Paediatric Surgery & Paediatric Urology Elective – part 2

A typical day in Paediatric Surgery & Paediatric Urology

Monday

Time     

 

AM

  • Pediatric  surgical radiological conference
  • Ward round
  • Grand ward round
  • General Paediatric Surgery clinic
  • Paediatric Urology clinic

 

PM

  • Combined Cleft clinic
  • Ward round

 

Tuesday

AM

  • Elective Operation
  • Ward round

PM

  • Elective Operation
  • Ward round

Paediatric Surgical cases

The disease profile of Paediatric surgical cases commonly found at Prince of Wales Hospital (PWH), Hong Kong included but was not limited to the following

  • Inguinal hernia
  • Sigmoid volvulus
  • Cleft lip & Palate
  • Phimosis
  • Undescended testes
  • Pyloric stenosis
  • Biliary atresia
  • Hypospadias & Chordee
  • Varicocele 
  • Choledachal cyst
  • Intra-abdominal tumor
  • Omphalocele & Gastroschisis

 

 

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Selfie before OT time!

Reflections

Paediatric Surgery (PSU) is the only surgical sub-speciality that is not confined to an organ/system, it is dictated by age. In Hong Kong Paediatric cases range from new-born to teenage years, the patient is only discharged from the PSU once the team has comfortably treated and managed the patient’s surgical compliant, regardless of whether the patient is now regarded as an adult case.

This allows for broader surgical scope which spans from General, Urology, Thoracic, Plastic & reconstructive and Colorectal surgical disciplines. The teaching at PWH was well rounded and structured, from bedside teaching during ward rounds, tutorials on common Paediatric cases with local 6th year students, exposure to and observing surgeries in the operating theater, opportunity to do physical exams on patients in the clinic under supervision. It also included being exposed to a variety of PSU clinics, such as General Paediatric surgery, Cleft lip & palate, Liver and Urology.

My impressions of PSU before the elective attachment was very limited and narrow, I thought of PSU as solely surgery without as much clinical and patient interactions, on an interpersonal level. My impressions were proved wrong, not only does PSU encompass a wide range of surgical cases it is not confined to operations and involves a substantial amount of clinic which involves a lot of interaction with children on an interpersonal level. PSU is a perfect combination and balance of Surgery and Paediatrics. 

Exploring more of Hong Kong

My elective attachment wasn’t just all surgery, attending clinic and departmental meetings. I also got to explore more of Hong Kong that I did not get a chance to see four years ago. Summary of the places I went to in pictures!

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Dragon’s Back hike

 

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Dim sum at DIMDIMSUM in Mong Kok

 

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Nan Lian garden

 

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Victoria Peak

My elective attachment was such an amazing experience, I also made lots of new friends both, local and other fellow-elective students. I didn’t get to spend much of my last break of med school relaxing but this was definitely worth the time and experiences I gained.

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Paediatric Surgery & Paediatric Urology Elective – part 1

Why Paediatric Surgery & Paediatric Urology ?

I’ve always knew that I wanted to practice/work in Medicine that revolved around working with children and in Child health, but what exactly? I did not know, there are a lot of options, in medicine and in surgery to work with children. Paediatrics & Child health was a no-brainer for me, but my love ; rather fascination with surgery made me consider a field that would combine both of these fields together.

Why Hong Kong?

I wanted a placement that would expose me to global Medicine, bu that was not too far from me, because of traveling cost and currency exchange rates. The medium of instruction would be in English, but with a Westerner perspective. An opportunity to develop a global perspective of Medicine. The elective application was free at Chinese University Of Hong Kong (CUHK), while most of the other places I researched involved a hefty elective fee and I could not afford that on a student budget. 

Application process

I started the process of applying for my elective placement a year in advance, and that is excluding the time I started researching about possible elective opportunities for international students studying in China. There is close to nothing on google ; there are not enough international students studying in China doing electives abroad. I had looked into Ghana, Hong Kong, South Africa, Singapore, Sri Lanka and Kenya. Narrowing down choices, based on practicality, speciality, finance and most importantly whether the institution had a well established elective program. 

I have broken down the application process into bullet form so as not to miss any important steps along the way. I will include links if/where necessary.

