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Cherish the Ideal

As a South African youth, as a woman of colour, as someone who was born into a country which disregarded my rights to dignity, equality and basic freedoms, I pay tribute to one of the many Freedom Fighters Nelson Rolihlahla Mandela, uTata Madiba.

I am too emotional to give a more sufficient tribute, but this: Siyabulela.

Without the sacrifices made by uTata Madiba and countless others, I can not imagine what would have become of my dreams…what would have become of me.

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Taxi Tales

It takes me about two hours to get to the hospital every morning.

I’m slowly becoming more and more comfortable with the public transport in this province, and although I never fully let my guard down, I think I’ve lost an element of the paranoia I had before that at any time I might get jumped and mugged. (I carry my otoscopy/opthalmoscopy kit, my stethoscope, my tablet and my phone everyday, along with enough cash for the four taxis I use. Let’s not even get started on how depressed I’d be if someone stole my lunch!)

So, since the drives are so long and I’m up at four every morning, I’ve taken to taking short naps en route to work. I never fall deep enough asleep that I’d be too out of it to notice my stop in time to yell “SHORT LEFT!” to the driver, so it was while I was in a state of mildly depressed consciousness that I heard cries of shock and outrage from my fellow taxi-takers. My eyes snapped open just in time to witness another taxi swerve out of our lane on the freeway without any kind of indication and ram into the side of a small car’s trailer. The car, in an attempt to avoid a more serious accident, turned sharply left–and into a concrete barricade.

There was a cloud of pale brown dust and debris as the trailer splintered and shattered. The car rebounded into our lane, but we’d already driven on so that the wreckage was behind us.

Every neck was craned in the direction of the accident, so intent on the horror that it was a surprise to hear someone else cry out an expletive.

“He’s running! That taxi driver isn’t even going to stop!”

We all whipped our heads back in the direction of the pale yellow taxi that was speeding down the freeway.

This, friends, is one of the reasons I hate taking taxis. Your life is in the hands of a total stranger who may or may not be completely sober, safe or sane. Maybe he fell asleep for a moment or maybe he was just being a daredevil. Maybe he was actually disturbed.

Maybe he’s carrying all his passengers away to a slaughterhouse.

Maybe not.

We’ll never know.

Not that any of the other cars stopped to help out, though.

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Under Construction

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Please forgive the lack of posting in the last 6 months. In the interest of patient and institutional confidentiality (and my own butt-saving) I’ve been re-evaluating the way I blog about my medical school experience.

Rest assured, the posts are ready and waiting.

Welcome to all the new subscribers!

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Health & Disease in Communities

Health & Disease in Communities

Ah, the fun we have…

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August 7, 2013 · 11:22 am

Every Study Cliché You’ve Ever Heard

When we were in first year, we had a module called Personal and Professional Development, PPD for short. Many of us detested this module–it seemed like a waste of our first semester, primarily regurgitating the things we’d learnt in High School during Life Orientation about Stress Relief and Conflict Management and Effective Communication. The only apparent difference was that the slides were wordier and the content was examinable.

PPD has since been the butt of many jokes about first year, particularly the Foundation Phase semester.

During one particularly dull week of PPD lectures–the tedium broken only by the fact that we did all first semester modules simultaneously and thus were adequately mentally challenged–we received a few well-prepared, if slightly redundant, lectures about study methods.

If the first words that pop into your mind at the mention of the phrase ‘study methods’ are mind and map or time and management, you’ve pretty much got the depth and scope of the lectures.

I left those classes laughing with some friends about the irony of being forced to attend such pointless lectures when our time could be more efficiently spent actually studying, and didn’t give it any more conscious thought until a few years later.

Fourteen theoretical and ten practical (clinical rotations included) modules later, and I can no longer scoff at the idea of being given a lecture on methods of effective studying.

