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My Elective - Blog 1

By Alice Gwyn-Jones

My Elective - Blog 1

Certainly, there was no grand welcoming for us as we turned up to the Hospital in Zambia. After completing the various admin, we were given a vague direction of where to head and told "green firm green firm".

The awkward feeling of being a third-year medical student on the first few weeks of clinical placement came rushing back. We had no idea where anything was or how anything worked compared to the UK. I couldn't even get the taps to work so I could wash my hands (later I was to find out that none of these actually worked and just gargled away, spitting air into the bowls placed below the taps).

I was supposed to be a confident 5th year that had passed all exams and elective being the only thing standing in between me and my graduation. Effectively my last clinical placement before the real responsibility of F1 began, I definitely shouldn't feel like I'd jumped back 3 years of blood, sweat and tears to be feeling this useless.

The first week was certainly an eye opener, being thrown straight into the major ward round: a weekly ward round with the professor, the green firm doctors and not forgetting the swam of medical students. As we randomly moved between patients, there was everything from gangrenous bowels to post-op infected amputations. Walking through the door with the hand-written note "side ward - burns unit" was a moment nothing could prepare me for.

A whole side ward of under 3-year olds with nothing less than 25% burns. Covered in bandages over all their torsos and even one little boy with severe burns to his face with half his head bandaged. Another 2-year old boy, who was a patient of the green firm, had been burnt by hot water and these burns had got infected.

Staying behind to help one of the doctors remove the bandages to check the burns, I tried to distract the little one with the only paediatric party trick I know: inflating a glove and drawing a face on it. Unfortunately, my efforts didn't succeed; who would blame him, a glove, me doing a weird face and silly voices was hardly going to distract him from the pain of the bandages being removed. To my dismay the doctor then proceeded to reapply the same bandage, stating that it wasn't that dirty.

The rest of the week involved a day in A&E where for a moment I actually felt useful being sent off by the doctor to clerk in a patient. "Let's just hope they speak English" she shouted after me. My patient was a 4-year-old boy whose mother of course didn't speak English and my diagnosis - absolutely no idea.

There was a very disjointed conversation between myself, the mother and the student nurses who were translating. I managed to deduce that the little boy had a lump on his back. This lump was no smaller than the size of a mango, so you can imagine my dismay when the mother said the lump had been there for over a year without any medical attention.

The fact was that they lived in a village and couldn't bring him into the city until now. This, teamed with the decreased appetite, fatigue and fever had me rather concerned. This lump was too big for Potts disease (Tuberculosis of the spine) or worse a spinal tumour, right?

I came up with a plan for investigations and went to present to the doctor, telling myself that she'd laugh me out of the A&E department with a "how do you not know its X disease, they're so common just send them home". Unfortunately, this wasn't exactly the response I got. The doctor agreed with my plan and added an admission to the paediatric surgical ward and helped me fill out the imagine request forms with a … "?spinal tumour". My heart sank.

It is a very weird feeling studying medicine in cases like this, on the one hand your instinct was right, and your management plan correct, giving you confidence that come August I might be okay. But on the other hand, your instinct being correct also means the worst for the patient.

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