Ottawa

The second round of electives started for us at the beginning of October. My first stop was in Ottawa. I worked at the Ottawa General Hospital Emergency Department for 2 weeks and got a chance to explore the day to day life of people in Ottawa. I was thoroughly impressed by the city’s beauty, bike friendly paths and wonderful diversity. So it was sad to see the tragic events that transpired on October 22nd at the war memorial. Only the week prior, at the same time of day I was walking by the memorial, admiring it’s beauty and reflecting on the sacrifice that was made by our service men abroad. Like many when I heard the news I was in shock, disbelief and anger. That same night, while walking to the coffee shop in Hamilton, I came across a gathering memorial for Cpl. Nathan Cirillo outside of an Army Garrison. As I stood there watching flowers being stacked one upon another, I began to fear what this event meant for our country, our society and our values. Since then, I have been pleasantly reminded of what makes up the core of Canadian identity and what I love about our country so much.

A couple of years ago, my grandfather passed away after a short battle with ALS. It was a shock to our family who believe that we would have more time together. As we mourned, I was amazed at how the empty sadness was filled with the love of friends and family, and in the process I learned more about my family than I knew ever before.

A week after the tragic events on the steps of Parliament Hill, I am again amazed at how beauty can blossom from loss. Our nation has reacted as only we could, as Canadians. We have resisted the temptation of isolationist thinking or conservative dogma that has pushed so many other countries in this situations to withdraw from the global community or worse lash out in search of revenge. Our media has reported the events with respect, helping the country mourn as one rather than stoking a fire of fear for capital gain. Even our politicians, the same one’s who normally like school children within the Parliament Walls, have acted honourably by taking a moment of silence to reflect rather than trying to reap polling points. Most of all, the Canadian public has held true to the values that Cpl. Nathan Cirillo dedicated his life to serve and protect. We have stood side by side with our neighbours, not allowing this to divide us by the diversity that is at the core of our identity. It doesn’t take a complex search on google to come across stories that remind us of this:
-http://goo.gl/47NZJ1
-http://goo.gl/wgRoJw
-http://goo.gl/m3MMXx
…..

What has been most inspiring is that we have looked within, rather than externally, to explain this. After all, the shooter was a Canadian like any one of us. For whatever reason, he decided that this was a reasonable form of action, and so in some way our society has failed him and us in general. I don’t think our society is broken or corrupt, in fact I believe it is very strong because it is able to reflect like this. But it is true that there is increasing inequalities developing within Canada, with more rigid class boundaries and reduced socioeconomic mobility. I hope we will continue to honour Cpl. Nathan Cirillo with our actions, I hope we look within focus our attention in giving every Canadian exposure to the love and support that was expressed this past week. I hope we stand guard for our values, and not let fear shake us from them.

Orienteering clerkship/Gros Morne Pt.1

First year of clerkship has flown by as faster than I could figure out which side of my stethoscope to use. It’s been an eye opening experience to see Medicine actually practiced on a day to day basis. Romantic notions formed from watching TV or reading books have been shattered, simple idealist approaches nurtured in pre-clership have been challenged and seasoned with grains of salt. It’s been the most intense eye opening experience of my life and probably the year I’ve learned the most in the shortest period of time.

By the time summer had came along, Medicine was a whole new world for me, I finally had the map for it and at least knew of all the amazing things I had yet to learn or understand. But this also came at a cost, first of which was a summer without break spent working and studying. Weekends are great and you can do a lot in a couple of days, but somethings are just not possible. For example, I realized I really missed hiking, especially exploring a new landscape with rough terrain. Multi-day backpacking hikes give me a sense of simplicity. Away from the buzz and the lights, life becomes about the pack on your back, the trail ahead of you and whatever comes around the corner.

By august, I was craving this and it was starting to effect my enjoyment for Clerkship. Lucky for us here at Queen’s, we have 5 personal days which we are allowed to use throughout the two years of clerkship as we see fit. So I used up a couple of these, tacked them onto Labour Day weekend and booked a flight to NewFoundland with my girlfriend Steph. We decided to do a backcountry orienteering hike called the Long Range Traverse in Gros Morne national park. I was first drawn to this park by the classic images of the fjord, but reading more about this epic 37km trail-less hike through the arctic like plateau really sold it.

