Monika Kondratowicz

Medical Elective Report

July-August 2018, Krakow, Poland and Sydney, Australia

My compulsory Medical Elective Placement was split into two, very different, halves. The first was spent watching mostly surgical procedures in the Oncological Institute of Krakow, Poland; while the second was within the Obstetrics & Gynaecology Department of North Shore Hospital in Sydney, Australia. Though both of these countries have similar resources and medical treatment compared to the UK, I came away from both having seen very different attitudes towards healthcare professionals (Poland still has an old fashioned “paternalistic” style of medicine) and different ways of running Health Services.

Poland

I knew that the medical practice and technologies of the economically-growing Poland would be similar to those that I was familiar with in the UK, so my main reason for choosing this country as my first stop was to improve my language skills (I am the grand-daughter of wartime Polish immigrants so my grasp is basic). Indeed, over the four week placement I became more and more confident in my conversational abilities, and even gained quite a reasonable medical vocabulary too. Perhaps my one slip up over the placement was thinking that the Polish words for “large intestine” meant “grossly obese” for a solid week. On reading the surgical list each morning I couldn’t understand why the gastric surgeons had such a plethora of obese patients!

I was attached to oncological surgery, so each day was attached to theatres, and I was given free rein of each of the rooms, moving between different ones to observe the different sub-specialities. The day normally started at 6.45am, with the handover meeting (here, people talked very fast so I often had very little idea of what was going on), before getting changed for AM theatres.

Even though I did not expect to have much responsibility in the way of the operations in Poland, I assumed that I would be able to do what I was used to doing as an English medical student; namely, scrubbing in and maybe assisting a little. I was to discover, disappointingly, that Poland, being a very bureaucratic country, would not even let their own residents (our equivalent FY1 and FY2) scrub into theatre, and therefore there was absolutely no possibility of my doing so!

Watching the surgery itself was useful in some aspects: I was able to see lots of techniques and methods that I haven’t yet been exposed to in England. There was, for example, the removal of a fairly superficial but grotesque tumour from the chest of an elderly gentleman: the surgeons gave it a wide berth, and removed and area of skin around the size of an A5 notebook, pulling either side back together to close the hole. I have to say that the sheer elasticity of human flesh really impressed me, and once healed this particular gentleman won’t look particularly notable apart from the fact that his nipples will be very close together.

I think, ironically, the most useful thing that this elective placement gave me, was a conviction that I do not want to pursue a career in surgery. After a while I did become a little bored watching similar operations day after day, and so I managed to ask for a week with the Oncological Pathology Department (housed upstairs in the same building). Here I was able to watch pathologists marking and slicing surgical biopsies, technicians making slides, and also spent time being taught by the cytology team. I felt that my Cambridge education prepared me especially well for the latter, because I was already familiar with many of the cellular markers that were being stained for. This week was probably my favourite in the whole placement, and I feel that every medical student should see at least once what goes on behind the scenes in the pathology department, and gain an appreciation of all the processes that need to be done to get that final pathology report!

Australia

The medicine which I witnessed in Australia was pretty much identical to that seen in the UK: there was even a huge number of British doctors, or “Poms”. My reason for going to this country was mostly for personal pleasure: I had only once ever left Europe, and wanted to explore this vast country “Down Under!”

In the Obstetrics & Gynaecology department I had mostly an observant role, spending time with the consultants in clinics, residents in theatre, and midwives on labour ward. I also took histories from patients and had the opportunity to conduct a number of minor procedures myself (many pap smears and even the removal of a cervical polyp!).

Two of the main highlights were unexpected: the first was a four-hour-endometriosis operation: seemingly quite boring (especially after many weeks of theatre in Poland!) but the supervising surgeon (a professor) proved to be the most enthusiastic teacher of anatomy, and he narrated non-stop during the mammoth procedure, making sure that I, and the other students, learnt at least one new fact every ten seconds. The enthusiasm and “Raw Aussie Energy” of many of the doctors I met was something to be admired.

The second highlight of my placement came after spending a few days on the NICU Unit. I woke up early to attend a 7am morning meeting with a presentation about Neonatal Prematurity Outcomes. I ended up staying behind after the talk had ended, and discussed the study with the clinicians and scientists. This solidified to me how much I adore scientific research. My appetite has been whetted to be involved in the Medical Academic Community during my career.

Of course, it would be remiss of me to not give space to talk about just what an amazing time I had outside of the hospital too; Sydney is one of the world’s major cities, and as a self-proclaimed “foodie” I had, culinarily, the best four weeks of my entire life. Asian Fusion food and Australian brunches made up the bulk of my diet. I also had the opportunity to visit countless museums and art galleries (The Museum of NSW was my favourite), hiked in the Blue Mountains, attended a rugby game, paddled on Bondi Beach (the water was a bit too cold in the Australian Winter), spent a weekend break in Brisbane, and went diving on The Great Barrier Reef. I met medical students from many countries: from England, Canada, Germany, Switzerland, Australia to name a few, and I feel incredibly blessed to have connected with such incredible soon-to-be-medical-professionals and now to have friends scattered all over the world.

