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.

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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

Reflections – medical school and mental health

 

This semester has gone by extremely fast for me, and at some point I felt like I wasn’t living anymore, that I was just going through space and time. We started our off-campus hospital clinical visits. I have been interested in learning the parallels between health-care and patient management in China and in South Africa. We visited two off-campus hospitals, a Tuberculosis specialist-hospital as well as a Neurology-specialist hospital, the Prof(s) were keen on teaching and seemed approacheable enough. But I didn’t like how in each clinical group we had about ten students on one bed. It didn’t feel right to the patient or was it conjusive for learning, it was  too crowded.

We also started our Clinical Medicine clinical skills class, which has been fantastic. I got to learn and harness my clinical examination skills along with my history taking skills. It gets easier for us to view the diseased human body in parts and Medicine in bits of pieces but when we started our clinical skills course we could finally view the body as a whole – using each system to paint a better picture of why we exam the body, to help us get clues to find a diagnosis.

I have been reflecting on the year 2015/16, it was an extremely hard year for me. Almost a year ago I was diagnosed with a mental condition and had to learn how to navigate Life with it. I didn’t really wanted to blog about it, at the time I felt it was too personal and it didn’t fit in with Stethoscope and Hanzi blog, but I feel more propelled now knowing how many students and people have mental health issues, according to National Alliance on Mental Illness 1 in 5 adults in the United States exhibit classical signs and symptoms of MH, including depression and or any other kind of mental health condition. It is so prevalent in society but still a poorly understood and ostracised. Mental illness (MH) in medical school and in society in general is still stigmatised, which makes it difficult for people suffering from it to seek and get help. I have been privileged enough to have a support structure and people who I could talk to when I was crashing down which most people don’t have.

I wanted to blog about it now because although I felt it didnt ‘fit in’ with the Stethoscope and Hanzi blog, it was something that was part of me, part of my journey in medical school, and so many medical students, junior doctors and people in general suffer from MH. I owed it to myself and to people who aren’t as privileged as me to have all these support structures, to share my part that hopefully it can help someone else.

I’m currently on my last week of exams, and then I go on vacation next week. I’m so excited about that, as usual I’ll be sure to keep you update with my adventures.

Blog keeping & Third year of Med School

Hello there!

I’ve been out of action for over five months now, I’m sure most of you thought I had abandoned Stethoscope and Hanzi, but the truth of the matter is, I have been going through a lot. I don’t know if I’m ready to blog about it, or if I’ll ever be.

Saying our goodbyes to Shunde

After living in the Shunde campus for two years, were we spent learning all of our basic medical science – we said our goodbyes, packed our bags and moved to another city, Guangzhou, where we will spend the remaining of our three years learning the clinical part of our program.

But before we left, we had our second annual Shunde Awards , remember those? This year it was bigger and better, I particularly loved how everyone in the participated because when I initially came up with them it was to celebrate everyone living in Shunde and not just the winners. Hoping the second years carry on the traditions and incorporate their own style to it.

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We also had a Shunde fun day event, which was fantastic, everyone came out with lots of spirit and enthusiasm. We were divided into color coded teams, a mixture of first and second years. We participated in half marathons, egg and spoon, relay and other sorts of physical games. The sun was out and it was a beautiful day in Shunde.

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The first years also threw us a farewell formal dinner party, with delicious food, music and heart-warming speeches. It really has felt like we were a family in Shunde, these past two years have shaped and prepared me for the following clinical years of my studies.

Summer break in rural Kwa Zulu Natal

Straight after relocating to my new campus, I packed my bags and took the next flight home. I was so eager to leave, the past academic year has been one of the most challenging year for me. Not necessarily the academics, but my well being was and is compromised.  I wanted to get away, see my parents, family and friends.

After a few weeks home, eating all my favorite South African delicacies, from billtong, rusks to maas, I drove five hours North of Kwa Zulu Natal to a small town called Ingwavuma. I was placed there on a rural medicine elective. Mosvold hospital, a 246 district hospital which serves a population of about 110 000 people, mostly isi-Zulu speakers with a substantial number of Swati people due to its close proximity to the Swaziland boarder. The hospital lead by an amazing medical manager, if I say so myself, along with a team of ten doctors. The hospital has six wards namely, Tuberculosis (TB), Maternity, Isolation, Paediactrics, Male and Female medical wards. The hospital also runs a TB, HIV and Eye clinic along with a substantial Therapy department including an Audiologist, Speech, Occupational therapist and Physiotherapist. It also has a Dentist.