We didn’t have the greatest weather but it was still awesome!

One of the exciting parts of this hike was the need to use map and compass to guide you through the park. I think growing up in Canada this is a necessary experience, it gives you a small sense of how this immense land was navigated by explorers. So needless to say we spent the better part of the month before the hike preparing and planning, and whether it was buying Gator’s or just researching route advice, it all came in handy.

Me after I lost my right leg to a bog. I was wet up to my hips but damn those gators kept my calves and ankles dry.

The planning really built up the excitement for our trip and it focused my attention briefly away from Medicine. This is probably not what my professors or supervisors want to hear, but I think overall this cleared my mind and made me a better clinician and care provider for my patients. The trip itself gave me time to reflect on my priorities, my goals and the reasons I chose to be a physician. But more on this in my next post…

One week, two different systems

It’s been nearly two weeks since I arrived in Brisbane, and I just completed my first week at Royal Brisbane Women’s Hospital. It’s be an interesting experience so far, a type of culture shock that has been a challenge to get adjusted to, but also a growing experience.

As medical students in our clerkship years in Canada, we play an active role in the delivery of care and hold some responsibilities in the hospital. Wether it’s rounding in the morning before anyone else to make sure patient blood work was up to date, doing initial exams of consult referrals or just tedious work like discharge summaries, as a medical student you provide added value by being at the hospital and your absence will be noticed.

RBWH is a large centre attached to the Royal Brisbane hospital and the Royal Children’s Hospital. This is one of many sites where the University of Queensland School of Medicine uses for their Obstetrics and Gynaecology, but it is by far the largest. Just due to its sheer size, we anticipated that things would be different from the intimate teaching environment of KGH and HDH in Kingston.

We were warned however that the differences went further than that, and they sure are! The Australian medical training system is modelled like the British system. Where we have medical students, clerks, residents and attending, they have Medical students, clerks, Intern/residents, registrars and consultants. Where our two systems don’t align is at the level of the intern/registrar, which doesn’t exist in the Canadian system. As a result, all the roles below that level are different in the two systems.

In Canada, you receive introduction to the clinical setting and clinical technique at the start of of medical education in years 1 and 2. In your final 2 years as a clerk you apply your foundational knowledge and skills daily in a clinical setting, do develop your clinical reasoning and understanding of patient care and management in the system. From my brief exposure to the system here, it appears that their is brief clinical opportunity in the first two years, and that our clerk experience is obtained after graduation from medical school, in the role of an paid intern/resident. At the end we all arrive at the same final destination and I think our two systems are very comparable in the level of care that we provide patients, however the paths are quite different.

It has been challenging to adjust to this limited role, and my desire to be more active in the patient care has created some personal frustrations at times. My communications skills have also been tested and pushed further than before, as I’ve found my self in touchy positions trying to give suggestions to an intern/resident for procedures like setting up an IV.

 

The view from my study spot, not -30 over here!

However, as with anything, this is a double sided coin and the free time makes it easy to regain perspective on this amazing experience. The limited clinical responsibilities means I can sit here on this patio, under the Australian summer sun, enjoy a delicious cappuccino and life in Brisbane; and maybe take Friday off to go to Melbourne for the Aussie Open….but keep that one to yourself.

Obs/Gyn in Brisbane’s RBWH

I am lucky to be part of 5 students from Queen’s University participating in a clinical exchange with the University of Queensland. Thats right, no winter coat and boots for me for the next two months!

We’ve already landed here and I’m fully settled in, with the exception setting up internet (which is always unbelievably difficult in Australia). After my first two academic days it’s clear that even though they dress much more formally here, the approach to medical education is very relaxed and laid back. So Hurrah!

So far Royal Brisbane Women’s Hospital is incredible! It’s on the same scale as VGH or Sunnybrook Hospital back home, but with more lounges and social areas for physicians and staff. Just take a look at this ‘sleep pod’ in the doctor’s lounge: 

Needless to say, life is pretty cushy here so far! Tomorrow is my first actual day on the wards, so I’ll get a better idea of how things work and run around here. But for now, I’m headed off to park for some time under the sun.

