Tuesday 31 August 2010

coconuts keep falling on my head...

Very quick, quite entertaining (but also quite sad) story from a days work in A&E, which complements the bananas on head story quite well. There was an energency paediatric head injury patient rushed into resus. I read the referral letter before i saw the patient so you can forgive my initial laughter at the situation. The referral letter read something along the lines of;
' please see this 3 year old girl with recent head injury from a 1.9kg coconut falling on her head from 9m'

When I later saw the patient she was actually in a very bad way with neurological signs and symptoms as a result of swelling and compression of the brain. The surgeons were takng over and drilling a hole in the skull to relieve the pressure. Because there are no CT or MRI scans, the diagnosis is completely clinical and in terms of prognosis, the only way to know is to watch and wait to see how she responds to the surgery.

Who knew coconuts could cause so much havoc.

Sunday 29 August 2010

night diving...

...was SO cool! I loved it! You can see much less...obviously. because its dark. But it was awesome to be deep in the water in the pitch black. We had torches to hunt stuff out, we saw shrimps, retractable worm, big crabs. It was fun! Although I stayed very close to my instructor the whole time! Getting out of the dive was not so fun - it was raining, again. and FREEZING!

Did another day of diving the next day - saw loads of sharks and eagle rays. visibility is about 20m which was pretty good, some of the coral on a few of the dives has been trashed by tsunami, but still loads to see. Its really nice not to have to wear a wet suit on the dives because the water is so warm. The dive guys are really cool.

On one of the other days we dived a WWII wreck which was amazing. Its a huge ship called the Tao maru, Japanese ship. There were loads of cool artefacts including a medical box with an oxygen mask, vials of drugs, packets of tablets in bottles in. There was also a big army tank on board and a motorbike and a phone. It was weird to swim in and out of!
Have finished all the diving im going to be doing in Gizo, which is a good job because i've managed to get an ear infection as a result of doing so much of it! Going to the hosp to get antibiotics was an interesting procedure - ive got drugs that are normally used for eye infections in the uk! But here, said drug is used for pretty much everything!

Seraghi village visit

Despite all these interesting posts of trips and activities, I have actually been doing work at the hospital, its just that for non-medical minds, the majority of my hospital stories are pretty boring!
Sooo I'll just carry on with stories of my other adventures...
Seraghi is a beautiful village in a really remote part of Gizo island. We made friends with some locals on our wonderings through Gizo market who live in Sergahi. The village was torn apart in 2007 by a tsunami (as were a lot of the pacific islands, and the 07 one is different to the boxing day tsunami of ...2004) but the family are now in the process of building a second house to use as a 'village homestay' for tourists etc to pay and come and stay for a night or several in their village and live their life for a couple of days. It's a really good way for them to generate extra income besides just selling fish. They have already had a few guests come to stay. The family is lovely and they are so genuine. I really felt so at home with them.
The sons of the family who are of similar age to us and who we get on with really well picked us up from gizo and we had a few stops along the way to look overboard at the Tao Maru ship wreck from WWII. We couldnt really see from the surface so I put on a snorkel and stuck my head over the side! ha!
Our next stop was at a set of very small islands that are all connected by strips of white sand. It was just like you'd imagine pacific islands to look. Stunning. We took lots of photos, climbed trees, collected shells.
We finally got to Seraghi and were greeted by loads of kids who were very excited to see us. The village looked like they'd had a professional landscaper in, its was incredible considering it was flattened 3 years previously. They had beautiful houses with displays along the small main road of shells and coconuts with various different plants and flowers carefully arranged. Meva (the mother) told us a pretty scary story of when the tsunami hit. It was really interesting to hear it from someone who experienced it first hand. We chatted a while with the family then headed back out with the boys to do some fishing...which was SUCH good fun! We caught loads, and its so much more exciting when each fish is crazy colours and you only have to wait 5 minutes before something bites! Ambrose said I was good at it anyway! haha! We then headed over to another island called Jarre for snorkelling - it was only on the way back to Gizo that we realised how close the island we were snorkelling pretty far off of was to a big crocodile hang out....brilliant! luckily we survived to tell the tale....
Meva had made us an amazing lunch whilst we'd been out and we sat down and had dinner with the family, it was so lovely! and there were loads of kids running around the place, such a nice atmosphere. We wanted to take loads of photos but unfortunately 3 out of 3 cameras were either broken or out of battery which was SO annoying! too many photos of the fishing!

