Internal Medicine

Published: July 10th 2018
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So I have started my placement on internal medicine now. There are a lot more patients and a wider variety of conditions, so it's been really interesting. This will probably just be a really long post about the most interesting things I've seen and learned in the last two days.

I saw a man with elephantiasis. Both of his legs were extremely swollen and his skin was scaly with lots of nodules. He was in because his skin breaks down a lot and gets infected. If you do a google image search for 'elephantiasis' you'll see lots of examples of the swelling. if you google 'elephantiasis hyperkeratosis' you'll see how their skin can look as well. It's caused by a parasite, a type of worm, which I knew. But I didn't know the worm was transmitted via mosquito bites! Luckily not here, it's South America, Africa and Asia. It's very rare now and is on track to be eradicated completely by 2020. But for people that have been infected and develop elephantiasis, there is no cure. Once the damage has been done, you're stuck with the condition forever, even if they kill the parasite in you. It's really debilitating. The man I saw went on holiday as a teenager to Venezuela. He caught the disease and has been disabled and housebound ever since. He's now 61. It's probably the worst condition I've seen here, just because of how a small mosquito bite that isnt really preventable has caused such a devastating condition.

I also saw a man with ALL (type of leukemia) that is normally in small children. There are some blood and genetic tests that can help tailor treatment, however they can't be done in St Lucia. He has to have a blood sample sent to Martinique. I'm not sure when he was first diagnosed, but they've tried twice to take the sample, but he hasn't had the money to pay for it. He now has the money, but the samples can also only be sent a few times a week to Martinique, so that tests can be sent in batches to be cheaper. So this man now has to wait until Friday before he can have his blood taken and then sent. It might not seem like a huge deal, but this is a type of cancer that can kill you within weeks if it's not treated, and his treatment won't start until the tests come back. And then, depending on what the results say, he made need to travel to Martinique himself to be treated as not all the treatments are available here either. And he'll have to find some money for that too.

There is still a lot of stigma about mental health here as well. There are still a lot of people that believe that mental illness means that you are evil and possessed by demons. The doctors will say that a patient has 'a history of mental illness', but if you ask, they don't know what kind. Mental illness can mean anything from anxiety to schizophrenia, so it's not a helpful term if you can't clarify, but they all get grouped together. There has also recently been a problem with the local drugs and alcohol clinic. It used to be across the road from the mental health hospital. People with addictions and alcoholics were referred there for treatment and rehab. It's difficult enough to convince an alcoholic to go get treatment, but some did. Now, the clinic has been moved to inside the mental health hospital. This means that anyone going for drug or alcohol treatment has to get a taxi or a lift to the mental health hospital. The doctor on the ward said that since they've moved, she hasn't been able to refer a single patient, because they all refuse to go to the mental health hospital and have people think they're mentally ill. We saw a man today who is desperate to stop drinking because he keeps coming back to hospital because of it, but he's struggling on his own. He refused to go to the alcohol clinic. He agreed to have a counselor to see him at this hospital, but said he wouldn't go to the clinic unless they moved it back.

I saw a man with some serious swelling in his legs for the past 9 months. He had been to see other doctors, but hadn't really been compliant with their medications, and now the swelling was worse and up to his waist. He has a kidney problem, and the previous doctors he had seen had told him this, but apparently he didn't believe them. He told us that he knew it wasn't his kidneys, because this all started when someone had stolen his shoes and socks and performed black magic on them. He believed he had been cursed with black magic and that was the cause of the swelling.

I also learnt some interesting/scary things about organ transplants here. Basically you can't get an organ transplant of any kind in St Lucia because they don't have the facilities. You could go abroad, but you can't be put on their waiting lists, because every country has their own citizens on a waiting list, so you'd never get an organ. So, the only way to get an organ is to find your own donor. Obviously this has to be a living donor, so it rules out most transplants other than kidney and liver. If you needed a different organ, it's tough luck really. So if you needed a kidney transplant, and found a friend or relative who was a match and willing to donate, you then have to raise tens of thousands of pounds to take you both abroad and pay for the surgery and after care for you both. People here are generally poor, so this is very very rare. The doctors say that they have known a few cases where this has happened, but usually, you just don't get the transplant.

There was a homeless man in the hospital today. He had been vomiting blood and was really unwell. He was sometimes lucid and making sense, and other times just wasn't with it. At one point he said that because he doesn't get much food, if he's really hungry, he will cut himself and eat/drink his own blood. The doctors can't be sure if he was lucid or not whilst saying this, so they don't know if it's true, but his blood results tend to agree. He had the worst blood results I've ever seen, and we all were shocked he was still conscious, let alone alive. It's hard to explain if you don't know the tests, but his creatinine was 1800 odd (normal is around 60-115), his eGFR was 2.8 (normal is over 90), potassium was 8.1 (Normal is 3.5-5, but anything over 7 causes your heart to stop) basically his kidney function was almost non existent and he needs emergency dialysis. Not only is there a waiting list for dialysis, but he is homeless. That means he can't pay for it. If a person can't pay, the hospital will still provide emergency and essential care, and a government fund will cover it. However, this won't cover much, and nothing very expensive. Even if dialysis was covered, because this man is homeless, he won't come for follow up dialysis (3 times a week) and definitely won't be able to afford that. So the doctors aren't giving him emergency dialysis. They are giving him infusions to try and correct his potassium and renal function, but it won't correct it very quickly, so this man's chances aren't good. It's just really sad.

Anyway, this has been a long post, because I've seen so much in just 2 days! It's just so different to the UK, and really makes you appreciate the NHS and the care we take for granted.


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