In just a single day at the Chris Hani Baragwanath Academic Hospital (sensibly shortened to Bara by most), Alex and I have seen more trauma and done (well, attempted) more practical skills than the past 5 years of medical school combined. It's been an incredible start with exactly what we were hoping for, but not without its fair share of surprises.
***
After a day of administrative challenges on Monday, Alex was pretty pent up with rage and needed to blow off some steam that evening with another session at Emet Gym. Not the best idea when you've been waddling around all day: found ourselves both yelping in pain at doing simple squats while the guys next to us were deadlifting nearly three Riki's-worth of weight.
Who did a better job of hiding their discomfort?
The following morning was our first day on the wards: groggily waking up to an alarm at 5:50am is generally not how you envisage the first day of your elective placement... but hey ho, be careful what you sign up for! The roads with no signs or rules (red lights seem to be an optional consideration here) and full of bus drivers acting like they were in bumper cars at a May Ball were enough to wake us both up though, seems we won't be needing coffee in Joburg.
We arrived at Bara at 7:00am to discover what can only be described as a herd of consultants, junior doctors and medical students migrating from one patient to another - this was the morning ward round. The three consultants would form a huddle around the patient as they discussed what had happened and what needed to be done. The junior and senior registrars would rapidly enclose the trio to form the perfect sound barrier. Lower-ranking doctors would try to poke their heads over the registrars' shoulders to catch the odd word here and there and perhaps catch a glimpse of the patient. Finally those who lie at the bottom of the hierarchy were the medical students and medical elective students: it was essential to polish one's ear canals thoroughly on a daily basis to have a chance of having any clue what was going on.
We made our way to the Trauma Unit where we would be spending the next 6 weeks of our lives and learnt how things worked: when patients arrive at the hospital they either go to the Medical Unit for medical emergencies (heart attacks, strokes, kidney failure, etc.) or to the Trauma Unit for emergencies due to trauma. Examples from Day 1 included a couple of "mob assaults," a teenager stabbed in the neck and another in the chest, a man with multiple gunshot wounds, and someone who'd been hit full on by a train... you know, all standard stuff. Students from the University of Witwatersrand (the local university, aka Wits) were totally accustomed to this to the point of basically being bored, while Alex and I were stood gawping at each new patient that came through the door. I worry that we're going to get back to the UK and find the problems arriving in A&E too tame: "I'm sorry sir what's that? You think you've broken your leg? Well it is wonky but I don't see any pieces of bone poking out, stop whinging. What's that? You want some pain relief? Well if you're going to continue moaning I guess I'll have to write you up for some, and the nurses will maybeget around to giving it to you in a few hours. Fine if you insist, please hop your way down that corridor if you really want an X-ray."
On a more serious note: we were of course somewhat aware that there would be differences in how things were done here compared to Addenbrooke's, but just how different was well beyond what we were expecting. There are too many things to list now, and I'm sure we'll have plenty of opportunities to rant about each in future blog posts, so I'll start with the title of this one. For those of you that don't know, instillagel is a mixture of lubricant jelly and local anaesthetic that we administer into a patient's urethra (the tube which connects your bladder to the outside world) before sticking a catheter in, to minimise pain and injury. Yes, unfortunately the title is a direct quote from a conversation I had with a doctor putting a catheter in - after my explanation he laughed, "Wow your patients really do live a life of luxury back in the UK, huh!" And yes, seeing the pain of the patient in front of me was more than enough to prove to me that instillagel really does help... it was a rude awakening to see one of the funniest sketches in the Addenbrooke's Charity Pantomime (for which Alex was director and I was producer, and which we had both been involved in writing) actually occurring in real life. What had been ridiculous in Cambridge was the totally accepted norm in Joburg. This and so many other things I've seen today make me realise how much we as healthcare professionals and patients alike fail to appreciate the NHS and the resources it provides.
I will never take you for granted again my friend.
The insufficient funding for resources and staffing though are what make a place like Bara so great for elective students. It means that the hospital will take whatever help it can get: we were clerking patients, taking venous and arterial bloods, administering fluids, ordering X-rays and CT scans, etc. etc. and while it was pretty haphazard at times (you know you've got off on the wrong foot with a patient when you start with "Hi there, are you Mr 'Victoria Street'?") by the end of the day we were starting to get the hang of things. For the first time in our medical careers we were valuable rather than a hindrance! We weren't having to timidly approach the friendliest-looking doctor we could find to ask to watch what they were doing. Instead, doctors were coming to us for help in managing the workload, which meant they felt it was worth investing time into teaching us new skills (I collected blood from someone's groin today... I didn't even realise that was a thing!)
The time flew by, and before we knew it over 12 hours had gone and it was time to go home. We walked out of the hospital in to the pitch black of winter. A smile grew on our faces though, as in the distance we saw the two rear lights of our car in the parking lot, acting as the beckoning glow of a big dinner and a warm bed....... "Wait a sec, why are the lights on??" We dashed over to our car to confirm that it was indeed our car, and no there was nobody trying to steal it at that moment, and yes Alex had left the car headlights and rear lights on at max for an entire day and completely drained the battery. Plonker.