  • Application form for elective placement 

(check block out periods which no placements can take place before choosing dates)

  • Choose your department(s)

(CUHK allows for a minimum of 4 weeks per placement)

  • A copy of academic transcripts
  • Passport copy and photo
  • Recommendation letter (either from your dean/prof)
  • Proof of financial support (A 3 month bank statement)
  • VISA application form ID995A (CUHK assists you with the application)
  • Curriculum vitae
  • Medical insurance

As I mentioned I started the application a year in advance because electives in CUHK are sought out and particularly surgical electives fill up earlier than usual. 

End of clerkship year

I handed in my internship log books today after getting all of departmental signatures. I am officially done with the clinical component of my MBBS degree.

A year later and internship year has passed. Last spoke about how I found it incredibly hard to balance work and leisure time, at the time I was currently rotating in surgery ; my social life was basically non-existent.

I suppose now that I have the time, I should break-down how clerkship/ student internship year is structured in our medical school and for the most part, in Chinese- medical schools. Intern year is divided into two parts, six-months in Internal medicine and six -months in Surgery. In Internal Medicine it is further divided into core medical rotations which are four weeks long and medical sub-speciality rotations which are two weeks long. Our Internal Medicine block was divided as follows…

Core Medicine rotations :

Gastroenterology – 4 weeks

Respiratory and Critical Care Medicine – 4 weeks

Cardiology – 4 weeks

Paediatrics – 4 weeks

 

Sub Medical rotations :

Oncology – 2 weeks

Emergency Medicine – 2 weeks

Nephrology – 2 weeks

Haematology – 2 weeks

Neurology – 2 weeks

Infectious Diseases – 2 weeks

 

Core Surgery rotations :

General surgery – 4 weeks

Orthopedic surgery – 4 weeks

Obstetrics & Gynecology – 4 weeks

 

Sub Surgical rotations :

ENT – 2 weeks

Urology – 2 weeks

Hepato-biliary surgery – 2 weeks

Anesthesiology – 2 weeks

Elective period : 2 weeks in any of either surgical or medical department.

I did my in-house elective in Plastics & Burns Surgery for 2 weeks.

 

We are put into groups A and B, and depending on which group you are in you might start in medicine and then move to surgery vice versa. The level of clinical exposure, autonomy, bedside teaching, procedures clocked etc  in each discipline differs according to your teaching supervisors’ and the type of department you are currently rotating in.

I feel the year doesn’t prepare us for what to expect when we eventually start practicing medicine in our respective countries, there isn’t enough emphasis on grooming us, the rotations were a mere observations and shadowing than actual learning and integrating the final year student into the department. It is for this reason that I don’t feel adequately prepared for the real world of practicing medicine.

 

There is work in place for us, South Africans who have studied abroad to catch-up and be adequately prepared for the realities of working in a South African healthcare system. I will share more on that later.

As much as I didn’t find that I gained as much clinical experience as I would have wanted, internship was and still is designed for the chinese graduate and not for an international student. I suppose this is the shortcoming of being in a foreign medical school. But all in all it wasn’t a complete waste, and I can hopefully work hard from here onwards to prepare myself for what lies ahead.

New Year in Bangkok, Thailand

Happy new year everyone and hope you entered the new year on a clean slate, whatever that maybe be for you. Wishing you all your hearts desires and more.

The year 2019 is a big year for me, and by extension Stethoscope and Hanzi . It’s the year I finish medical school, graduate and leave this country I’ve called home for the past six years and return ‘home’ ; to South Africa. There is a lot of big changes, uncertainties and adulting decisions to be made ; which I’ll hopefully share with you here as the time comes. As well as reflecting on my time, my experiences and what I take away out of this beautifully complicated mess ; that is med school and living in China.

We got the 31st and 1st off as part of the national holidays, so I decided to ask for a few more days off to spend new year in Bangkok, Thailand. This is the first ‘proper’ break I’ve had since I started 4th year back in September 2017. So it was long overdue and well deserved.

This is a glimpse of what I got up to in pictures…img_2661

Final year ; am I working or am I studying

Am I working or am I still studying?

