it gives you perspective

Almost done with another week...and another time to be reflective on the medicine here.

It's interesting working with the University of the West Indies medical students. First off, their curriculum is five years and they're taking all the final exams now--they haven't taken anything, like we have earlier. So their studying right now is far more rigorous than anything I've encountered. Their exams are also partially oral, in a practical sense; they'll be interpreting x-rays, examining patients with actually pathology, etc.

So 'lectures' are completely different. I was explaining today about the huge lecture halls and projectors, and apparently they have that on campus. Out here in the satellite sites, there's nothing like that. In fact, we have to go get one of the two projectors the hospital owns when a lecturer brings a powerpoint. Usually it's just the socratic method, so you have to know your stuff.

For example, a few days ago, we started talking about peripheral artery disease (PAD). Pathogenesis of PAD? Atherosclerosis, we can all answer that. How does atherosclerosis happen? That was met with pure silence, which didn't make me feel so bad. I could contribute a bit about the foam cells developing from macrophages, but we all struggled to get to that point and to how it contributes to PAD. It's a way to test how well you know your stuff--did you skim the surface or did you actually dig deep and do you know it.

I obviously took to this quite well, since I don't like being all that embarrassed and having to say I don't know...which I really don't like saying as the 'American medical student.' I feel a lot of pride in being an American and representing America here, in addition to my own personal pride. So the next day was aneurysms and I totally showed my stuff, but I didn't hold it over the UWI students. It made the whole lecture more comfortable, and now I know aneurysms really well myself. Win-win.

Oral examinations meant that you have to know what you're talking about, and quite frankly, it points out to me all the things I've forgotten in being on clinical rotations and learning about how the computer system works, and those kind of practical things. It sets up an interesting conundrum for taking step three in the upcoming months (the last of the board exams--you take it after you graduate).

The pathology has changed some too...I evaluated a patient with a goiter today, something you wouldn't see in the US. Particularly not one this big. I knew what it was at once, but it's not something I've seen in person before today. We also had an interesting moment later, when a patient's culture had come back with Pseudomonas, a fairly resistant and hard to treat bacterium. We had to switch the antibiotics, and the residents had no idea about double coverage and also what to switch to give pseudomonal coverage. It was a little hard to cover my surprise, but considering they don't even talk about MRSA here, why should the residents know about pseudomonal double coverage?

I can't get over the wards. This photo is deliberately blurry, but you can see how there are three beds fairly packed in with just the half-hearted attempt at curtains to shield. We had to tell a patient today that we had to amputate below the knee, and she got to cry and try to deal with this information with absolutely no privacy.

This is the most technologically advanced their medical records get. There's also no sort of order--I saw a patient in clinic the other day whose appointment for 24/3/14 (European style dates here!) was shoved in the middle of her records from 2002. There are no tabs for lab results, consultant's notes, or imaging. We're talking about patients who are actively bleeding and the last check of their hemoglobin was three days ago. There's also no blood to give patients right now (and if I were convinced of the sterility of the procedure, I would donate some, but there are about 10 patients on the wards right now who need blood...one donation can't stem that tide).

This is their ER, or A&E as they call it here--accident and emergency. There's a separate section for 'actual' emergencies, this is rather like a holding area. Consultants go see patients down here, and they could be here for days. Beds are just lined up, as many as you can fit in the small space.

On a lighter note, you do have to dress modestly! I can't wear anything less than short sleeves, and if I do, I have to wear my cardigan over it. And remember, it's 80 degrees shortly after sunrise and often will be humid so the heat index is frequently 95ish.

And for the lightest note possible, I was doing blood sugar checks recently on an outreach day and got to find out that they use a different scale than we do in the US! We use a mg/dL scale, so you want a fasting sugar under 100 and somewhere not too much higher for random sugar. I checked mine to make sure the machine was working, and the number popped up 5.2! I was like what the heck! That makes no sense! The girls from the UK and Norway filled me in--it's mmol/L. So 114 on my scale, a number I can interpret.