Hey everyone! Here’s the continuation of last week’s Medical Journal! Enjoy 😊
On my first day at the Evelina London Children’s hospital/St Thomas’, I was welcomed by a Paediatric Surgery Registrar, Dr Hemanshoo Thakker. I accompanied him to see a case of a Pilonidal sinus in a 12 year old boy at the A&E. It was my first time to see such a case. I was intrigued by the doctor’s ethical approach towards the patient who was accompanied by his mother. He started off with a polite greeting. He introduced me and took consent from the boy’s mother. There was a broad smile on his face and good rapport throughout the conversation. This I found very interesting and it was totally different from what I used to see back home. In my country, doctors are often seen as the last hope and sometimes considered as mini gods by most patients. So many doctors take advantage of this and often neglect the basics of medical ethics and professionalism. I have learnt that sometimes reassurance is all that certain patients and their caregivers need. I think healthcare workers (Doctors) should adopt the practice of reassurance therapy more especially in low-come countries like Sierra Leone. Addressing patients’ ideas, concerns and expectations goes a long way. Learning more about how to respond empathically to patients, show them you are listening, and give individualised information that they are ready receive. Seeing medical ethics been practically applied on my first day of electives was very fulfilling.
My supervising consultant, Dr. Dorothy Kufeji asked me: ‘Mohamed what would you want to achieve by the time you complete your electives?’ Thoughts started stumbling in my head. Just before I could spill out to her that I’d like to learn how to perform a gastrostomy, she smiled and told me to go home that day and list a set of goals and objectives of my placement. I went home that evening and listed down everything I had in my head. I wanted to learn how to recognise surgically relevant anatomy and understand the pathology behind common surgical disease processes in children. Problem solving and clinical knowledge: attending ward rounds and practicing examination skills, observe informed consent processes noting potential effect(s) of doctor-patient imbalance and cultural differences. As a medical student filled with research aspirations, I have always wanted to improve on my online research skills: accessing, analysing and evaluating scientific and medical literature in order to address learning needs. And of course, scrubbing into theatre was at the top of my list.
Dr. Kufeji also talked to me about reflective learning. In fact, it was the trigger for this journal. I came to realise that for every learning adventure it is vital to reflect upon one’s experience and lessons. The ideas and thoughts that came up will often form the basis of a foray into the past, reviewing the lesson structure and clinical knowledge and skills in order to make a few tweaks to it ready for your next encounter.
As my elective went by, I encountered children facing a variety of problems ranging from acute conditions like a torted hydatid (of Morgagni)-which mimics a testicular torsion, appendicitis and the likes, to other conditions such as a case of dystonia. Congenital anomalies were very common; countless cases of the VACTERL group that I saw. For each and every case, I carefully observed its management plan and how this compared to Sierra Leone.
One difference that I noted was there were children with debilitating conditions and congenital problems, whom probably will not make it to their second birthday if it were in my country. But this is largely as a result of the high dependency on care they receive in the UK and the human resource available to look after them.
My consultant introduced me to different departments in the hospital. I started at the radiology department. Upon arrival that morning, the consultant radiologist welcomed me with some questions relating to the specialty. He asked me about the common conditions seen on X-ray in my country. Tuberculosis is endemic in Sierra Leone and CXR is a common diagnostic tool used in many hospitals, if not all. Pneumonias, CHF were among the few that I mentioned. He then handed me a textbook titled “Fundamentals of Paediatric Radiology by Lane G. Donnely” and asked me to go through one of the sections having to do with CTs-which I certainly didn’t have much idea on. After reading the book for half an hour, it was now time for some practicality. My first encounter was to identify an aberrant left subclavian artery on CT. I got the chance to learn a lot about CTs, ultrasonography, and countless CXRs and AXRs throughout the day. I witnessed many cases being diagnosed including a Tetralogy of Fallot, Hypospodias etc. The experience was wonderful and I learnt many new things.
The next day I was going to another department-but this time, Cardiology! Since my very first day in medical school I’ve always dreamed of becoming a cardiologist. During my medical elective application, I registered for a placement in cardiology but the competition was high and I was offered a space in Paediatric surgery instead. Well, I love kids and surgery is cool so I had to go for it. After spending four weeks at the Evelina I can now confidently say I’d like to be a paediatric surgeon one day. In my country it can be hard to follow your dreams because opportunities are limited; we have no room for postgraduate training in the country and postgraduate scholarship comes by merit. So someone dreaming to be a neurosurgeon may end up becoming a Public health specialist or a very senior medical officer (To say the least!). The doctors at the cardiology department were very happy to have me around. We started off the day with a review meeting and then ward rounds. I loved the review meetings at Evelina. They were very educative. Different consultants come together and discuss all the cases from the previous day. The doctors were very knowledgeable and I was able to learn a lot from the discussions. On the wards, I didn’t get to perform physical examinations on patients since I was not allowed but the doctors always encourage me to observe keenly and I gained a lot from their skills and techniques. I’d have actually loved to have hands-on experience to improve on my clinical skills.
I also spent another day at the HIV Medicine department at St Thomas’. HIV/AIDS is common in Connaught, the hospital where I come from. So I was very keen to see how HIV patients are managed at St Thomas’.
On one of my free days I joined my friend, Paddy at the hospital where he works in Barnet, North London. Paddy was one of the KSLP volunteer doctors in Freetown. Throughout my stay in London, Paddy has provided a great deal of support to me. If I can proudly talk about my great time in the UK, he is one of the people that made that possible. I had an invaluable one-day experience at Barnet hospital. It was one of those hectic Fridays as there were only two doctors were running the entire respiratory medicine unit. We started the day at Radiology review meeting. Many interesting cases were discussed. I got to learn many new things. The case that interested me most was BCG-osis, which is a disseminated granulomatous disease following intravesical Bacilli Calmette-Guerin (BCG) immunotherapy (a commonly used treatment for superficial bladder cancer). I saw many other cases with Paddy during ward rounds. There were many old patients with respiratory problems at Barnet. However, in Sierra Leone many young people present with respiratory diseases; TB, Pneumonias, and the likes. I gained a lot of experience on the way patients are monitored and treated for different conditions.
And that’s all for this week! Join us next week as Bella shares more of his invaluable experiences!