This is the question I have asked myself numerous times, but mostly at 2am walking back to my place after an 18 hour surgery shift. Or during anytime when I felt like i wasn’t learning any new medical knowledge or procedure, that I was cheap labour to a system that relied heavily on final year students to keep it afloat. And that maybe, this is how I learn ; this is how I gain clinical experience and this is the cost.

So far I have rotated in :

1. Endocrine and Metabolism

2. Oncology

3. Respiratory Medicine and Critical Care

4. Gastroenterology

5. Cardiology

6. Infections Disease

7. Paediatrics

8. Neurology

9. Emergency Medicine

10. Obstetrics & Gynaecology

11. Orthopaedic Surgery

12. General Surgery

13. ENT

14. Urology – current

I struggled to keep myself motivated as I went through different rotations, I have spent most of my time at the hospital than anywhere else this year. I have clocked more hours in surgery, scrubbed in, done a number of procedures and lost sleep doing so. And I am burnt out.

I wanted to do a dedicated post for each rotation, to keep track of my experiences and reflect on each department as I went by. But at the end of each day or week all I could do was catch on sleep and, then watch some TV.

I am trying to get back my life, or atleast strive to have balance. I need to have a life outside of Medicine, anything. I am falling out of love with Medicine and I do not want that.

Clerkship year

I’ve just come out of a gruesome semester, and without a break inbetween I’ve moved to a new district and hospital for my clerkship or student internship year.

Our clerkship is a year long intense clinical teaching phase, where all of our learning takes place on hospital ground. Its divided into two parts, Internal Medicine and Surgery. We all rotate through different departments within Medicine and Surgical specialities, including core rotations such as Obstetrics & Gynecology, Paediatrics, General Surgery, Cardiology, Respiratory Medicine & Neurology etc.

I’m starting off with Medicine and will do Surgical rotations in the second half of the year. I’ve just finished a week in Endocrine & Metabolism department, there wasn’t alot of clinical work to do. I mostly saw alot of type 2 Diabetes and Thyroid disease, the department was fairly relaxed. The next upcoming two weeks I’ll be in Oncology service.

4 Years of China-living and Med school

A few weeks back Facebook reminded me that four years ago, on an insanely humid night I landed at the Beijing international airport. It’s been four years of China living.

I have to say, I wouldn’t have imagined any of the things I’ve done and experienced over the past four years. There’s been good times, and alot of bad ones too. I think the bad ones outweigh the good. And I wouldn’t want to experience any of it again, I’m glad though, that I’m almost done. And that the MBBS is almost palpable.

We kicked started our fourth year three weeks back, and boy doesn’t time fly. The pace is fast and the content we have to cover this semester is alot. This is also our last semester of contact teaching, from next semester we start our clerkship. Which is solely based in a teaching hospital affiliated with our institution. All of our learning at that point happens on hospital ground, what we call bedside learning. Our clerkship is a whole year, and there are no holidays.

This semester I am taking Paediatrics, Ophthalmology, Infectious Diseases, Rehabilitation Medicine, ENT, Clinical skills, Obstetrics & Gynaecology, Neurology, Oral Medicine and Dermatology.

Bracing myself and hoping to get through these last two years of medical school. Please send me positive vibes. I’m simultaneously excited and nervous, but overall glad that I’m almost done with medical school.

Sawubona dokotela – a rural greeting

Sawubona dokotela..”

”Yebo, ninjani?..”

”Siyaphila…ninjani?..”

”Siyaphila nathi.”

This polite exchange happens every morning, when I walk from my moderately resourced park-home to the doctors lounge for the morning meeting.

I’m in Northern Kwa Zulu Natal, Ingwavuma, back for a rural Medicine elective. I’m on my summer break. The second semester went by well and finishing third year of medical school was such a relief.

I’m spending three weeks in this dusty town of Ingwavuma, half of my summer holidays. Five hours drive away from my home town. I am not complaining though, the work I get to do and witness here is exponentially amazing.

On South Africa, and its reality on health care. A majority of South Africans heavily rely on state funded healthcare, and most are from low-socio economic communities. Access to health care along with social class is interwined, and along with access to quality basic education. These factors make for a very burdened and diseased community.