Medical Elective in Vanuatu, some advice

I was recently contacted by another medical student looking for advice on their future trip to Vanuatu and thought I would post that information here for others to see as well.

1) Housing:

a) Coconut Palms Hotel: I would really recommend staying here, it’s clean, has great staff and is relatively affordable compared with the other options. It is just around from the hospital on the way to the city and beachfront making it ideally located. There are daily events held by the hotel staff and a highlight is the Trivia nights on Wednesday. Round up the team of medical students and have a go as ‘Team Baby Docs’. It’s a fun time and the prizes are well worth a serious attempt at winning.

b) Mangoes Resort: This is actually where Aaron and I stayed during our rotation. It’s a very nice, clean resort situated right behind the hospitals back gates. Unfortunately this makes it slightly further from the city centre and it’s luxuries are represented on the price. There are no events and it tends to be pretty quiet guests.

2) Phone:

I would recommend getting a phone upon landing, it’ll come in super handy in planning and coordinating shifts with doctors as well as any extra-curricular activities you get up to during the weekends.

3) Hospital:

There are five different opportunities at Vila Central Hospital: Internal Medicine, Surgery, Maternity, Pediatrics and outpatient. There are also visiting specialist who you will also be able to work with, however they are mainly there to teach local students. You are free to arrange your time as you wish between these wards, but I’d recommend rotating at best on a weekly basis. Chat with the other students already there and it’s best to keep it to 2-3 students on each ward at a time. Rounds generally start at 8am and you can arrange the rest of the days with the resident depending on clinics and theatre schedule. My favourite wards were Medicine and Peds, both had great residents keen to have students and teach.

3) Food and drinks:

a) Numbawan Cafe: Great hangout spot on the waterfront, ideally located near the local dive shop as well. Awesome place to grab a drink at the end of the day and really enjoy the beautiful surroundings. They have free WiFi which is another visit and have multiple outdoor movie screenings through the week.

b) Numbatwo Bar: Fun bar/brewery with the best beer on Vila and the best place to stay tuned with International sports.  Awesome staff, introduce yourself early and make some awesome friends!

c) Market food: BEST place for any cheap meal! These outdoor stands at the market are run by incredibly friendly locals, pick one you like early and stay loyal. The are a range of dishes, but generally stay away from the fish and anything that is not cooked fresh, everything else is delicious and safe to eat! The steak or beef stew are safe choices and the portions are huge. If you want a drink, run over to the local supermarket next to the market for cheap drinks and bring it back.

d) Chinese restaurants: There are a few chinese restaurants on the island that serve cheap food comparable to the market. These are a good choice if you want something quick and close to the hospital, but the market food is much better.

4)Island Travel:

Flights are the only way to get about Vanuatu, and it ain’t cheap: somewhere in the $200-300+ range for short round-trips. Make your weekends 4 day long when flying to make the most of your time on these islands. There are local travel agents be the waterfront supermarket who are very helpful in arranging these outlying island adventures.

a) Santo: Vanuatu’s largest island is home to world-class Wreck diving and beautiful picturesque beaches.  Must do for any Diver.

b) Tanna: Beautiful island with live volcano and ash planes. Also has a very diverse and unique culture, just ask your residents about Kustom medicine. If you’ve ever wanted to look into the cauldron of a live volcano there is no better place in the world!

c) Ambrym: Awesome lesser-know island great for any adventure seeker. If you’re interested in hiking up a tropical mountain with 2 live volcanoes and ash plains at the top this is the place for you. It’s a bit harder to get to and back from Ambrym so arrange early and don’t do it right before your flight out of Vanuatu.

d) Vila: A great way to explore Vila’s blue holes is by bike. Ask your hotel front desk about arranging hire. These are long rides (30+km) but they have incredibly scenery and are well worth it if you’re up for the exercise.

5) Local travel in Vila:

a) Walking is very easy and everything is close. We never had any issues with safety but always wear shoes as there is a lot of broken glass.

b) The local buses  or people driving vans are the second best option if you’re feeling lazy and don’t want to trek up the hill back to the hospital. Just make sure you take ones that are empty, otherwise you might be taking the long route to your destination.

c) Taxi’s are expensive and we never really needed to use it.