During my research I found out that most foreign-qualified medical students, upon returning to South Africa struggle to adapt and keep up with how Medicine is set up in South Africa. This is due to a lot of factors, one because of the dire health-care system in SA, lack or insufficient clinical exposure of Medicine in Southern Africa by foreign-qualified graduates, a huge burden of HIV, TB, Trauma and socio-economic associated conditions which aren’t necessarily common in other parts of the world. I choose a rural hospital because I felt it was there were I could experience all of the realities facing South Africa today, but now that I think about it, even in a tertiary city- based hospital I would have encountered the same pathologies because  after all this is South Africa.

I spent four weeks of my holidays at Mosvold, and during that time I rotated in TB, Maternity, Paediatric and Male medical wards. I tailed along with the medical officer in charge of running the ward I was rotating in that week. One of the most astounding thing about my time there, was how prevalent HIV and TB was among the patients I saw. Our medical manager even said to us ”I can’t imagine medicine without HIV and TB”. I also spent my time at the Out-patient department (OPD), where I got to learn more about and see for myself the inequalities South Africa is still faced with, post 1994. A substantial number of the patients walked into the moderately resourced cubicle with chief complaints, at times, which were non- medical but social issues. In most cases there wasn’t anything we could do besides offer an ear and listen to their concerns, and if there was anything we could do – we’d refer the patient to the social worker. But with limited resources and NGO’s available, we would send the patients home without offering any valuable help. Working the OPD taught me valuable lessons as a clinician, about how your job description goes over and above being a health-care provider. And because of South Africa’s past, these are situations unique to my country and I wouldn’t have encountered them in China or if prevalent, but not to the same degree.

 

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Third year of med school

School re-opens today for a new academic year and I have mixed feelings about being back in China and starting my last leg of medical education. It feels so close towards the end, and yet still so far. Add that with living in a new big metropolitan city into to the mix. But overall I’m hoping for a smooth year, and even if I’m tested with difficult situations that I rise above them.

The past semester I had a managed to find a ‘balance’ between my studies, eating healthy & exercise. I’m unfortunately still struggling to attend lectures as diligently as I’d like to, especially morning lectures.

This semester we’re taking Foundations in Surgery, Traditional Chinese Medicine (TCM) I’m super excited about this course, it’s a service course offered to us studying Western Medicine to gain a glimpse of what TCM is all about, it doesn’t really go into much depth, Basic techniques in Nursing, Medical Statistics, Clinical Diagnostics, Medical Imaging, Laboratory Diagnostics, Pharmacology and Medical Functional Experimentology which is a weird course if I say so myself, common in Chinese medical schools.

I’m so relieved about being close towards the end, and I hope that this academic year will be more kinder to me and filled with overall happy moments. Here’s to being half way through and being a step closer to making the dream a reality.

Semester 4

It’s been three weeks since we kick started out forth and last semester in the Shunde campus. I think I’ve mentioned this before, that after the first two years of medical science training, we are to move campuses. Our final, clinical years will be based in the city campus.

Over the past year and half I’ve enjoyed living in Shunde, I particularly liked the slow paced life here and how our beautiful campus sits literally in the middle of nowhere. As I’ve spent my time here, learning basic medical science, somehow along the way I couldn’t help feel demotivated after a while. With the constant pile of theoretical workload we had to grasp with little to no clinical aspect, I eventually got bored.

Semester four has re-energized me with the topics we are currently looking at, I can’t begin to explain how excited I am that I actually enjoy learning ( which is new to me, by the way). This semester we’re taking Pathology, Patho-physiology, Medical Parasitology, Experimental Physiology, Med Psychology, Med Genetics and Immunology. My timetable is usually packed and I still struggle to wake up for my 8:30 am class. I enjoy independent study more, anyways. I like how the courses we are taking this semester have a strong emphasis of diseases and syndromes, everything we are learning relates to a clinical aspect which is fantastic and keeps me alert. We also have case study examples, which are a great way of relating and linking the medical science with practice of clinical medicine.

But what I’m just as equally excited about is how I’m taking better care of my well-being, by making sure that I eat healthy and allocating time to exercise. This is important to me that I keep a healthy balance, especially because I don’t want to ever go back to the space I was last semester.