Your work as a rural doctor goes over and beyond managing HIV regimes, doing TB work-ups and treating severe mal-nourished children. It also entails dealing with a heavy burden of social issues, from domestic abuse, sexual assault, herbal medication use to teenage pregnancy, all this made exponentially complex due a deeply cultural isiZulu speaking community.

I have learned and acquired skills and knowledge which I haven’t covered in my medical education. I’ve learned compassion, and better clinical judgement. To be part of a community, and sense of belonging. But, the most important skill I’ve learned over my time here, is how crucial counselling is and getting It in a familiar language. I can’t recall how many times patients thanked me or felt relieved and even immediately agreed to give consent to a procedure after I had explained and counselled them in IsiZulu. But the most alarming response I get is when they would tell me ” Thank you. We never get a dokotela explain things like this to us’. This was incredibly sad and shocking to me.

This is due to the fact that rural Medicine in South Africa is built and ran by foreign doctors, predominantly British medics. And because of that, there is a cultural and language barrier between the patients and doctor. Most would utilize the nursing staff to translate, which inturn makes one less staff available.

I have enjoyed my time here, I have witnessed a struggling health care system pull through with miracles, and I have also been frustrated and failed by it. From the lack of resources, to patients dying when we could have avoided it. I have been helpless, and devastated. But I have also been restored with faith and sense of pride with the work I got to witness and do.

Rural Medicine makes you feel alive. The work you do here is needed and there’s a huge sense of gratitude from the patients. It is very rewarding, and truly a great experience.

It’s suppose to be a Fu*king lifestyle

My revelation on working out and leading a healthy lifestyle, is that don’t do It for the wrong reasons. 

I’m glad to admit that I know better.

I had a slim physique and could eat as much as I wanted without ever having nothing but a flat belly. Young, good metabolism.

I turned 23 and my body didn’t react the way It had in all my 22 years, It also happens to be the year I moved to Asia. I didn’t pay much attention to it, I figured It was my body adjusting to my new environment and new Asian dietary I was not accustomed to. I would bounce back in no time. Year 2013.

I gradually gained the weight over the years but It wasn’t until last summer back in SA that I hated myself because how relatives & family members were treating my ‘new weight gain’. Three years later, my body is unveiling the consequences of me not taking care of It as I should. Year 2016.

It was a conversation starter, you know when you have a band aid on your forehead and its the first thing everyone notices about you and that’s the only thing they want to talk about? Yep, that was my weight and my protruding belly.
I got tired of making excuses, coming up with more witty replies as why I had gained so much weight and having to mask my dis satisfied face with a faux smile. ‘Food is delicious, okay. I’ve gained weight because I love food and It loves me back and It doesn’t question me on anything. I also don’t exercise. ‘ – that’s what I wanted to say, but I didn’t. Every single time. 

I got back from my six week summer holiday in SA, and decided that I didn’t want to be over weight anymore but more importantly I didn’t want to be subjected to family members and relatives opinion about my body. So, I decided to join the gym.

I signed up for whole years membership, that was brave. And scary. I didn’t know If I would go to gym for a whole year consistently but that’s what I did. If I’m being honest, mainly because a membership fee for a whole year was affordable than a six month fee, and I’m working with a student budget here..hello.
I mostly spent the first weeks on the trendmil running, running. I felt like I was going to throw up, collapse and die every single time. Every single time.

Without revealing my initial weight, according to my body mass index (BMI) I was over weight. I didn’t mind my weight though, I mostly despised my protruding belly. It was a conversation starter, It was the bandaid on my forehead – everyone noticed It and wanted to speak about it.
So I ran, and ran. I felt like I was going to throw up, collapse and die every single time. Every. Single.Time.

Three months in I had lost all the extra weight and my protruding-bandaid-on-the-forehead-belly had shrunk. I had made progress and I was ecstatic. My belly was no longer the conversation starter, anything but my body was the conversation starter. 

This is where It got tricky, and confusing. I had maintained a consistent workout plan and had witnesses results. Yay! But the Life hack is, this is meant to be a lifestyle. You have to workout every week, for the rest of your Life. You don’t get to stop, now that you’ve lost all the weight and have achieved your personal goals. It’s. A. Fu*king. Lifestyle.