Here are the Top 10 study cliché’s every student knows, and how I personally rate them based on my few years as a medical student:

    1. Get Enough Sleep
    Perhaps the most solid–and most impractical–advice ever given to medical students is to sleep. We’re told to get at least eight hours of sleep a day, because sleep experts and neurologists and psychologists all say that sleep is vital for encoding new memories. During a good night’s sleep, your brain supposedly organizes and categorizes the day’s information so that it is more easily accessible in the short and long term. Good sleeping habits have also been shown to reduce anxiety and usually lead to better test scores. Sounds great, right! People take all sorts of stimulants and supplements to get the same results, so who would say no to something as simple as sleep? Why aren’t all the medical students racing to their beds by 10pm each night?
    Well, like I said, that advice is (largely) impractical. Most people you speak to would agree that the primary problem with medical school, especially in the theory years, is the sheer volume of work one is expected to stuff into one’s brain each block. During modules like Haematology where the workload is conspicuously decreased and the need for understanding over regurgitation is increased, eight hours of sleep nightly makes sense. During modules like Musculo or Neuro, where the concepts are endless, the pathophysiologies lengthy and complex and the time available limited, one can barely get away with six hours a night in the attempt to master most of the material in time for the assessment.
    And, speaking of assessments, the funniest thing I heard in first year was that students should actually sleep earlier than usual for an entire week leading to a big test, to facilitate retention and avoid insomnia on the last night. Which is all great, if we ignore the fact that there is usually so much work to cover that one feels they’d rather cover it all during that last stretch and lose some sleep, than cover most of it in exchange for sleep. I’m not defending this mentality (I know it makes no sense long term) but I’m just saying that that’s the way it is.
    It’s a jungle out here, and many would sacrifice their health and sanity to avoid having to spend anything more than the six allocated years on this campus.
    But, all excuses aside, the sleep thing works. Whenever I sleep well–usually this is during call-free clinical rotations where you spend all morning working at the hospital, and all afternoon studying your eyes off–I find that I’m not only sharper and more permeable to new information, but that I’m also generally more confident. I can think my way through questions I don’t have immediate answers to, I can absorb key concepts in lectures that would usually put me in a coma, I can get more done a day because I’m more energetic and optimistic.
    Because I love sleep anyway, I usually get enough during those first couple of weeks of a block. But by the time assessment week rolls by, I’m guilty of cutting back by hours in the crunch to get all my work in my head. Maybe it’s poor time management. Maybe it’s really just a matter of impracticality.
    Whatever the reasons, I cannot deny that this piece of advice definitely has its merits, even if it’s difficult to put into practice.
    Rating: 4/5

    2. Pre-read Before Lectures:
    Ah, the good ‘ol prepare for your classes tip. Yes, how many times have we heard that repetition is king, and that preparing for lectures, even via a cursory glance through the slide-shows makes you more alert, increases retention of key points, and enhances the overall learning experience?
    When I was in first year, especially during the Pharmacology lectures of second semester, this study device saved my life. There are just some things that aren’t interesting, no matter how hard you try to convince yourself otherwise. Some stuff just doesn’t stick, and since I have such poor memorization skills, repetition was the only way to make them stick.
    I’ll admit that I haven’t used this study device as often as I should, considering the wonders it brings about when I do. Mostly it’s because lecturers don’t load their notes until after their classes, although that is a weak excuse at best seeing as I live in Res, surrounded by seniors who have last year’s notes. Sometimes it’s because there are so many lectures crammed into a day (hello, Infections and Clinical Immunology!) that prereading would cut into what little leisure time I manage to schedule after revising.
    But this overhyped study method is GOLD. Pure gold. And I highly recommend it, because you don’t necessarily have to spend hours prereading in order for it to be effective.
    Rating: 5/5