Winter break in Siem Reap

We’ve been on winter break since last week Thursday, wrote Biochemistry as my last exam. I haven’t blogged much, feeling no remorse in not doing so either; I have told myself repeatedly that if I had nothing to share on Stethoscope & Hanzi, I shouldn’t feel bad.

This semester was really challenging for me, it was more fast paced than I anticipated. We had mid-term exams, which was/is new to us, we also had a lot of report writing which consumed most of time. Reflecting over the past semester and the thought that it’s over makes me relieved, and besides not feeling well for the most part, I actually learned more useful material this year, than in most of my first year of medical school. Dissection work in Regional Anatomy was demanding but it was bearable because I had a great team, even at times when I didn’t feel like pitching up for evening sessions. One of my biggest lessons though, is taking care of my well-being. Medical school cultivates and allows this culture of working too hard, with little care for one’s self, this starts earlier on and I’ve seen it right through to practicing Consultants, were their well-being is compromised because they have to do the work. I’m learning that my well-being is just as important as putting in hours or doing the work. Maria Phalime explains this well (for me) in her book about the culture in medical school & in the medical fraternity as a whole.


 

I’m in Siem Reap, Cambodia for a few nights. I’m loving it, the weather is fantastic ( there’s currently a snow-blizzard in China, and for the first time its snowing in the South). I’m not planning on making a long post, I’ve had a packed day of sight-seeing, that coupled with Siem Reap’s heat has me burnt out. I’ll let the pictures do the explaining..

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Night market , bargaining skills acquired from three years of living in China came in handy
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Freshly fruit shakes- I’ve had two, maybe three every single day, planning on trying all the flavors!

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Angkor Wat & Angkor Thom Temple

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Regional Anatomy

 
I arrived late, we were told to arrive early as all the proceedings of day was supposed to be done outside of our teaching hours. We all lined up in our respected groups outside, between the Anatomy and the Chemistry building, all in our white lab coats, with sun right in our faces. We were given yellow ribbons to tire onto our wrist as symbolic sign to give our respect to the dead after we had sworn an oath. To respect and honor the bodies, not to take any pictures of the cadaver and consumption to the public. That all work in the lab were to remain there.

It’s astonishing how we’re conditioned from the beginning in medical school to deal with death, subconsciously even if we are not aware of it. I hanged my bag outside the lab, after taking out my atlas, grabbed my gloves and stood there. As I entered the lab, five silver tanks stood boldly on each side of the lab.

We are divided into groups of four per limb, I’m paired with three female students. We will be together for the rest of this semester, for this course. We slide the top part of the tank into opposite sides, rolled the handle clock-wise and up came a body, raised up to us as we were struck by the heavy smell of phenol, in our nostrils and eyes. I stood there, I thought I wouldn’t be prepared for it but here I was.

 

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Campus and everything inbetween

Celebrated Halloween in the city this past weekend. It was crazy, went to a place called Perry’s which had moderately priced drinks, frequented by students. The vibe is fantastic, it was too full though but luckily the guys came early and secured a table for us. Halloween is fast becoming a big deal for locals and not just celebrated by expats anymore.

The semester is picking extremely fast, had to attend lectures the whole week since our school is being evaluated for International accreditation besides that nothing much has happened here in Shunde. Wrote my Medical Document retrieval exam and it went well (I think). I’m glad that I’m done, meaning we won’t have any evening lectures. I’m not going to lie, I despise evening anything school related. Just submitted a very long Biochemistry write up, and after all these years I still struggle with using Microsoft excel. I have to watch Youtube videos before I attempt to do any graph every single time, without fail.

After our Physiology lecture yesterday, I had some time to go take pictures around campus. I never really get enough time to practice my photography skills, been trying as much as I can to take raw shoots to get all the authentic textures and colors. What better way to practice than on campus, We have a beautiful campus by the way, situated in the middle of nowhere with greens everywhere coupled with living in South means we have our own little piece of heaven. It’s Autumn now, but it still feels like summer. Practically good weather all year round.

We start our Medical Microbiology block next week (YAY), I always liked Microbiology especially doing the streak-plate technique and arriving a week later to marvel at how your colony has grown, some even assume very poised pattern. I’m going to catch up on my American series now, it actually feels like a Friday already today considering the week I had, so planning on taking it easy tonight & cooking dinner. An aunty who has a garden on campus gave me some white-colored carrots, which she grows on campus. How cool is that?! How generous of the University management.

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Campus Library/图书馆
Campus Library/图书馆

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