the sweat is tested to determine the sodium and chloride concentrations.

Treatment

Survival improves year on year.

  • Intravenous antibiotics to prevent and treat lung and sinus infections
  • Lung transplantation – both lungs have to be replaced otherwise the one not replaces would infect the new one
    • Only 160 lung donors in the UK annually
    • 10% of lung transplant patients die
    • High concentration of salt solutions (hypertonic saline)

New treatments are being developed for specific mutations. In the UK gene therapy aims to introduce normal CFTR using a viral vector. In the USA medicines are being developed to make the abnormal CFTR work as normal would. This is only available for 2 of the known mutations and therefore less than 5 % of CF patients.

 

My EP Journey – Part 2

I have finally decided on my EP title! I have put together two of my initial questions that I am most passionate about; the ones in bold in my previous post. My title is “How are stem cells used in the treatment of neurodegenerative diseases?” This really interests me and I think there will be a lot that I can write about the topic.

Also, I now have a supervisor! At first, I asked my biology teacher, Dawn, but she had already agreed to supervise 2 people’s extended projects which is the maximum teachers are allowed to supervise. She recommended the Vice Principal of my college, Vince, who is also the head of the biology department. I asked him to be my supervisor and he said he would be delighted to, so I am going to meet with him soon to discuss my project proposal.

My EP Journey

I am about to start an extended project. This is a non-graded, non-certificated 5000 word essay linking together 2 of my subjects (Biology and Chemistry). I have to fill out a project proposal form and hand it in by the 26th June to register my commitment. I have a few ideas of possible essays but I’m struggling to choose between them. My prospective titles are: (The ones in bold are the topics that I am most interested/passionate about)

How does Calcium help prevent osteoporosis?

Is there a connection between diet and cancer?

What is the cause of Neurodegenerative diseases?

Can activating brown fat help fight obesity? (maybe not enough information available)

How do Stem Cells revolutionize modern medicine?

How do drugs affect the brain? (Does Cannabis cause Schizophrenia?)

My concerns about some of the essay titles are that there will not be enough information to write a 5000 word essay on. Any comments?

 

My Local Hospital

My local hospital is Frimley Park Hospital. I am a member of Frimley Park Hospital NHS Foundation Trust and I attended a meeting last Tuesday. At this meeting, the membership manager went through what has been happening in the hospital lately.

Exterior view of the hospital

 

Frimley Park Hospital’s catchment area contains a population of over 400,000 which the hospital treats. In a year there are approximately 100,000 A&E attendances and 327,000 outpatient attendances. Also there are over 5000 births a year. In addition to the main hospital site at Frimley, it runs outpatient and diagnostic services, bringing a range of services closer to communities. Frimley Park Hospital’s mortality rates are in the best 10% in the UK and Dr Foster’s Health Guide has named it as one of the most recommended hospitals in the UK.

Frimley Park Hospital has a £3.5m Cardiac Centre and is recognised as the regional centre for vascular care. A midwife-led unit for lower-risk births is being developed. There is a £750k upgrade to Elderly Care wards happening at the moment and the hospital is about to invest in a second CT scanner. A £22m emergency department and day surgery unit with a helicopter landing pad has recently been built.

Monitor, the independent regulator of NHS Foundation Trusts ensures that “foundation trusts are well-led, that their leaders are focused on the quality of care patients get and that they are financially strong.” They look particularly at “whether they are meeting the required quality standards, as judged by the Care Quality Commission, and at the trust’s financial strength.” For governance, monitor has rated Frimley Park Hospital green, for all departments, which is the highest rating. For finance, the hospital is rated 5 for four sections and 4 for one section (5 being the lowest risk).

At the meeting I found out about some of the problems the hospital has had and how they are dealing with them. A lot of money is wasted by people who don’t attend their appointments (also known as ‘DNA’s – ‘did not attend’s). Mostly this happens with young parents who make an appointment for their child, then later decide that their child is healthy so instead of cancelling the appointment, they just don’t attend.