6) Kava:

This is the local drink and it has an entire culture around it. I’m not a fan of the taste but while you’re in Vanuatu you should try to go to a Kava bar with a local. Going on your own you will miss out on most of the experience, just ask any of the physicians and they’ll probably be more than happy to take you.

Don’t hesitate to contact me if you want more details on any of this, tried to be short to keep it manageable on here.

Last week in Vanuatu: Part II

So this post is picking up from where the previous one left off about our last week in Vanuatu. If you’re feeling confused, try reading the last one, might put things into context 😀

With Dr. S

After dinner on Tuesday night with Dr.L, we took a quick siesta back at Mangos before heading back to the hospital for a night shift on call. Nothing had happened on my previous on call, but this time Aaron and I split up in the hospital to cover more ground. He slept in maternity and I slept in peds, and we wrote our names on the medical and surgical wards to be called if anything came through. At 10pm I crawled into my tiny peds cot, and slept under the furiously spinning fan. I thought it was going to be another silent night as nothing happened in the first few hours.

It was 5am when I heard a knock on the door and the lights flashed on blinding me momentarily. It was Dr. S, he said there was some complications with a newborn up in Maternity. I chased him up there and woke up Aaron along the way. We took our shoes off and entered the NICU where the baby was in obvious distress.

The baby had been born during the day, but was in intensive care because of meconium aspiration. Now the child was in acute distress. Dr. S went into action with newborn CPR, we stood behind still getting out of our haze. As Dr.S was performing CPR I was flashing back to earlier today. It was really a weird situation, calmer than before without all the crowd but I didn’t have the optimism I had that afternoon. I didn’t know what to expect but I didn’t see it coming when Dr. S stopped performing CPR. The child had passed away, in only 24 hours we had witnessed two of the most shocking moments of our careers so far. It was nearly 6 am when the Dr. S left the room to talk with the mother and we heard the cry through the door. At that moment I thought it was going to be on of those days, when nothing would go right and no matter what we did we would fail on every front. It was especially weird when Dr. S asked us to examine the newborn for sign’s of life and try newborn resuscitation techniques. It was a strange and fearful experience learning in that situation, but we couldn’t see an alternative and appreciated the opportunity to gain experience without risking further damage. Sometimes, like this, medical education seems very weird and barbaric, at the time it’s easy to justify it with the idea of helping out in the future but I’m not fully sure it appropriate.

Feeling right at home 😀

 

Our Maternity friends 😀

When we we’re feeling our lowest one of the nurses from maternity came to get us. There was a new birth in the ward and we were invited to go watch. Seeing a successful birth was a great change of events and got us energized and excited again for rounds in the morning.

After a quick break to shower and eat breakfast we headed back to the medical ward for rounds. Some of the new patients were one’s that we had admitted from Clinic the day before so it was interesting to present cases during rounds and know a lot of the details. There was one patient with advanced Cirrhosis with ascites and an extremely distended stomach with a inverted belly button. The patient was terminal but we had admitted him for a palliative drainage of the fluid in his belly (paracentesis).

Our medical ward friends

It was my turn to do this and I had spent some of our time the night before reading up about the details of how to do it. It seemed pretty straight forward, follow sterile procedures and stick a needle in to drain the fluid.  As Dr. L looked on, I began the procedure and slowly setting up my tray and prepping the patient. The whole thing was very straightforward, but I still felt a big sense of relief when I saw the backflow of yellow fluid through the needle.  I connected the draining tube and collecting bag and the golden fluid slowly flowed out.

We packed up all the supplies and went back to dispose the sharps. In the 10 minutes we were away, the draining bag had filled up (nearly 2 litres). In the next 24 hours, the nurses drained the bag another 5 times removing almost 12 liters of fluid. It was still obvious the patient had fluid remaining in his belly but we were worried about the patient’s blood pressure so we stopped the drainage. I felt pretty good about doing so well on the drainage, it felt weird to stop it since it was so successful. I really wanted to see the final number of liters drained but I also didn’t want any harm to come to the patient. It’s an odd thing being a medical student, wanting to learn and see interesting presentations but also fearing what that means for the patient.