    3. Attend Lectures
    Lectures are scheduled for a reason, they say. Lectures are a great study aid because attending them means you’ve gone through the work at least once, they insist. Lectures incorporate learning with at least two sensory organs, your eyes and your ears, they point out. Plus, for the first two years of medical school, lectures are compulsary. So there’s that.
    I attend about 99% of my lectures where possible, mainly because I like to hear first hand what’s important so that I can tailor my studying accordingly. Not the best motivation, but there you have it. But I can’t deny that all of the above is absolutely true. If you’ve attended the lecture, you’ve already been exposed to the work, even if the lecturer wasn’t stellar or engaging. Sure, you can watch the podcasts at twice the speed and cut your academic days in half, but podcasts don’t have facial expressions, emphasis can be lost and if you have a question or don’t understand something, you’re going to have to go through so much more trouble to get answers.
    Sure, some classes are absolutely pointless. Some lecturers just stand there and read the slides even though they are aware that we are fully capable of reading by ourselves, thank you very much. Some lecturers literally have one relevant slide nestled into an hour and a half of stories and history and illustrations. That can easily come across as a waste of time. In fact, I think that it is. But these lectures are in the minority, and eight times out of ten, attending class is worthwhile.
    I just completed my most mind numbingly boring theory block. I mean, I know it was probably the most important block we’ll ever do given the context of the South African health system–HIV, people! TB, people!–but I struggled to get past the fact that the content was as lackluster as its presenters. And I’m not someone who gets bored easily. Anyway, the only reason I managed to pass this module was because I attended classes. Had I been faced with the task of approaching the content for the first time in my room, alone, I would surely have given it up as a bad job. For lazy people like me, class is a blessing.
    Rating: 4/5

    4. Attend Clinical Tutorials
    Register taken or not, tutorials during clinical modules are an absolute must. After years of cramming and listing and cramming some more, clinical tutorials put everything in your head into nicely organized approaches that you can use in practical settings. Instead of simply giving facts about diseases like lecturers do, tutors often present you with clinical scenarios that force you to think less like a student and more like a doctor. While I can understand how some people may find independent study more efficient than the lectures in our theory blocks, when it comes to clinical rotations I’ll never understand why people bunk these things.
    Rating: 5/5

    5. Revise New Work On The Same Day
    Did you know that your ability to learn something new drops significantly after twenty-four hours? (I know, I myself am surprised those study method graphs actually contained information so useful!)
    The cliché usually goes something like this: for every hour lecture, you should spend at least thirty minutes immediately (or as soon as possible) afterwards, cementing the key concepts. This can be done in many different ways. You can read through the notes again, this time more thoroughly than if you’d preread, with more time spent on topics that were emphasized during class. You can watch the podcasts, if they’re available, and give yourself a short quizz after each one to make sure you’ve actually retained something. You can summarize the slideshows into note form for later exam studying. You can draw mind-maps (more on this juicy method later!) or make pneumonics or simply discuss the lecture with a study buddy. The options are endless, and it doesn’t have to be a tedious review session where you’re fighting to keep your eyes open.
    Rating: 5/5

Wow, this post is getting a little lengthy. I’ll post Part 2 separately, with study cliché’s 6-10 and why I think they’re worth more than an eyeroll.

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Yes, Ma’am.

During my Paediatrics rotation, I had the misfortune of being part of a firm that had perhaps the worst Registrar I’ve ever met.

He was cold to patients, rude to the nursing staff and completely ignored the students. I only was in his firm for a week, and I was alone because my clinical partners were doing a different subrotation, and we weren’t an even number ever since we lost our fourth member earlier this year. One of my group members–the one who was technically partnerless–had complained that she was always being forced to work alone, so I’d volunteered to take her place during Paediatrics because I felt it would be a welcome challenge, not having someone else to cover for me in ward rounds or share wordwork with. Being alone scared me, but I felt it was time.

Having swopped subrotations with my groupmembers, I was warned that the Register was a ‘tough nut to crack’, that he barely taught and that I’d have to be persistent if I wanted any kind of attention.

Steeled for the worst, I entered the firm on Monday. The Consultant was a dream, so patient and yet so persistant, challenging me and the student interns to think like doctors. I left that day feeling inspired and motivated.