Frimley Park Hospital now texts patients, with consent, to remind them of their appointments. In some special cases, they remind the patients by calling them. However, this is costly in money and time so cannot be done for many patients. The national average of ‘DNA’s is 8.9%. Frimley Park Hospital has less at 6.9%, but we want to get this down to 6.2 %. The hospital asks patients to contact them at least 24 hours before their appointment if they can’t attend, so that the slot can be given to someone else. I suggested that they advertise the problem in the hospital, for example have a poster on the wall saying “X patients have not turned up this month for their appointments, costing out hospital £Y”.

For more information about Frimley Park Hospital, go to http://www.frimleypark.nhs.uk/

 

UK vs. US

Some of my family friend’s are visiting from America for a few days. They are both girls and medical students. I was talking to them about medicine for about an hour as I was really interested to know about the system in America. I can safely say after talking to them that I am glad that I am living in England. In America, they study medicine at university for 8 years, instead of the 5 years we do in the UK. Also in America, they have 3 foundation years instead of our 2.

I found out that the medical degrees are different too. In America, the degree is MD which stands for Doctor of Medicine, whereas in the UK it is MBBS or a similar degree which stands for bachelor of medicine and bachelor of surgery. I researched the topic UK Vs US Medical Schools and read some of the posts on forums about it. The general consensus seems to be that neither produces better doctors than the other; it is purely just different systems.

I am sure you are familiar with the university application process in the UK for medicine so I will just explain the US process. They don’t have a limit of 4 universities to apply to, they can apply to as many as they want; 15-20 is recommended. I don’t know whether that is an advantage to students living in the US or not. They would have a bigger chance of getting into medical school but perhaps they would have put less thought into which university they really want to go to and which course would suit them best.

There is an application form, similar to the UCAS form, where they put their personal statement and can describe relevant work experience, extracurricular activities etc. They also have to send coursework. Instead of just having one letter of reference sent to all the universities, they have up to 10 letters of evaluation which they can target to a particular university and specify which letter goes to which university. There is a standardised test that all medical school applicants have to take, called the MCAT (Medical College Admission Test), and their scores are sent to the universities they apply to.

Medisix 2012

Last week I attended the Medisix 2012 conference held at Nottingham University. It was a fantastic experience and I recommend it to anyone thinking of studying medicine at university. The lectures were inspiring and very informative about the different specialities of medicine. This was very useful to me because I hadn’t previously thought much about what speciality of medicine I would like to have a career in. The specialities that I was particularly interested in were Oncology, General medicine, Psychiatry and General practice. The talks informed me about what was involved within the speciality, the advantages, disadvantages, history and advancements within each specialty.

Another memorable lecture was the Pre-Hospital Care one. The doctor warned us that he has had people faint in this lecture due to the images and videos shown and true to his word, about 3 or 4 people fainted. I did not, but I admit the videos did make me feel a bit queasy. The stories the doctor told us were inspiring and also heartbreaking in some cases.

We were also given lectures about how to choose a medical school and what they are looking for. I feel so much more informed and better prepared having attended these lectures. There were so many factors that I hadn’t thought about, such as how universities use your UKCAT scores differently, the different styles of interviews and which universities have which style of teaching (traditional, integrated or PBL). Before attending this lecture, I had a rough idea of which universities I was going to apply to, but I completely scrapped that and started from scratch. I am going to find out everything I can about all of the different medical schools and then see which best suit my

Personally, the most valuable lecture was the Edge Session. This gave me an insight into what the universities are looking for and what I should be doing now to make my dreams of becoming a doctor come true. This brought it home to me how fierce the competition is, how difficult it would be to get into a medical school and that I really need to go the extra mile as there are on average 22000 applicants to medical schools and only 7000 can get places.

Staying in the university halls of residence and meeting lots of new people my age gave me an extremely valuable university experience. Attending Medisix 2012 confirmed to me that I really want to be a doctor. I cannot imagine myself doing anything else. It was a great experience. It gave me a taste of independence, the medical lectures inspired and interested me greatly, I feel more prepared for applying to medical school and I made some great friends.