Our almost unstoppable trivia night team 😀

When our rounds finally ended we went back to mangos to crash. It wasn’t till 6pm that we woke up, it was nearly time for trivia night with all our baby doc friends. We headed to Coconut Palms, a nearby hostel to defend our trivia night victory from the week before. Our group was well balanced, 2 Kiwis, 2 Brits, 1 Ni-van (Dr.S) and us two Canucks. James, the Ni-van trivia night master, read the clues in his usual incomprehensible yet hilarious way. It was our fourth week, so it was easy to decipher his clues, and our group managed to squeak out an early lead. A few stumbles in the music round with our limited knowledge of Madonna singles and Nickleback history dropped us back into second late in the night. That’s where we finished when it was all over, but the night was just getting started as we reflected on the past 48 hours.

I won’t go into any more detail on our night, the photos tell enough of the story. Part III covers our last weekend in Vanuatu when we hiked a volcano in Ambrym. It was by far our best non-medical experience so far, so stay tuned (if you can) :D!

Ambrym, read part III for more details 😀

Thanks for reading!

Last week in Vila: Part I

This the medical ward

On our last week here in Vila Central hospital, Aaron and I decided to team up in the Medical ward. It was the first time we had really worked together in a clinical or academic way since the start of medical school. The medical ward here is probably the second busiest specialty after Surgery, and is host to every type of presentation imaginable. The predominant presentations are liver disease, tropical infections, diabetes and cardiovascular diseases. During our week, we saw all of it and more! It was a week of many firsts, but for the sake of brevity I’ll take you through Tuesday, June 26^th and Wednesday June 27^th.

The morning started at 8am with rounds led by Dr. L.  Dr. L is a third year resident here who basically runs the medical ward. He’s a young guy (26), and both of us really enjoyed having him as our teacher. We joke around a lot, but we feel comfortable asking him questions and offering any knowledge we have, and he always challenges us to explain

Vila Central from it’s best angle 😀

our though processes and try new procedures. This morning, he challenged me to do my first Urine Dip test. It’s an incredibly simple procedure that is just as easy as it sounds, but one that I had never actually done. The process was alien for me and it took a while to find the right material but with a few jokes about apple juice we got it done. In rounds we had a new 15 year old male admitted that was presenting with confusion, weakness, personality changes and just simply weird behavior. The boy’s name was Jimmy and Aaron and I had him pegged as an obvious Psychiatry case until Dr. L showed us that his positive Babinski reflex. For those of you who don’t know, this is a reflex that we lose as children and is a sign that there is something wrong with your higher brain function. With these symptoms, Dr. L suggested that Jimmy had encephalitis: this is swelling of the brain tissue and can be fatal. To test his theory, Dr. L got Aaron to do a Lumbar puncture (LP) so that we could test Jimmy’s Cerebrospinal fluid. We’ve had practice doing LP on plastic models before, but this was Aaron’s first time poking patient a real patient. After a quick revision of our handy pocket guides, Aaron stepped up and drained a couple mL’s for testing on the first go! Our confidence as a duo was pretty high for the remainder of rounds that morning. Before lunch we did our  ‘Sticke’em rounds’, which is when Aaron and I collect all the blood samples we ordered during rounds.  Today we went 100% , so we were feeling pretty happy with ourselves during lunch.

After lunch, we joined Dr. L for his clinic hours. This is when patients come in for follow-up, re-assessment or prescription refills.  It started at 1:30pm and we had planned for it to finish around 4pm so that we could eat and rest up before returning to the hospital for a night on call. The first patient came through the doors right at 1:30, but it wasn’t even 1:35 before someone knocked on the door and said something in Bislama that got Dr. L right out of his seat and out the door. Following like ignorant sheep we marched down the medical ward to a patients bedside. The patient had been admitted earlier that day with a suspected heart attack, but had been stable since admission. Now, the patient was unresponsive and his spouse was calling his name with confusion and fear in her voice.

