Multicultural Week

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Hi everyone,

It's now Thursday night after a spectacularly long day or so it seemed I have finally stoppped and am now going to tell you what I've been up to since Sunday. It's been a multicultural week with a little bit of chinese, nigerian and indian thrown in the mix. Once again a lot has happened in 4 days so I'm not sure if I'll get all the right bits of the story in but I'll do my best.

Monday- Handover in the morning nothing too exciting to report patient wise but I presenting my management of status epilepticus to everyone which seemed to go quite well and I seemed to have found the correct information so that was a relief. I stayed on the ward to help with the round which we managed to do quite quickly despite quite a late start. Most of the patients were well which was good news. There was a lecture at 12pm on Q fever which is something I know nothing about so that was interesting but could have been a little bit more clinically relevant. After the lecture we headed back to the ward where we saw a few new patients and finished up the jobs before heading home around 4:30/5 so quite a reasonable time.

That evening it was Ren's last evening (a student from Manchester finishing a years placement) so we went out for Nigerian food which was quite good. Some of it was a little spicy and I wouldn't say it was the best meal I've ever had but it was a good experience and nice to eat some authentic African food. The restaurant owners saw us coming though and tried to charge us almost 400 dalasi each not including drinks. We ended up negotiating the bill down to 300 dalasi each not including drinks so that was a slight flaw in the night. We should have decided on a price when we rang them to book. We headed home after that to what was a very sticky night.

The next morning was my morning to go to the old jeshwang health centre to help the midwives with the maternal and infant welfare clinics. I arrived by myself having got a taxi by myself as Julian decided to go to a lecture instead. I got there at 8:15 after my 50 dalasi (about £1) taxi and waited for the day to start. I helped out in the antenatal clinic weighing patients and taking their blood pressure. I asked a few questions but unfortunately all the midwives were speaking in mandinka, wolof and fullah so I didn't understand what was going on. It really wasn't very interesting for me so I'm hoping that when I go next week I can do a bit of the infant welfare clinic and that might be a bit more interactive. I got a taxi back and then grabbed some lunch before coming to the ward to help out. It was a very long day, when I got there the ward round was still going on and it was 1:30pm!!! After the round finally finished we helped with discharges, made sure the jobs got done and chased some cultures before seeing a few patients who had been admitted from clinic. I got home about 6:15 and decided to try to beat the rain and go out in search of orange juice and garlic. I was paying for my purchases in the shop when the heavens opened causing a power cut which was exciting, I paid the cashier the right money but she had to trust me as the total was trapped in the till which she couldn't see with the power off. I stepped outside and got a little bit wet but nothing like the soaking I was expecting and within 5 mins the rain had stopped again. I got home after buying a mango and stepped in the door to hear the heavens open. We had rain then for the next 12 hours with thunder and lightening to accompany it. I was so glad I got home when I did. We stayed in on Tuesday and I read my book enjoying the time to relax.

Wednesday I decided to spend in clinic with Dr. Anderson after the handover. She had a few errands to do first so I tried to help on the ward for a little bit. In clinic we saw lots of patients all with complicated problems. There was a lady with bilateral leg swelling who was only 36, a man with yellow eyes and weight loss who was only 19, a 10 year old boy with rheumatic heart disease with multiple murmurs awaiting surgery in 2 months who Dr. Anderson thinks is unlikely to survive that long and a 7 month old baby with Down's syndrome who was very cute. At 12:30 Dr. Anderson had yet another meeting so we postponed clinic and went to the ward. On the ward they were about to preform a lumbar puncture on a 10 year old Indian Child who had fever of unknown origin, headache and neck pain, he was also very drowsy. He had had an LP over the weekend when he had come in unwell but since then had got a bit better and been sent home only to come back with his parents saying he was more drowsy. We gave him some midazolam to make him feel a bit sleepy so he would be relaxed, the dose was quite small as we were being cautious in an already drowsy child. This proved not to be the way to do things. He was playing up to his parents that he was sick, when we tried to get near him with the needle he almost shot through the ceiling and wriggled away from us, playing a game and laughing. It was hard to believe at this point that he was very sick, we tried a few times but decided it was fruitless and moved on. I didn't go back to clinic then instead we went to see another baby who was having temperatures of unknown origin and tried to talk to the mother about doing some blood tests. It is hard to take blood from babies as both the mothers and babies get very upset as it seems to hurt the babies. We managed to convince the mother to let us do all the tests except for testing for HIV. Her husband had died when she was 1 month pregnany possibly from HIV and she was very upset so we decided to leave her. I watch nisha do a lumbar puncture on this baby as well which some of the resutls came back today (thursday) and showed she had done a perfect lumbar puncture that wasn't traumatic. After that we phoned the on call lab technician to come and get the samples and got home for about 5pm.

Last night we went to a Chinese restaurant called Bamboo Gardens which was really nice, it was good chinese and a very pretty place. It was one of the Manchester students boyfriend's last night here so we said good bye to him before reaching home. It was a nice night.

Today (thursday) has been a very long day again. I decided to stay for the ward round after the handover. I even talked to a few of the patients myself and assessed how they were coming along. It's always a learning curve as everyone does things different ways. The way I like to write in notes is not how other people like to write in notes so I kept getting told off. Dr. Anderson accompanied us on the ward round which was good for learning purposes, she always alerted me to good clinical signs and made sure to ask me lots of questions. It's hard work and at times discouraging as I don't know the answers quite frequently. I was talking to one of the doctors about this today as I was feeling very worried that my clinical skills and knowledge weren't up to scratch but she reminded me that Dr. Anderson was a 3rd year medical student quite a long time ago and forgets the level of knowledge that we have required. I like being asked questions by Nisha as she has a fairly good idea of what level I should be at. It is certainly being eye opening being here as it is highlighting areas of my knowledge that need to be reinforced.

There were quite a lot of interesting cases today. We managed to do the LP on the 10 year old Indian child today despite his screams, he was a lot more sedated though. There was also a 17 year old boy with a large pericardial effusion which will need draining however he is stable enough to wait until tomorrow under ultrasound guidance, I really hope they give him adequate sedation unlike with the old lady before. There was another child a 15 year old boy with a heart rate of 134 (very fast) we did an ECG on him and it showed he was in a supraventricular tachycardia. This is pretty scary for him and to an extent for us, he felt pretty unwell so we thought it would be a very good idea to do something to help him feel better. We found some adenosine on the ward that was miraculously in date and decided to try to convert his rhythm back to normal. This is quite a scary procedure for the patient as it makes them feel quite dizzy and peculiar for a few seconds, we tried to explain this to him as best we could but I don't think he enjoyed it all the same. We also tried carotid massage and the valsalva manouvere on him but these didn't work. In the end the drug we gave didn't really have much of an effect so we have decided to treat him slowly with digoxin to slow his heart rate down so hopefully he will feel a bit better. It was found a little bit later on that he had a raised potassium which could be cohntributing to his fast heart rate so we gave him a few drugs to help that and will review him in the morning. Nisha is on call tonight, it's her first shift on call and I think that she is very nervous but she is more than competent she just needs to believe that she will be fine. I've tried to be as helpful as I can for her but I am hoping she has a quiet and uneventful night. I will hear in the morning I guess.

Now I'm back here and thinking that I should go make myself some dinner. So my week was a little bit multicultural with Nigerian, Chinese and Indian experiences as well as of course being in Gambia so everyday is an African experience!

I shall write again after the weekend hopefully the weather will be good again and I will make it to the beach!

Bye! x x x

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