Clinic

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A&E is split into two parts here. When you arrive, the nurses triage you and decide whether you are ill enough to need a stay or treatment here, in which case you'll go to the ER side, or if its a minor problem that will just need a review and prescription, in which case you go to the Primary Health Centre. The Primary Health Centre is just another room in A&E with an examination bed. I spent the day there, which was actually quite fun. All of the problems were minor, and things you'd see at a GP in England. I saw UTIs, ingrown toenails, heart palpatations, etc. Although they were simple problems, it meant I could do the full history and examination, and I knew the diagnosis and the sort of management they'd need and present it to the doctor. And I got to see more patients than I have any where else. Made me feel like I was doing proper doctoring.



I did find that people were presenting later than they normally do in England. I think it's a mix of having to pay to see a doctor, and just a fear of medicine and surgery here, but a lot of people try home remedies and herbal medicines for a while before they come to hospital. For example, I saw a 16 year old boy with ingrown toenails on both big toes. They were bleeding, very painful and he said they had been oozing pus and he'd had a fever. When I asked how long he'd had it, he told me it was since last August! He hasn't been able to wear a pair of closed shoes in 10 months, he keeps having time off school when the fever and pain is at it's worst, and his toes have been bleeding and infected for almost a year. The only reason he came today was because he has graduated high school and starts working at the ministry on Monday and needs to wear smart shoes! Needless to say, he'll need antibiotics, anti-fungals, anti-inflammatories and surgery to remove the toenails. He won't be wearing smart shoes on Monday.

I also saw a woman who came in for something else, but mentioned she had fibroids and was meant to have surgery soon. She then said that she's been cancelling and rescheduling the surgery for about 6 months and the fibroid is the size of a grapefruit now. The doctors also told me that Caribbean women have the largest fibroids they've ever seen (they've all studied in USA, Cuba, UK, Canada, etc), because women leave it as long as possible before seeing a doctor, and then put off surgery for as long as possible too.



Basically, in every ward and clinic, people are a lot sicker before they come to hospital than you generally see in England. And that probably contributes a lot to the high mortality rates and the strain on the hospital's resources. It was just quite interesting to see.

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