Medical Elective in the Pacific Islands

This may shock you, but today I worked a full shift of 8:30 to 5 in ED, without even a lunch break. Are you proud of me? I certainly am!  We're still getting to do lots- we even get patients designated as ours by the consultant for who we have to do all the paperwork and referrals etc. which is pretty cool, even if he does sometimes tweak our plans first.  That's one way to discourage coffee breaks...! I'm also starting to see the limitations on healthcare here more too: today we discharged a patient with ?cauda equina, which would NEVER happen in the UK. Here, however, there's no MRI scanners to confirm the diagnosis and no surgeons who would be able to operate, so there's a certain grim acceptance here that patients will just have to go home and lose the function in their legs. I also got laughed at for suggesting taking a baseling HbA1c for a diabetic patient- apparently they rarely do baseline tests here, because of the associated cost. You live and l...

Started for real in Vaiola Hospital this morning. The other students had told me that there was a) no point trying to find an administrator and b) Things kicked off at 8:30, so armed with this knowledge I headed off this morning in search of the ED. It was about five times smaller than I'm used to, so that took longer than planned, but luckily I spotted some of the others on the way in who were able to point me in the direction of an ambulance and I figured out the rest for myself! Outside the hospital   There's me and another girl in ED at the moment, and for a decent length of time we outnumbered the patients. Ellie claims that she's cursed, and whenever she's in ED no patients show up, but as the morning went on more and more trickled in. We saw a women post car accident, a nasty compound fracture, two cases of gastroenteritis, a 12y/o girl who keeps fainting in school, and a case of cellulitis. Overall, not too bad going!  The doctor was great- he let ...

Here in Tonga, Sunday is strictly a day of rest and religion, with most of the local population heading into church for a large chunk of the day. Almost all shops and restuarants are shut, catching a bus or taxi becomes near impossible and even working out is frowned upon. Not a bad place to spend a Sunday To pass the time, I headed with a group of other medical students to Pangaimoto, a popular island resort just twenty minutes from the harbour, where a huge chunk of the non-religious population gather on a Sunday. For only ~£15 you get a boat transfer, lunch, and free reign of a beautiful island and its white sand beaches. I was there from 11am till 5pm enjoying the sunshine, swimming in the calm water and playing card games in the shade when it got a bit too much. All in all a tough day!  You can climb up this sunken ship, and jump off into the sea Here is the first place I've spotted any signs of damage from the recent cyclone- when you head around the island yo...

Getting here was wonderfully easy. The flight out of Suva wasn't cancelled last-minute (unlike some others on the same day!) and I had the slightly unusual  experience of sharing a table for coffee with the man who turned out to be my pilot at the only cafe in the aiprort. We came in very early- nearly an hour before we were scheduled- but luckily the guy who owns my hostel noticed and was still there to pick me up from the airport. The place I'm staying is really nice, and convient for both the hospital and the centre of town, but the biggest downside is that I'm the only one here at the moment. I'd sort of thought that travelling solo wouldn't be too much of an issue because I'd meet other people at my accomodation etc. but there's no one else arriving till the 6th, so I'm going to have to get very used to my own company! After getting unpacked, the owner, Will, took me into one of the popular bars where a lot of expats go, for a couple of d...

So that's it- Fiji hospital work is over with an x-ray meeting, handover, and some intern teaching on managing severe acute malnutirition (SAM). Sign off went much more smoothly than expected, probably mainly because Dr Ily couldn't actually be bothered to try and hunt down the interns for comments, and we've said our goodbyes and thank yous to all the doctors we spent time with. After one last lunch in town the girls headed down the bus-stop to catch a coach up to Nadi (where they're flying out) and I finally braved the walk uphill from town to home. Ironically, it was a much easier climb than I'd expected, and actually a very pleasant walk- it's a shame that'll be the last time I do it! So now I'm sitting alone in the apartment for the first time, killing time until my flight to Tonga tomorrow. It feels very strange not to have them around after being in pretty much constant contact for the last month, and I can't quite decide what to do with m...

It's that moment when your heart sinks into your boots, and you hear the words: "Leave your form with me, and I'll ask around for feedback."  Now, it's not like we haven't been going in or anything- Mazza and I have both been in most days for the last four weeks. It's just that the interns I was with for most of that time are no longer in the department, and I can count my interactions with the registrars on the fingers of one hand, so this was not the response I was hoping for when presenting my form for a signature to confirm I'd been attending for the last four weeks here in Fiji.  Sign-offs are my own personal nightmare- I loathe them in a way no-one else seems to, and have spent many a sleepless night trying to plan exactly how I'm going to cram in all the signatures required for a placement. So when it comes to elective, despite being fully aware that there will be some students who got signed off on their first day and never set foot in ...

Time is flying by now, and I'm desparately trying to get my head around heading to Tonga in a few days and what I need to have done before then! Today we made one last trip into Suva town to pick up some sunblock and few bits of food to last us till we leave (we may also have treated ourselves to some cake while we were there). I also needed to exchange some FJD to Tongan Pa'anga (still not sure how you pronounce that) so I headed to the currency booth in the centre of the mall.  It was an unusual experience to say the least- not only did I have to provide my passport and proof of my flight out of Fiji, I also had to show them proof of my address here, and my occupation (luckily I'd brought my student ID!). It was way more intense a grilling than I'd experienced trying to change money anywhere else, and when I asked the woman at the counter, she said it was to try and counteract money laundering. I'm not sure if that's a big problem in Fiji, but it was a lot o...

There's only one week left here at the CWMH, so I thought I'd take the chance to reflect on the medical side of my elective, and how this last week has gone. Certainly, moving over to the neonatal side of things, I feel like I've been able to get a lot more stuck in and involved than I did on my ward weeks. I've been sharing a ward round with one of the interns (sure, most of the babies are healthy and just need to stay for the mandatory 12/24hrs that are required here, but I still get to examine and write up and feel generally useful), going with her to labour and c-section calls in case any resus is needed (luckily none has been so far!) and even managing a few succesful bloods on the neonates. That's not to say things have always been straightforward since swaping sides though- take this morning! Straight after handover I headed to the ward like always, and waited two hours, but no intern showed up. The nurses had no clue where they were, the registrar had n...

We left the last day of the weekend free to check out the nearby 'Garden of the Sleeping Giant', and to have a wander around Nadi, as we hadn't yet see any of the centre of town. Unfortunately, we all now agree that this was a poor decision. Garden of the Sleeping Giant To be fair, the gardens weren't a mistake- they were lovely. There's a fairly short trail you can walk around, a walkway full of orchids, and a decently sized hill you can climb, which gives you a brilliant view of the area. It was a hot day, so by the time we reached the top, we were surprisingly tired and sweaty! At the top! Luckily as part of your admission you get a nice cool glass of fruit juice at the end, and we spent some time relaxing there, trying to arrange a new taxi back after our previous driver abandoned us and refused to come back (the staff said we'd probably agreed on too cheap a rate for the journey out-oops?!). Views from the top When we finally got ...