Crazy eights has been a regular in our last week

Dr. L did a quick assessment and then began CPR. It took Aaron and I a little bit to comprehend exactly what was happening in front of us. It’s something we’ve read about, trained for and practiced repeatedly, but still the shock of witnessing our first cardiac arrest was a paralysis that we had to wrestle off. After 30 seconds, I substituted in for Dr. L on compressions to free him to do further assessments and set up other equipment. Aaron jumped on the mask to deliver 2 breaths after each set of round of compressions, and we switched every couple rounds to stay effective. It wasn’t long before we were dripping sweat on to the patient’s chest with every compression. Behind the curtains, family had gathered and we could feel their anxious terrified stares as we counted up to 30 over and over again..

We continued CPR for nearly 13 minutes until Dr. L told us to stop. It took a moment to process everything and for our heartbeats to slow down, it wasn’t till then that I realized we had lost him, the patient was dead.  Moments after we stopped it seemed like the previously impenetrable dam that was the curtain had cracked and slowly the family without cue trickled in. The last place I wanted to be was in that room, it felt like we had failed and it was hard looking any of the family members in the eye. Quickly Aaron and I squeezed our way out of the room to debrief with each other, Dr. L stayed behind to explain everything to the family.

Our servers from our goto drinking hole in Vila

When Dr. L emerged from the room, the debrief was short and he led us quickly back in to clinic and onto the next appointment. The transition was hard for me, my thoughts kept venturing back to what had just happened and what we could’ve done differently. However, the day didn’t stop for my reflections and we saw patient after patient. When it was all over, it was 6:30pm and Dr. L invited us out for dinner to talk about the Cardiac arrest that was nearly a distant memory. It was interesting to chat with him about what had happened, but also sad to learn that it was a far too common occurrence. A lack of resources prevents them from setting up monitoring on all suspect cardiovascular patients who are admitted and therefore its tough to respond effectively and quickly when there is an arrest. It was another example of some of the luxuries we enjoy back home but are so desperately lacking here in Vila.

If you’ve been reading up to here, I have to give you a big thumbs up! I’m going to continue this on my next post just to break things up a bit. There’s still loads of stuff that happened in the next 24hrs/week, but I wouldn’t blame you if your eyes need a rest.

Our gang at Trivia night with the Trivia Master James :D. For more about it, read part II of this post.

Hiking the Ambyrm Volcanos this weekend, huge update Sunday night!

Sorry about the lack of updates recently, we’ve had an amazing last week and there’s loads to catch up on. I’ll write a couple updates Sunday night when we get back 🙂

Got invited to a local wedding yesterday…

The feast was huge, and of course a pig was involved!

There were actually three weddings in Erakor that day, we were there for the middle couple.

 

One of the doctor’s at the hospital was getting married yesterday, so naturally nearly the entire hospital shut down and everyone went to see the ceremony. What was most striking was all the vibrant colours everyone was wearing! The feast afterwards featured a sacrificed pig, and our plates were heaped with all kinds of local food despite our plea’s of “small-small” to everyone serving. A siesta was in order after all this.

Making our rounds of the wedding party.

A sleepover in Pediatrics

my sleeping quarters for the night

Tonight I’m sleeping over in the Pediatric ward, under the hardworking but underachieving ceiling fan in the clinic room. I’m hoping to see what it is like to be on call and see some cases as they first present. During the last week, I’ve been in Pediatrics doings rounds and clinics, but we hardly see any new patients during those times. Often the residents have already admitted patients and done assessments, and I’m playing catch up trying to put Bislama and English together to make out the cases. So tonight I’m the resident’s sidekick, I’m sleeping on this cot with my legs hanging off the end and ear tuned in to the ring of the telephone.

While I lay here waiting to hear the nurse’s knock on the door, I’ll update you guys on what’s happened in the past little bit. Last week I was on Pediatrics, which was a specialty I’ve always been interested but hesitant to explore. I’ve always enjoyed working with children through coaching and volunteering, but wasn’t sure I could handle pediatric medicine because of the hard reality that it isn’t possible to cure every child. Compared to back home, that is unfortunately much more of a reality here.

