I always know when I’ve had a big week, because my first thoughts are “Wow, those seven days went by incredibly quickly”; then when I really reflect on it I realise that the week before seems an absolutely age ago. As is the case with my first week out here in the Philippines.
I guess it is a result of having such a good time, where I have fully enjoyed pretty much every single minute, whilst at the same time having had so many completely new experiences that my mind just cannot quite process that it has all happened in such a short space of time.
After the excitement of the first two days it was down to business on the Tuesday, with an 8am start in the office of Internal Medicine. I was instantly made to feel very welcome by the team members, all of whom seem to have a much better level of English than I had anticipated (doubtless there will be members of the Work the World staff having kittens at this statement – sorry, yes I’m sure that is covered in the pre-departure call, but I am male: I can barely be expected to listen, let alone actually process information). It turns out that their entire medical education is taught in English and is what they use in medical records and presentations. All of which is very reassuring to a sweaty jet-lagged Brit on his first morning.
I started off timetabled to be on ER, but it wasn’t long before a doctor from one of the wards came and asked me if I would like to join her on an ambulance transfer across the city to another hospital, in order to get a CT scan done for an unstable patient. As I climbed into the ambulance I saw the patient in the back being ventilated by a concerned-looking family member. As we got to the hospital and I was opening the doors, the patient went into cardiac arrest. There was a brief moment when I mentally took a step to the back of the room, as the medical student in me tried to get out of the way of the on-rushing crash team. But this time there was no on-rushing crash team, and the doctor in me realised I needed to actually do...stuff...Uncertain as to what this stuff was out here I asked the other doctor, who was already on the chest compressions. I already had a feeling there wasn’t going to be any sort of reassuringly-beepy machine we could hook up and this was confirmed – out here they go straight for the adrenaline.
Confusingly, we then started to drive away from the hospital we had just driven to. It turns out that they didn’t have an Emergency Room so it was back to the one we’d just left, as the drama unfolded in the ambulance. When we got back the patient was attached to a heart monitor, as I was struck by the surreal realisation that I was actually the only person tall enough to administer CPR without the need of a box to stand on. It’s strange how the mind wanders in those sort of situations. Thankfully, and much to my surprise, we managed to get a heartbeat back after about 5 minutes and numerous doses of adrenaline.
Three of my patients needed admitting there and then, two with pneumonia, and a third with suspected ectopic pregnancy.
Whilst all this had been going on, the ER was beginning to fill up quite considerably. I later learnt that rumours had begun circulating that I was “toxic”, ie that I attracted trouble (some of the doctors are well known for being toxic and people hate being on the night-shift with them, because they inevitably end up getting very little sleep). They decided to ship me out of the ER and back into an ambulance again, this time with a “stable” patient, a lady who also needed a CT head, but at least was conscious. As we drove across town for a second time I was holding my breath, desperately hoping that she wasn’t about to hold hers...But this time it thankfully all went according to plan...
Back at the house that evening we had our first language lesson. The Philippines has English as its official language, but there are a huge number of different indigenous languages spoken, and the one best understood is Hiligaynon, so this was the basis for our tuition. I don’t think Mishie and Nelli could have anticipated quite what sort of phrases we were going to be asking them to translate; they did a very good of getting the basics down and then translated a few body parts for good measure, but very soon we were throwing the full S.O.C.R.A.T.E.S. at them, along with the Bristol Stool Chart definitions, including my favourite: Number 4 – slippery like a snake. OK so the latter isn’t entirely true, but I hope you’ll forgive me a bit of dramatic license; “When did you last open your bowels?” and “Have you been taking your TB medication?” didn’t have quite the same impact.
On Wednesday I was on the Outpatients Department. It is explained to me on the way over that people get appointments based on a ticketing system, which is given out on a first-come-first-served from 5am every morning. Why aren’t they given appointments by post? “Because there isn’t any postal service and most people don’t actually have addresses, even if there was”, would have been the answer, if the doctor hadn’t – entirely reasonably - completely failed to understand what on earth I was going on about. When we got to the OPD, there was a crowd stacked several people deep which we had to fight through in order to reach the doctor’s office.
Thanks to the efforts of the Work the World staff I had now become a dab hand at running a medical consultation so the patients could actually understand me. What I hadn’t prepared for was what would happen when they started answering my questions. I didn’t even know what “yes” and “no” were, so most of the consultations went the same way – I would ask how they were in Hiligaynon. They would answer me. I would stare blankly at them for a few moments. I would then ask them if they had any pain. They would stare blankly back at me. I would then ask if they had any fever. Cue an awkward Filipino smile and a desperate look towards the nurse who would inevitably drop what she was doing and come over to translate for us. I never realised the OPD was going to throw up so many interesting cases. Three of my patients needed admitting there and then, two with pneumonia, and a third with suspected ectopic pregnancy. I shudder to think how they had been able to sit there waiting for so many hours.
It was a good day for bonding with the other doctors in the OPD though, and afterwards we went out for a meal at a lovely beachside restaurant, the kind where you pick your seafood as it swims around in a tank. I wasn’t quite sure I was in the right frame of mind for this, so I deferred my selection to my fellow diners. This had the potential to have been a bit of an error, and indeed it proved to be as I was brought out a number of local “delicacies” including a blood and intestines soup, followed by a dish made from fat and pig’s liver, called Sisig (pronounced Seasick and looking unerringly similar). Both actually didn’t taste too bad at all, but I resolved in future never to ask what a dish is before eating it; I know I’m too polite to actually turn something down, and these dishes taste so much better when their contents are a mystery.
I can’t believe I have rambled on for quite this long and still only reached Thursday. I will have to rush over the rest of the week...On Thursday I saw my first patient with tetanus and an intubation without sedation, which was incredibly traumatising - for me let alone the family of the patient, and possibly the patient himself (although I’m not sure how much a person with a GCS of 5 will be aware of?). Sadly this happens pretty much every day somewhere in the hospital, as they can’t afford for sedation to be used outside of the surgical setting.
In the evening it was the Work the World Philippines inaugural rooftop barbeque. At about 7pm we stepped out of the house into a gorgeous rooftop scene, beautifully lit by the light of about thirty candles in paper bags. Gerry served us up a delicious spread, including some of the largest prawns and mussels I have ever seen, and a lovely cooling breeze swept across us as we ate and chatted. Every time the breeze changed direction yet another paper bag would catch alight, and somehow the sight of June scurrying furiously across to stamp out the fires only grew funnier and funnier as the evening wore on.
OK, this has actually turned into an essay, and one which I’m pretty sure nobody will still be reading. But if you are, then I’m sure you get the general idea – essentially this week has been barely credible from start to finish. I have met some lovely people, seen some crazy things, and already got more involved than I thought I would do before I started. And I’ve only been here for seven days! I can’t wait to see what the next one has in store.
Rob is a 5th year medical student from Barts & The London, Queen Mary's School of Medicine & Dentistry