Eating healthy, less carbohydrates specifically less processed carbohydrates. More fruits and vegetables and water. Less  refined fats and oil. More natural fats and oil. I did not follow this as much and frequent as I wanted to. My family also has a history of Hypertension, I know better on what I’m not suppose to be injecting into my body better than anyone. I also know better because I’m a Biochemistry major. I also know that cupcakes and voetkoeks and donuts are delicious. You see?

I had to realize that eating healthy combined with a consistent workout plan was the only way of changing the course of my health. The only way. I had to accept that I love food. It doesn’t ask me silly questions. It’s just delicious. I also had to accept and be honest with what I wanted more, which is a non-protruding-bandaid-on-the-forehead-belly. I’m kidding, which is a better healthier version of myself. 
I had to be honest with eating a donut, cupcake or voetkoeks every week. I love that sh*t. Who doesn’t? I had to accept that I was always going to eat them every single week, without fail. I also had to accept that I had to control how much I consume, and that I didn’t go over my weekly indulgence. And that I was okay with that.

Three years later. Seven months of a combined eating and workout plan I can finally say I did it. I didn’t start out for the right reasons, sings ‘non-protruding-bandaid-on-the-forehead-belly conversation starter’. But I did it, and during the whole process up until now, I realized that a better healthier version of me is what is most important to me. That is suppose to be a lifestyle. Every single week I have to show up, eat better and workout. For the rest of my Life.

India escapade

Spending about two weeks of my winter break travelling India, it has been such an amazing cultural experience for me. Overwhelming for most part of my time here, and filled with bizzare ways of doing things. It’s like any other place I’ve been, mainly because I’ve never been to India before- duh!

With the second largest population in the world, no doubt the streets and practically everywhere you go, it’s croweded and a little bit intimidating. I was however intrigued by the gender disproportion, there seem to be alot more men than women on average, everywhere you go here. And alot of places are segregated based on gender, from the subway coaches for women only – which you are fined a fee of about 5000 Rupees if you’re caugth in, to ques in the train station with counters specifically serving women only. I heard read that India has one of the most highest sexual assualt cases in the world, but seeing how the Indian government is ‘managing’ that was abit shocking for me. That was obviously not the only reason for the disproportion in women to men ratio, I read about female infaticide, which is the deliberate killing of newborn female children. Selectively abortion of female fetuses. I don’t how prevalent this kind of practice is India now, but I read that it was practiced there. There was actually a show that was gowing to play at the American center in New Delhi, showcasing and raising awarenss on female feticide/infanticide.

Of course these issues are hightened in a patriarchal society, and women generally don’t work, so men would be more visible during the day while the women tended to house duties. Alot of social issues stood out for me while in there, I saw an obscene amount of homeless people,children, especially in Delhi. This has always been the most difficult thing to do for me, blocking out the social and political circumstances of a country or place I’m visiting too. Colorism was/is still very apparent in India, I had already noticed how rife it was from the countless billboards in Delhi. How only light/fair-skinned Indians would be commercials and billboards. Even in the workforce, you would notice that frequently darker-skinned locals would work as cleaners, street vendors and auto-riskshaw drivers while the lighter-skinned counter parts would assume higher more established positions. I also witnessed an encounter of colorism live in Starbucks, it was really sad to watch and how deep discrimination goes into the mindset of people.

I’ve tried street food and luckily enough I haven’t gotten sick the famous ‘delhi belly’, the food has been great. I’ve eaten Indian food before but it’s different here, I’ve mostly stuck to eating vegetarian dishes. Everyday I eat something new and please don’t ask what it’s called, I can’t remember a thing. It’s very spicy though, that I can tell you!

I’ve met so many wonderful people here and all of them have invited me to their countries, I literally have a couch in almost the entire world where ever I want to travel to. This is also one of my highlights of travelling, meeting people from all over the world, I’d like to believe it’s people like me who benefit from globilization. I know alot of people have their disaagrements with it and how political leaders use it for self-serving interest. Enough about me, here are some of the snaps I took.

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Lotus Temple of the Ba’hai faith
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Lodhi garden
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The Taj Mahal – exquisite
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Gate way of India