Nusatupe night

Spent an amazing evening on Nusatupe Island on 24th Aug. We made friends with a guy working for 'World Fish' (ha!) and he lives on Nusatupe in a little shack with the only company being one other guy (who also works for world fish), several dogs and a whole ton of giant clam ponds! ha! the only other thing on the island is an airport landing strip that receives all the flights for people going to Gizo.
Anyway, Tim (World Fish man) picked us up in his boat and drive us over, we went snorkelling looking for turtles but it was abit too dark by the time we got in the water so we didnt see any. We had an AMAZING spag bol dinner and encountered a few incidents trying to gut and cook reef fish from Gizo market...World Fish man obvs came to the rescue with that one! It such a surreal lifestlye, there are more dogs on the island than people, and its so quiet and he lives right on the beach in the middle of the pacific ocean....
Getting back to gizo by boat in the pitch black very late at night was interesting, especially with alex being trusted to shine the light on the navigation posts.... we made it though!

funny story

So I was in outpatients in Gizo...one of only 2 medical students running the clinic... and a 16 year old girl came in with a classic history of migraines...so naturally I asked her if there were any exacerbating factors - her response was 'sometimes when bananas fall on my head, that makes it worse'.
I had to try very hard not to laugh. Only in the Solomons are bananas falling on ones head an exacerbating factor for migraines! love it.

Monday 23 August 2010

The Hash

Gizo is really quite small so any expats residing here all know each opther in one way or another, and every Weds they have whats called a 'Hash" which is basically where all the expats/tourists/volunteers meet up and go on a big run/walk (i was in the latter group!) around the island and then back to an agreed location - which is usually someones house and have food and drinks etc. its a really nice way to meet people doing loads of weird and wonderful things in the sol islands. We all went on Weds...we didnt realise quite how challenging the walk would be and so rocked up in our plkastic flip flops only to realise we had to climb up muddy mountains and random bits of jungle! ha! luckily i finished the walk with both flip flops still in tact!
We went back to a RAMSI police officers house this week, he's australian and when we walked into his house our eyes lit up for 2 reasons 1; he had a huge washing machine and tumble dryer and 2; we spied a massive BBQ with a load of meat on it : )
the food was amazing. meat has never tasted so good! We made sure to bond with the RAMSI so we could come back and use his washing machine...which we did on Saturday! : )

*RAMSI; Regional Assistance Mission to the Solomon Islands. Its like a second poilice force made up from aussie and NZ police who are over here to maintain stability and encoutrage better work ethic in the local police force...or something like that!

Tuesday 17 August 2010

Community clinic and A&E Gizo

First hospital day I went on whats called a GUNS clinic - no idea what it stands for! But it's a small group of nurses that go out to remote villages. This time we went on a little boat over very rough seas to a tiny village on Kolombangara island to do a school visit. Unfortunately the school was having exams so half the kids the clinic was aimed at werent tehre! but for the few that were we did head to toe examinations checking or any abnormalities with any kind of system basically! One of the kids had a booming heart murmur - but the reality is that although we referred him to hospital on the main island, there isnt actually anything they are likely to be able to do! If he goes to the capital - which is unlikely because of the distance, they have only one day of the week where an echo might be able to confimr the type of murmur...but there isnt any surgery that can be done for him now... We also checked that they had had their BCG vacc and gave them tetanus and polio vaccination.
After we'd seen all the kids there, we packed up and went over to one of the nurses houses to wait for the tropical rain to stop! Dodged some pretty huge spiders along the way and hoped not to see any crocs!

Spent today in A&E Gizo. What an experience that was! There was just me and one otehr med student running the place... my medicine/common sense is surprisingly good when it needs to be! I ended up prescribing drugs, most of the time which werent even available from the phamarcy - including basica antiobios. WISHED i'd brought my BNF. Luckily, the Oxford Handbook has a surprising amount of info in it! Saw lots of interesting cases, had to tell some pts to wait and come back another day when a doc was around becasue there was nothing i could confidently do to help them! I ended up using tyhe light on my mobile phone as a light for doing female speculum exams - because there is no light in A&E. Its SO basic! Theres just no equipment - there are barely any sterile gloves, the one sink doesnt always have running water, crazy. Learnt TONS though, esp dosages of drugs that were regularly being needed - the nurses came in SUPER handy for that info too!

xx

A&E adventures Honiara

I forgot to mention my last friday in Honiara was spent in the A&E dept. Surgery is quiet on Fridays, so wondered over to the ED. It was SUCH a good day, I learnt loads and wished i'd spent more time there! Started off clerking patients which is always fun when you are left to do it on you own in a foreign language! The gesturing really came into it's own! I was very much left to devise my own care and treatment plans for the patietnts i'd seen...which was a little scary but I enjoyed the responsibility...at the time I didn't realise what Gizo would involve...thats another story for my next post.

