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…

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.

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 🙂

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

First day on the wards

We started our rotations on the wards today, I chose to begin with Paediatrics. Right from the get go I felt really energized and excited to learn, a feeling I hadn’t really felt to the same degree since the first couple of months of medical school. Seeing actual patients with signs and symptoms of illnesses I had previously didactically heard about made me very interested in learning about them. Especially here in Vanuatu, where resources are low, you learn much quicker and you see diseases in their full presentation. So my homework for today is to learn more about some the case I saw, here are a few:

• Pott’s Disease (with potential superimposed tertiary syphilis)
• Necrotizing enterocolitis in a newborn and the Kramer score for Jaundice
• Physical presentations of Lupus
• And brush up on developmental stages and trisomy 13/18 deformities

The list is a bit long and makes me wish I had retained more from my lecture but I’m excited to look them up tonight. Tomorrow I’ll be working with the same amazing group of doctors, which may be why I enjoyed today so much. Dr. Sale is a first year resident who I worked closely with today and he’s awesome. The rounds and clinics here are a lot like back home, minus some of the technological luxuries. What they don’t have in modern innovation, the docs here easily make up with creativity and ingenuity. For example they don’t have proper needles to draw blood from young children and newborn, so they’ve devised a method of breaking off a 22 gauge needle to collect blood in a tube for labs, and old plastic gloves are used as tourniquets whenever possible. Anyways, I’m off to do my homework, night!