Physicians here are great investigators and develop great differentials from their histories and physicals, but they’re often limited by their access to diagnostic tests such as labs and imaging. We’ve had a few cases where children have presented with neurologic symptoms that were clearly caused by a mass in the head. However, since there is no MRI or CT scanner, nothing further could be done. In other situations, families have pooled up relatively huge sums of money to send for lab results from Australia or New Zealand. These often take a few weeks, whereas we get them back on the same day or same week back home. Even then, it isn’t clear whether the necessary treatment is available once the diagnosis is made. Cases like these have really reshaped how I think about waiting times back home.  In our pre-departure training we spoke a lot about reverse culture shock: the difficulty of re-integrating into your culture back home after being somewhere else for an extended period. I suspect I’ll have trouble with this when I’m in the wards back home trying to understand patient’s unhappiness about having to wait for an MRI or CT scan of a torn ACL or MCL.

Despite these challenges, I’ve really enjoyed working in Peds. I’m constantly amazed by the resiliency of the children and their ability to have fun in the hardest circumstances. Our afternoons are usually pretty light so I’ve made it a habit to do a ‘play rounds’.

Our guides on Malo

A couple of days ago we even had a small improvised volleyball game in the hall J.  It’s this side of Peds that I knew I’d love and really enjoy, but wasn’t sure I could handle with the reality that some patients wouldn’t make it. It hasn’t been easy, but seeing the kids smile during games or finally being discharged home after a long stay definitely helps balance things out.   These are still very superficial observations of pediatrics and its practice back home is almost certainly much different from here, but I’ve definitely developed a greater appreciation for it. I’m planning on sticking with Peds for the rest of my time here to get a better idea of what it is like with some more responsibilities.

Olive on the beach!

A beach 🙂

Hasn’t been a knock yet, so maybe I’ll update you on our weekend a bit too, but I’ll leave most of it for the photo’s to tell. This past weekend we flew up to Santo in the north, Vanuatu’s largest island. We had gone for two reasons: 1) it has world class dive sites; 2) we each had a Doc invite us to their family’s place here.

After our dive at the SS Coolidge

On our first day there, we dove the SS Coolidge and beautiful reef in the morning. The SS Coolidge is a WWII passenger ship that sank here at the end of the war. The 200m ship sits just off the coast and is pretty easily accessible.  On this dive, we dove for the ‘the Lady’, a statue inside is haul. It was pretty unreal swimming through it’s different halls and rooms, and like most other wrecks I’ve seen we’ve made a stop near it’s toilet facilities which were very well preserved. On our other two days on Santo we visited Malo on it’s South Coast and headed up near Champagne beach to the North. I’ll let the picture tell most of the story. Along the way we met some amazing people and heard some really cool stories. For example, our taxi driver up north has the largest family I have every heard of. I’ll let you do the math but here’s the story: his grandmother had 16 children, his parents had 10 children, he’s the youngest of the bunch and has only 2 kids but his sibling have on average 5-6 kids each, and on top of that all his niece’s and nephew’s are starting to have kids of their own. Not really sure how he manages to remember everyone’s name. When we asked he just laughed, a classic Ni-Van laugh that is infectious and enjoyed by everyone within shouting distance. Really that’s what is most amazing here, despite all of the country’s shortcomings people are so kind and peaceful. Last week a sheriff we met told us he doesn’t need a gun or handcuffs because if he finds criminals they don’t resist or run, they’ll come in for sentencing quietly. That’s just the kind of place this is, simple and beautiful. More than anything else, our trip up north showed us that the people of Vanuatu are really the happiest on earth and quite possible the most welcoming and kind as well. For another, probably more detailed take of our weekend on Santo, check out Aaron’s recent blog post at: http://aaronthesideofcautionblog.wordpress.com/2013/06/19/maternity-and-santo/ This weekend we’re heading to Ambrym to hike the Volcano’s and hopefully meet some local black magic/voodoo shamans. Let me know if you got any one you want to put an enchantment on or if there’s a ring you need to dispose of for safe keeping.

this storm looked way more intimidating from afar, passed by in jiffy.

The passenger ferry terminal on Malo