Tuesday, 29 July 2014

Unpublished elective posts: My first solo ward round!

Unpublished elective posts part one

A few years ago I published posts from my medical school elective in Tanzania whilst I was out there (see 2011 around september time in archives).  I used to write them in the evenings on my PDA and then publish them as and when I was able to get access to a computer.  As my elective was in a very rural village this was quite sporadic - the hospital did have one computer but being the only computer for a hospital of 120+ patients it was frequently in use and even when you could get access to it (usually late in the evenings if you could find the key to the computers room) the internet could be outpaced by carrier pigeons and power cuts were very frequent meaning I often lost blog posts and emails halfway through trying to send.

The upshot of this is that there are several partial or fully written blog posts lurking on my computer that I never published.  Its difficult now to publish the partially written ones as the me that would complete them now already feels like a remarkably different person to the wide-eyed enthusiastic fourth year medical student who was getting frustrated by the level of care given at the hospital and the memories of that frustration have already begun to fade.   But, I will try and slowly publish these posts and stay as true to the thoughts I had at that time because my elective remains my most enlightening medical experience and so the most worth blogging about in my opinion.   I will say with each post whether it has been partially written in recent times so you can decide for yourselves how accurate to my experiences at that time the blogs are.  I won't delete bits of the blogs however much they make me cringe now!

My first solo ward round! (minor additions to first paragraph only)
Accidentally ended up finshing up a male ward round by myself today because the clinical officer had to go to opd and asked me to see the last few patients.   Pretty strange having two nursing students plus 1 qualified nurse following me and pushing the notes trolley; I am used to being the ward round follower or notes trolley pusher!  This entourage was definitely useful though in terms of taking a history when I do not speak swahili! This translation service wasn't completely useful however as clearly there are boundaries out here that we wouldn't feel were appropriate within a medical setting in England.  For example the nursing students refused to translate "When were your bowels last open" and giggled at the very suggestion.  Unfortunately this question wasn't really something I could charades-style act out...

In total it was only a few patients that I had to see on my own, but think I did manage them correctly and even noticed that a patient who appears to have had a stroke secondary to hypertension has not actually received his prescribed antihypertensives for the last 3 days, something which has not been noticed in the last 3 ward rounds! So feel pretty proud of myself really, maybe I will make a doctor yet!

Rest of day was pretty full of responsibility as well.  In maternity ward there was a patient in the labour room with poor progress of labour who was on an oxytocin drip which was supposed to be given at an increased speed every half an hour, however despite the fact that there was 3 midwives about plus an insane number of student nurses, every time I popped into the labour room from ward rounds the increase in speed would be massively overdue and still not done! So had to do it myself as well as go on two ward rounds - multitasking skills!

While I waited for the doctor to come and review this patient after the oxytocin had failed to increase the strength of her contractions, I watched the nursing students being taught how to perform a vaginal examination of a pregnant woman.  Craziest teaching of a pv exam that I have ever seen!About 20 students all round one patients bed whilst the teacher performed an examination this intimate examination on her! Poor patient! Talk about intimidating! Also some of the smaller girls standing at the back clearly couldn't see so I'm not sure how much they learnt from the experience. Very, very different to how this is taught in England!

The examination - there are two pregnant ladies within this corner - the one that is being examined and one nearer the camera that students are leaning over in order to see the examination

Halfadoc x


  1. Oh dear. I am speechless. Poor patient. I can't imagine the terror of being suddenly in charge. Well done indeed.
    I also think my clinical elective was the most enlightening and empowering experience in med school.

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