A&E in Honiara is actually quite a new building with air con (thank god!) and is kept relatively clean with alcohol hand gel in at least 2 of the dr consultation rooms. GASP! I spent some time writing discharge summaries, prescriptions ready for the doc to sign, and then more clerking and pt examinations in the afternoon. It was interesting to learn a bit about requesting ultrasound scans, xrays, bloods etc. There are only very few tests that can be done and if you dont request it before about 3pm then it basically doesnt get done until the next day because staff go home!! It also wont get done between teh hours of 12-1 becasue staff go on lunch. Very frustrating at times when patients begin to back up A LOT! Similar frustration at thelack of drugs...again - 10 times as bad in Gizo. I did an 8-4 day for the first time since being here probably! Definitely going to do more when I go back for the last few days in Honiara.

Sunday 15 August 2010

spiffing time at the birtish high commissioners

Hello from Gizo!
We arrived in the Western Province yesterday on a rickety little plane with no air conditioning - not pleasant! Although they did give us a very nice chocolate wafer biscuit. Ha! We got here in the pouring rain and soon realised that on a sunday taxis dont run. not a great start! we managed to contact our accommodation and they came and picked us up in their jeep with no working clutch which surprisingly got us all the way up the huge hill to phoebe's resthouse which is where we're staying!

Anyway, before I start raving about Gizo - we had a very eventful last few days in Honiara. On one of ourmany days at Honiara pool some of the girls bumped into the British High Comissioner of the Solomon Islands! Who knew they even had one! He was a very well spoken Cambridge graduate (of course!). Lovely young 'chappy', who has had the pleasure of meeting generations of medical students it seems! He invited us to use his house (which is more like a work of art) for showers, washing, food, guitar hero... We later got an invite to a cocktail party at the 'Residence of the British High Commissioner' (theres a very posh sign outside). We turned up and had to be buzzed through the huge securtiy gtes, it was a very posh affair, and we spent the evening mingling with other high commissioners of new zealand, people working for the world bank, people from various different ministries and political stuff! needless to say we felt very out of place in our slightly unclean, well travelled clothes! But a few champagne cocktails in the moos soon lightened up! We ended up on guitar hero until early hours of the morning! It was a very surreal night! And a nice change from our usual ventures to club extreme! (which we did later end up at on this same night...!)
We made some Fijian friends at extreme who were also keen to offer their house for showers and washing! It's a shame we're leaving honiara really just as we've made a load of new affluent contacts!

So, Gizo - Phoebe's Resthouse is a very sweet shack in the middle of a mini jungle type setting - perfect for mosquitoes as im beginning to find out! The view is stunning from the balcony. We met upwith some of the med students we first met in Honiara who moved to gizo a few weeks back which was nice.Theres also some others here who we are bonding with! There is a tv! GASP! and a shower with running water - although this is apparently very temperamental.

Internet and life generally is even more expensive here than in Honiara. Brilliant. But its much quieter and way more like what I would imagine the Solomon Islands to be. We are venturing to the hospital tomorrow.....

Tuesday 10 August 2010

checklist of important things

  • number of times I wish I'd bought my own hair straighteners; at least 7
  • number of days the water supply has been off at Kiwi house so far; 10
  • number of hangovers;...I wouldnt like to divulge this information
  • number of mosquito bites; 30-ish
  • number of arguements between me and Alex; surprisingly few! maybe...2. over very mundane things.
  • number of hours spent at Honiara Hotel pool; 100 odd
  • number of hours spent at the hospital; significantly less than the figure above
  • number of times i've had cheese and crackers for lunch; every day. i am not at all bitter about this

to be continued....

And so the fun begins...

