When we used to go to work in St Mary’s, we often used to jokingly tell each other we were off to another day of “saving lives.” Now of course, the fact is in UK medicine, particularly as a junior doctor, most work is very routine, and the actual opportunity to save a life is very few and far between. (Maybe more in A&E resus, but still.) Not so in Juba! I’ll come back to this thread later...
So teaching this week to the Grand Round was on Shock and a little bit about fluid balance. This is a big issue for JTH, as often patients in circulatory collapse are not fluid resuscitated adequately, or at all. Everyone there knew this was relevant and mattered to them, and we had a really good turn-out, including a lot of the House Officers (first year doctors) who needed to know it more than anyone. This was actually quite a significant breakthrough, as we’ve been struggling bit with attendance. However, progress is being made, and we’re getting very positive feedback from those who are coming. Moreover, we were still getting questions right until the end (18:00!) and we nicely facilitated a lot of comments and discussion points from the seniors to the juniors and each other throughout. Again, a healthy sign in any presentation.
Reflecting on teaching style and delivery, we feel that there’s generally a negative attitude from juniors to teaching, as unfortunately their undergraduate medical education is delivered in a rather, shall we say “old school” manner. That is didactic lectures and teaching by humiliation. So not only are we trying to teach new things, we’re also trying to do them in a new way. These things take time. Nonetheless, as I say, it’s well received
and slowly but surely we’re getting there. We have some UK consultants from St Mary’s coming to join us next week which should help pick up the momentum a bit and roll things forward.
In other news, we had a very restful Sunday, which mainly included hanging around with our friends from Tear Fund, which included the consumption of bacon for breakfast. Very nice. Then later, we visited an expat church which was another interesting experience. All in all, a good day. The weather’s heating up though – it’s been around 37oC here today and very humid with it. I’m hoping for rain tonight, but no signs so far.
So to come back to today. My first patient of the day had been shot in the chest, and my last had been stabbed in the back, so a good solid day of Juban trauma. (They were both fine by the way.) You just don’t get all this stuff on the Island! So, to come back to life saving. I came out of the surgical emergency unit back into outpatients and found an elderly man lying on the floor looking very sick. There was no word of English spoken, but I gathered he had had diarrhoea. This is technically a medical rather than surgical problem, but my boss was there, and I asked if we could just stabilise him on our unit (it was quite quiet.) He agreed.
Now, another important part of our overall teaching strategy is demonstrative and working alongside the house officers, so I took one of them along with me and we worked through the problems and management together. The diagnosis was clearly late stage hypovolaemic shock, the treatment was rehydration (with the correct IV fluids) which was exactly what we’d been talking about on Saturday. It's the basics done well here which make the difference, and it worked very well. This was a) a relief and b) a great teaching aid! I’m in no doubt he would’ve died on the floor otherwise, and I made that very clear when I thanked the House Officer and Nurse helping me. It’s a great way to start your day. His family came and thanked me later on when he’d perked up a bit – again, not a word of English, but it was touching nonetheless. Perhaps more so.
This case also introduces the complex issue of triage here (and the lack thereof) but I’ll keep that back for another day.
Sorry there’s not more photos today.
James
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