***
After a day of administrative challenges on Monday, Alex was pretty pent up with rage and needed to blow off some steam that evening with another session at Emet Gym. Not the best idea when you've been waddling around all day: found ourselves both yelping in pain at doing simple squats while the guys next to us were deadlifting nearly three Riki's-worth of weight.
Who did a better job of hiding their discomfort?
The following morning was our first day on the wards: groggily waking up to an alarm at 5:50am is generally not how you envisage the first day of your elective placement... but hey ho, be careful what you sign up for! The roads with no signs or rules (red lights seem to be an optional consideration here) and full of bus drivers acting like they were in bumper cars at a May Ball were enough to wake us both up though, seems we won't be needing coffee in Joburg.
We arrived at Bara at 7:00am to discover what can only be described as a herd of consultants, junior doctors and medical students migrating from one patient to another - this was the morning ward round. The three consultants would form a huddle around the patient as they discussed what had happened and what needed to be done. The junior and senior registrars would rapidly enclose the trio to form the perfect sound barrier. Lower-ranking doctors would try to poke their heads over the registrars' shoulders to catch the odd word here and there and perhaps catch a glimpse of the patient. Finally those who lie at the bottom of the hierarchy were the medical students and medical elective students: it was essential to polish one's ear canals thoroughly on a daily basis to have a chance of having any clue what was going on.
We made our way to the Trauma Unit where we would be spending the next 6 weeks of our lives and learnt how things worked: when patients arrive at the hospital they either go to the Medical Unit for medical emergencies (heart attacks, strokes, kidney failure, etc.) or to the Trauma Unit for emergencies due to trauma. Examples from Day 1 included a couple of "mob assaults," a teenager stabbed in the neck and another in the chest, a man with multiple gunshot wounds, and someone who'd been hit full on by a train... you know, all standard stuff. Students from the University of Witwatersrand (the local university, aka Wits) were totally accustomed to this to the point of basically being bored, while Alex and I were stood gawping at each new patient that came through the door. I worry that we're going to get back to the UK and find the problems arriving in A&E too tame: "I'm sorry sir what's that? You think you've broken your leg? Well it is wonky but I don't see any pieces of bone poking out, stop whinging. What's that? You want some pain relief? Well if you're going to continue moaning I guess I'll have to write you up for some, and the nurses will maybeget around to giving it to you in a few hours. Fine if you insist, please hop your way down that corridor if you really want an X-ray."
On a more serious note: we were of course somewhat aware that there would be differences in how things were done here compared to Addenbrooke's, but just how different was well beyond what we were expecting. There are too many things to list now, and I'm sure we'll have plenty of opportunities to rant about each in future blog posts, so I'll start with the title of this one. For those of you that don't know, instillagel is a mixture of lubricant jelly and local anaesthetic that we administer into a patient's urethra (the tube which connects your bladder to the outside world) before sticking a catheter in, to minimise pain and injury. Yes, unfortunately the title is a direct quote from a conversation I had with a doctor putting a catheter in - after my explanation he laughed, "Wow your patients really do live a life of luxury back in the UK, huh!" And yes, seeing the pain of the patient in front of me was more than enough to prove to me that instillagel really does help... it was a rude awakening to see one of the funniest sketches in the Addenbrooke's Charity Pantomime (for which Alex was director and I was producer, and which we had both been involved in writing) actually occurring in real life. What had been ridiculous in Cambridge was the totally accepted norm in Joburg. This and so many other things I've seen today make me realise how much we as healthcare professionals and patients alike fail to appreciate the NHS and the resources it provides.
I will never take you for granted again my friend.
The insufficient funding for resources and staffing though are what make a place like Bara so great for elective students. It means that the hospital will take whatever help it can get: we were clerking patients, taking venous and arterial bloods, administering fluids, ordering X-rays and CT scans, etc. etc. and while it was pretty haphazard at times (you know you've got off on the wrong foot with a patient when you start with "Hi there, are you Mr 'Victoria Street'?") by the end of the day we were starting to get the hang of things. For the first time in our medical careers we were valuable rather than a hindrance! We weren't having to timidly approach the friendliest-looking doctor we could find to ask to watch what they were doing. Instead, doctors were coming to us for help in managing the workload, which meant they felt it was worth investing time into teaching us new skills (I collected blood from someone's groin today... I didn't even realise that was a thing!)
The time flew by, and before we knew it over 12 hours had gone and it was time to go home. We walked out of the hospital in to the pitch black of winter. A smile grew on our faces though, as in the distance we saw the two rear lights of our car in the parking lot, acting as the beckoning glow of a big dinner and a warm bed....... "Wait a sec, why are the lights on??" We dashed over to our car to confirm that it was indeed our car, and no there was nobody trying to steal it at that moment, and yes Alex had left the car headlights and rear lights on at max for an entire day and completely drained the battery. Plonker.
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