I managed to get signed off today by the head of surgery here (who's seen me all of about 3 times) but he ticked excellent for all the boxes so I must have made a good impression : ) It's tempting to take the rest of the time off, but I have been learning a lot, so will probs last the rest of the 2 days in Honiara hospital before we move to placement in Gizo.
Went to a surgical referral clinic this morning which is basically potential surgical patients that have been referred from the island provinces with problems which may not be able to be treated in the province but need to be seen in honiara. I sat in and saw some very interesting cases to do with the thyroid and complications of this surgery, ltos of query pyelonephritis and kidney stones, was good practice for doing GI examinations and examining hernial orifices - which there were also lots of.
Weds pms on surgery are quiet so to avoid spending the afternoon doing nothing I'm going to sit in on a paediatric clinic (assuming the doctor lets me).

Other exciting news - the market has been restored with its pineapple supply : ) so I just bought a huge one!

xxx

hot bread kitchen pizza...hmmm

WHY I have only just discovered the title of this post I do not know. but on my wonderings around honiara today i made a standard visit to said kitchen and they had PIZZA!! and its amazing, and cheap. and makes for a much more exciting lunch than cheese and crackers (which, by the way, have become part of my staple diet!).

Placement in the surgical department has improved having stuck with it. Monday afternoon I admitted new patients which made me feel useful, it also led to some very interesting consultations with patients in quarter english, quarter pijin and half gesturing - which when you're trying to ask about breast lumps and bowel habits, can prove to be difficult. It's only when the first patient was laughing hysterically at me that I reliased how it might have looked! haha!
After admissions I scrubbed in for a psoas abscess drainage procedure and got to suture the drain in, the wound etc so I felt I'd had a productive day.

This is my third day in a row on the internet which has caused great excitement for me : ) As has washing my clothes.... IN A WASHING MACHINE!! Never have I been quite so thrilled to wash my clothes; whites were becoming greys, darks becoming white. And the smell...well. (joke) One of the guys that we've become good friends with lives in a very posh hotel apartment with a washer and tumble dryer. So Alex and I took all our washing round in bulk and spent the night putting on loads! We ended up there untill quite late and having consumed several bottles of red, we ended up in the hotel pool at ridiculous hours in the morning. Security weren't impressed! Oops!

The next day I wasn't feeling great....

Sunday 8 August 2010

Savo island

Hello again!

This weekend all the residents of Kiwi house (which is now a total of 7, including 2 new girls from cardiff uni) went to Savo island. Its a very small island which was supposedly only and hours boat ride from honiara....WRONG! it was an hour and 40 minutes on VERY rough waters in a tiny tiny boat not really designed for 7 passengers! it was very entertaining for the first half hour...but eventually the bumps, sea spray and scorching heat began to take their toll! we all wobbled off the boat at the end feeling quite abused by the elements! luckily we were greeted on the shore by the staff of the lodge we were staying in with coconuts with little flowers poked in the top - definitely not the type of service we have been used to in honiara! the lodge was situated right on the shore of a beautiful pebble beach. It had amazing snorkelling really close to the shore, we only realised afterwards that we had spent all afternoon snorkelling in shark infested waters! apparently they are only littlies though... I saw one roaming around the place whilst sat on the shore.
Saturday - I went on a little walk (much more manageable than the previous waterfall hike!) to nearby hot springs (savo has 2 active volcanoes), which i actually found fascinating! the locals apparently cook over the steam of the springs because its so hot.
In the afternoon we went swimming with dolphins which was AMAZING! i loved it, despite the numerous jelly fish stings which weren't so fun! The only down side to savo was the abundance of flies! absolutely everywhere.
The boat ride back was much less traumatic! and we spent the entire of sunday afternoon at the honiara hotel pool - where else!

In terms of other general news - we have found a resident 'dad's band' within the hospital compound - they were playing at the end of one of my shiftsthe other night so I went over and they had a full set of drums, a keyboard and 2 electric guitars with a whole crowd of people that eventually gathered to watch. it was really nice to shill with the locals! they askled if i could play anything, i had to say no, but jokingly offered to sing, and then REALLY wished I hadnt! ha! i managed to get out of it. they played requests - lots of bob marley!
Kiwi house is still standing, but the water supply becomes more and more temperamental as the days go by... I';ve taken to showering in the hospital operating theatres most days now!
This morning I have been to book flights to Gizo - a western province island where they have another small hospital which Alex and i will be working in for 2 weeks (in between diving and snorkelling!). So we're flying there on the 15th august and coming back to honiara on the 30th august for a last few days before oz!
Theres been a general election going on throughout the Solomon islands the past few days, there has been lots of speculation about whether any trouble is likely to kick off, but as of yet only a few ballot boxes have been burned... apparently any potential trouble will start when they announce who the prime minister is out of all the elected candidates for each region...luckily, by that time I will be in Gizo which strikes me as somewhere which has a less significant mob culture! There is a big police and army presence around at the moment though in case anything kicks off so I think it should be fine!
Spent last night in 'club xtreme' again last night....its becoming a regular occurence! but the music is just so good! shame about the expensive drinks though...but this problem has been solved on several occasions by befriending certain expats who throw their money around!

