One week in...

The last week or so since I arrived has been a pretty interesting time, I've had to find my feet in a new hospital, new city, new country (new to me and new to itself) and new culture. Although I've been here before, I've realised it's very different when you're by yourself, especially when you're not naturally that assertive or confident. Thankfully, I have settled in and have got to know the hospital, some of the staff, and have even made some friends from outside the hospital. Every day I think of something that I could write about on here, but no-one wants to read what I think that much, so I think I will just pick up a couple of thoughts that I think are particularly interesting, and help me to give a picture of things that happen while I'm out here.

While I was planning this trip, one of my main aims was to improve my clinical medicine (to any non-medics reading this, clinical medicine is using what the patient tells you and what you find on examining them, rather than test results), because it isn't as easy to run a whole barrage of tests like we do in the UK. However, I am learning that it is not going to be straight forward.

When I am working, I spend most of my time in the clinic, which is where all the patients initially present to the hospital - if the are really sick, we admit them, if they are a little bit sick we give them treatment and send them home. Common presentations in clinic are fever, vague abdominal pains, headache, diarrhoea, and a myriad of rather weird complaints. A lot of the histories are quite vague, which I struggle with; I like to spend a while working out exactly what the pain is like, and the complete sequence of events. I was thinking about why this might be and realised it's probably a mixture of a 3 main things. Firstly, there are a number of language barriers; most of my patients speak english, but sometimes I need someone to interpret as the patient speaks arabic or one of the many tribal languages. This is definitely less effective than me talking to another native english speaker. Secondly, a lot of the conditions that I see present quite vaguely anyway - the main one is malaria, which can have a huge range of symptoms - fever, headaches, diarrhoea, coma, heart failure. The final reason is to do with patient education; even though a lot of my patients are from the South Sudanese middle class, the rate of secondary education is pretty low. Often the descriptions of symptoms are pretty bizarre, or inaccurate - several people complaining of complete leg weakness even though they can walk normally. It is interesting to compare this to patients back home who are often very well informed on their condition, although this often isn't a good thing - there are lots more websites telling you that your headache is a brain tumour rather than the classic migraine that you're having.

I'm slowly getting to grips with the subtle nuances of history taking here, but the standard approach from the doctors here is to take a quick history and then run off an array of tests, almost blindly checking for malaria, amoeba and other infections. So I'm not sure that I'm going to be a diagnositic genius by the end of my time here, but I should get better at assessing sick patients. A lot of the tests that I would do on a very sick patient (O2 sats, blood gases, cultures, regular monitoring) aren't available here, so I have to trust my clinical skills and frequently re-examine patients to see if they are improving or if I need to do something else. This should be useful when I'm back in the UK as tests take time, and often making decisions on what to do next is based almost entirely on clinical judgement.

That's probably enough for now.