On Tuesday, a second Registrar joined the team and we rounded on our patients. The Consultant was absent, so the first Registrar was technically in charge. He seemed pressed for time, ignoring our requests that he sign off on the changes we’d made to our patients’ feeds, unwilling to authorize that the weekly bloods be done on the patients who routinely had them drawn. He dismissed a nurse’s objections when he told a mother that he would discharge her baby who had been hospitalized for weeks and had recovered marginally, but was still experiencing loose stools, not tolerating oral feeds well and had failed to catch-up weight. I had to go to a long procession of Tutorials immediately after rounds, so I didn’t know what the final outcome would be when I left the wards.

On Wednesday, my last day in the firm (due to the public holiday on the friday pushing our test and OSCEs up to Thursday) we had a lightening-paced round. I had no idea what was going on to be honest, until we arrived in the room of the patient who had supposedly been discharged.

She and her baby were still there.

“Mama, what are you still doing here? You were supposed to leave yesterday,” he asked with a touch of impatience, paging through her nursing progress and pulling out the discharge form that he’d filled in.

“The other doctor told me to stay, she said she wanted to wait until my baby was better.”

The Registrars locked eyes, but the second Reg held her ground.

“I didn’t feel comfortable discharging her. I’ll take responsibility for her if you’d rather not.”

“I didn’t discharge her because I didn’t want to take responsibility. I discharged her because I don’t think the baby’s going to be getting any better here than at home. They’ve been here for weeks.”

“Then let’s continue management and investigate other causes. Maybe it isn’t *working diagnosis*.”

“Of course it’s *working diagnosis*,” the first Registrar snapped. Then, remembering he had an audience, he turned to the mother and said, in a low and persuasive voice, “Mama, surely you want to go home? I’m doing you a favour here. The sooner we get you out, the sooner you and baby can get home.”

I was so shocked by this exchange–really? That’s his reasoning?–that I hadn’t noticed that the mother had put her baby down and was now standing with her arms folded tightly across her chest.

“Doctor,” she began, speaking in informal Afrikaans so that I was able to understand, “I’m not leaving here until my baby is well. I’m not leaving here until the treatment works. I’m not leaving here until his tummy stops running. I’m not leaving here until he gets big again. I don’t care that you think we’re wasting space, my baby is still sick and if the nurses and the other doctor think I should stay, I’m staying. I don’t care about home. I care about my baby.”

At this point, I had to use all my willpower to suppress the urge to applaud her.

The doctor stood, thunderstruck, and then mumbled something about resources and overreactions before shooing us out of the room to continue rounds.

But my mind remained with the brave, young, uneducated mom who hadn’t let the tall, learned doctor bully or swindle her into doing what her instinct told her wasn’t best for her child. Parents rarely stand up to doctors in our hospital. After all, what would they say? They trust us, the healthcare workers and students, to make the best decisions regarding their children’s health and often feel afraid to speak up when they feel something isn’t right.

I had a patient the previous week who’d been in hospital for weeks, and yet neither she nor her parents knew what exactly was going on. They’d asked, of course, but the reply, “That’s what we’re trying to find out” had been all they’d received. And, feeling the doctors would speak when they had answered, they hadn’t pushed further since. Not because they didn’t care, but because they felt intimidated by these clever stethoscope wielding minigods and felt they wouldn’t be able to exert any real pressure or influence on the process.

If they were private patients, or educated folk, they would have no doubt been kept in the loop.

But because they were ‘regular folk’–a teacher and a domestic worker–the doctors had decided informing them wasn’t a priority, since they assumed they wouldn’t understand regardless,

I hate this attitude. I hate that paediatric patients from lower social statuses have their only advocates disregarded and end up being run through the system simply because some lazy doctor can.

I applaud doctors who will take the time to sit with patients and their families, to explain what’s going on even if they don’t have all the answers yet. Who treat everyone with the respect that is due them, regardless of educational background.

And I applaud the woman who kept her ears and eyes open, spotted the flaw in the system and then, more importantly, opened her mouth.

Yes, ma’am. Yes, ma’am.

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She’s Coming

You’re not ready. You think you are, but you’re not. It’s okay. You’ll most likely recover, but you’ll never be the same.

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February 3, 2013 · 3:32 pm