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.

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.

Iphone’s new feature : Earthquake alarm clock.

This morning we hit snooze on our Iphone, only to get woken up 10 minutes later by a small earthquake. At first I thought I was just in my bed back in Kingston and truck had just gone by. It was a minor shake but a good reminder that we’re sitting on top of a very active seismic zone. The only signs of it in the afternoon was reduced visibility during our two dives, otherwise everyone went on as normal.

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!

 

 

 

Sunday ride to the Lagoon

We went on amazing bike ride today to Eton blue lagoon on the other side of the island. Saddled up on our very fancy mountain, we set out at 8am with our packs on our back and helmets on our noggins. The trip was going to be about 32km each way, so we tried to keep our packs light and buy refreshments and food once we arrived at the lagoon.

The ride was incredible, as we set out of Vila there was some traffic and the roads were riddled with potholes. On some of the hills we panted and our legs burned, but the most painful part of the ride was the hard seat under our bums. After dodging potential graves for a few kilometres the traffic settled and the countryside monopolized our attention. At some points it was easy to forget we were in the pacific. The rolling hills of the roads flanked by cow pastures could’ve easily been mistaken for the countryside in Ontario or France. Small peeks out to the turquoise coast quickly reminded us of where we were and how amazing Vanuatu’s landscape is. Exhausted, but excited, we arrived at blue lagoon ready to ditch our hard seats for a nice dip in the water.

The Lagoon was amazing and beautifully clear. When we got there we had a lot of company, but soon everyone got back in their tour van and left us alone in this small paradise. Unfortunately, our plan of packing light back fired and there was no where to buy refreshments or any food. Like a scene from Castaway, we went into water conservation mode and not a drop was wasted from then on!

The bike ride was a bit easier because the wind was at our backs, but legs shivered at the site of every hill. Unfortunately (but secretly a blessing), I got a flat in my back tire about 2/3 of the way back. But like the rest of our trip, we got lucky and got picked up by John a local Sheriff. He was going around the Island looking for people that were on trial when he spotted us and he turned back to help us. Another example of how great the people here are! More than anything though, this ride really made us appreciate what our friend Joe Gabriel (www.cycleforcanada.org) is doing this summer. With that thought I’m going to bed, terrified of the soreness that awaits us in the morning :).

Firedancers at Mele Beach

Last night we headed out to Mele beach outside of town to check out the amazing fire dancers.

Meeting the boss

Tuesday we got to learn more about our elusive supervisor, Dr.C, at the hospital. He’s a tall imposing Nivan man in his 30’s, intimidating at first sight but quite laid back and approachable like the rest of the island when you talk to him. In our encounter on monday at the hospital he was relatively formal, a lot like any exchange a medical student would have with a supervisor in Canada. When he told us to that afternoon off we knew it wasn’t all like Canada, and it became clear it wasn’t Tuesday after our first shift.

After finishing our shift on tuesday, we bumped into him in the hospital and he invited us out for Kava drinking. Kava is the traditional drink here that men drink socially. It’s derived from a special root that is mashed and then has water strained through it, to produce a dirt water like product. Apparently drinking this stuff was one of Dr.C favourite past times so we felt pretty lucky to be invited out, especially since he hadn’t done it with any of the other students at the hospital.

The stuff comes in little cups of about 150mL and the idea is that you want to take it quick and all at once to minimize the misery. It looks and taste like dirt water and leaves your mouth feeling slightly numb. Following Dr. C’s lead, Aaron and I both had a couple of cups and managed to keep it all down. The effects weren’t overwhelming, probably because it was hard to lose focus on the miserable aftertaste that lingered in our mouths. But soon, as everyone’s Kava started to kick-in the field went quiet and everyone leaned on the nearest fixed object. All the loud boisterous and cheerful men just sat peacefully gazing at the scenery and talking softly to their neighbours.

The experience was an interesting insight into the local kustoms, but also a great introduction to Dr. C and his life away from the hospital. Not sure if we’ll do another Kava drinking, probably only if Dr. C insists, but we have challenged him to a game of basketball by the end of the month. He said he’s going to train for it so we’ll let you know how we do.

It’s Sunday morning in Vanuatu

We’ve landed at our destination….finally! It was a long trek to get to Vanuatu, starting in Kingston tuesday afternoon, going via Whitby, Toronto, Vancouver, Sydney and Brisbane before arriving saturday evening at Mangoes Resort in Port Vila.

It was long with many connections, but we lucked out on every step with good leg room and great company, and it helped to be connected all along the way. After nearly 26 hours of pure flight time on our comfortable commercial airlines, I’ve really grown an appreciation for what explorers and even regular traveller’s endured before the invention of flight and the computer.

But we’re here now, in where I can only describe as Paradise! It’s funny to think that we’ll be working at the hospital here for a month, it’s easy to think we’re on vacation. Port Vila is a small town on the coast of beautiful turquoise waters backdropped by lush green tropical hills. It’s sunday, so the town is quiet but I have a feeling things will just be a bit slower and quieter here in general. I can feel my biological clock setting itself to island time already!

Our accommodations are nicer than we had anticipated and I’m a little embarrassed to post a photo on here. Let’s just say we’re on the hill over looking the lagoon, and if that wasn’t enough our patio doors open up to the sun rising and a beautiful pool. The staff here are amazingly friendly, we got our first Bislama lesson from Richard, our server last night:  Tankyu tu mas =  Thank you very much. Easy enough, I hope asking ‘does it burn when you pee?’ will be as easy in the clinic.

The hospital and our resort are across the street from each other, we’re really excited to get to stroll to work tomorrow morning. We’re still not sure what to expect at the hospital exactly, we haven’t heard back from our supervisor in a week :P. I’ll let you know how it goes tomorrow, but we’ve heard from a few locals that Dr. Cullwick is a pretty cool dude.

For today, we’re taking it easy and checking out the lay of the land. So far, very very good!