All in all, things are still all good, and we are loving the Solomons but REALLY looking foward to a change of scenery in Gizo.

xx

Monday 2 August 2010

some things never change...

So it turns out that surgery is just as much as a lads club as it is at home! Brilliant! Today was hard work.

xx

Sunday 1 August 2010

we're going hiking...

Sunday 1st Aug;
Well, I've made it to August! It feels like I've been here MUCH longer then 2 weeks, not because im having a bad time but life is just so slow moving!
Today we went on a waterfall hike - I did one of these last year and didnt love it, but for some reason I felt compelled to pay to do another one in the Sols! It was fun when we eventually got the the falls (which were beautiful!), but it was a looong walk - much longer than specified! We also came close to being ripped off by locals for 60 pounds (no pound sterling sign) to do with fees etc for crossing the village which we had already paid for. It made for a very awkward 10 mins trying to negotiate! We all went for a swim in the waterfall pool, the guide assured us there were no crocs...none of us were entirely convinced - it looked like a croc haven, but we still had a swim and have all subsequently caught colds, which may or may not be due to the water! (dont worry mum, I'm fine!)

Monday;
Today I've started in the surgery dept. Have already seen diabetic foot cases that would just never present so late stage in the UK. A 31 year old guy had a bilateral below knee amputation as a result of diabetes. He seemed surprisingly upbeat on the ward round - the doc said that he's got a prosthesis for one leg and will be given a wheelchair and that physio will be in to see him. (yes, they have a physio dept - and a speech therapist!). There were lots of infected wounds the opening of which on more than one occasion involved the flight of dead necrotic skin being flung in my direction...ergh. I've learnt to stand behind the doctor when he's unwrapping wounds.
I'm going back in this afternoon to help with admission of new patients which will be good pijin practice and general history taking practice!

lots of love xxxx

a very exciting day : )

So Friday (31st Jul) was an interesting one on labour ward! I delivered a third baby - completely by myself. I can assure you that this was not intentional! the senior midwife happened to leave me at a vital moment just as the little bubba was popping his head out. I was left with a student midwife who apparently knew less than me about delivering babies! Luckily, I had already done a couple of assissted deliveries and seen lots so roughly knew what I was doing - turns out there isn't a lot to it really! Baby and mum were both fine and neither too traumatised...I'm not sure the same could be said for me! Haha! Delivering babies was much less...magical than I had imagined! I got to fill in lots of birth certificates and sign them too which was cool, and defo not something we'd get to do at home.
Friday was my last day on labour ward and I'm very sad to leave them since despite all the hanging around doing quite mundane obs and examinations, waiting for babies to be born, I have learnt LOADS. I've probably learnt more in one week on the Sol Islands labour ward than I did on 4 weeks of obs and gynae placement during third year!

Friday night me and the other residents of kiwi house went out for dinner at the nearby hotel, had a few drinks at the bar and then went on to 'Club X-treme' !! It was interesting to say the least! Its a night club run out of a very posh hotel in Honiara (the capital). We met up with our beach friends for a few drinks in their VERY posh hotel appartment and then headed down there with them. There was a little incident with the bouncers since they didnt want to let one of our guys in who was wearing flip flops - apparently they arent allowed in the club - but unlike at home - instead of kicking up a fuss - the bouncer just swapped shoes with the guy! It was probably a had to be there monent but at the time it was hilarious! Our friend had to walk around with huge clumpy bouncer shoes on with shorts - not a very fashionable look!
We had such a good night - it was so nice to hear loud music that wasnt just blaring past our window out of buses really late at night. I had an interesting time trying to explain to a local that I wasn't for sale...he was trying to buy me off the guys, which he was amazed to find out didnt 'own' me! cheek! Women's rights here arent big. Got in at 4am and managed to wake up the whole of kiwi house...oops!

xxx