Monika Kondratowicz

Izzie Dugdale

Elective Bursary Report

I would like to start with a wholehearted thanks to the trustees of the Kidderminster Medical Society for their generous bursary for my elective earlier this year. Before planning my elective, my excitement had been tinged with anxiety about how I would make the most of such an opportunity, with the limited savings I had left after seven long years at university. To have some of that burden lifted was an incredibly special gift.

I spent my elective in Galle, Sri Lanka, on the South West of the island. I was placed in the Emergency Assessment Unit in Hemas Hospital, a small private hospital. Because it was a private facility, this influenced the demographic of the patients accessing the clinic, and although I did see some acute illnesses and emergencies (such as a traveller with dengue fever, several minor injuries following traffic accidents and a traveller with a facial injury from a surfing accident), I was surprised by how many subacute and minor complaints presented in Emergency Assessment Unit. It was the turn of the seasons when I was visiting so these presentations included asthma check ups, seasonal tonsillitis in young children and, perhaps most surprisingly, regular appointments for children's ear piercing! I was quite shocked by this at first until one of the nurses explained that the hospital is a very clean and controlled environment, so it actually makes a lot of sense to offer such a common practice as ear piercing in this environment, for a small fee. It was certainly a novel insight into how service provision can differ between countries or cultures, and between government and private health provision.

My day to day schedule consisted of attending emergency clinic from 7 am til 12 pm, after which sometimes teaching sessions were offered; if not I began to put on teaching sessions for the other elective students, as a lot of them were pre-med or very junior students. This was a great opportunity  for me to exercise some teaching skills as this isn't something I've had the opportunity to do previously. After clinic and/or teaching was over, the doctors would leave Hemas to attend ward rounds at the local government hospital, as doctors in Sri Lanka are expected to split their workload between private and government service. At this point we were allowed to enjoy our free time in beautiful Sri Lanka! I spent most evenings with friends from the hospital at the local beaches or in Galle itself, a beautiful fortress-town with much local and touristic charm to offer. At the weekends we travelled further afield, visiting some of Sri Lanka's infamous landmarks such as the ethereal hill country- oceans of tea plantations peeking out from among the mist; national parks home to herds of elephants in their hundreds; ancient cities and cultural hubs such as the colourful Kandy.

Before visiting Sri Lanka I had little knowledge of the place, other than guidebooks and anecdotes from friends of friends, all of whom had attested to what a beautiful country it was and how welcoming the local people were. Often people are quick to exaggerate the positives of a destination if they know you're set to visit, but I know now that Sri Lanka needs no overselling; I had the most fantastic time. It is a truly beautiful place with more to see than I ever could have fit in, even if I wasn't juggling my travels with a Monday to Friday placement. My time at Hemas offered a precious insight into the healthcare service of a totally different place, and also gave me some insight into the differences between private and government led healthcare. I would recommend Sri Lanka as an elective or travel destination without a second's hesitation.

Izzie Dugdale 

Sam Owen-Smith

Elective Bursary Report
 

My elective took the form of two placements in very different locations. The first in Mseleni Hospital, Kwazulu Natal, in rural South Africa and the second at the Royal Orthopaedic hospital in Birmingham in Orthopaedics and Anaesthetics.

South Africa

During my time in South Africa I was exposed to injuries and diseases I had never encountered before. The first patient I saw was an infant with Severe Acute Malnutrition (SAM). The paediatric consultant was keen for me to learn about the condition as she recognised that it was unlikely I would have seen it before. This teaching took the format of a grand round. This differed from any grand round I had experienced in the UK because all the doctors attended at the patients bedside and not in a lecture theatre. The infant in question demonstrated classic symptoms of SAM i.e. she had a sunken fontanelle, reduced hair growth, abnormal breathing and was listless.

Other patient interaction highlights included snake bites, which are quite common in the area.  A patient I spent the most time seeing had been bitten by a Cobra. Cobras cause ecchymosis in a skip lesion distribution. I was interested to learn that anti-venom is not used as commonly as perceived. This is due to a high risk of causing anaphylaxis and it also carries a high risk of serum sickness.

In additional there was a large amount of Psychiatric pathology  in Mseleni. Each day on the male ward round I would see multiple patients suffering from psychosis. Patients very often would refuse to take anti-psychotic medications when they returned back to their community. Staff at the hospital also informed me that many local remedies for illnesses also precipitated psychosis. These patients were treated with anti-psychotics exactly the same as we use back in the UK.

Whilst in Mseleni I assisted in hip replacement surgery for Mseleni joint disease. This is a disease that causes premature arthritis and is of unknown aetiology and affects people from the local area. All of these operations are performed under spinal anaesthetic. Interestingly a representative from the prosthesis company was present in theatre, similar to the UK, however they also brought the equipment for the operation and assisted in the procedure as a second scrub nurse.

There were many features of this experience which were very familiar to me. This included monthly Morbidity and Mortality meetings (M&M) which took a similar format to those we conduct in the UK. At first the idea of attending a M&M meeting shocked me, although on reflection I think this was my prejudiced view of a healthcare system that I wrongly assumed would be more primitive compared to the UK. Both here and in South Africa we practice evidence based medicine. We strive to learn from our mistakes and M&M meetings serve to facilitate this learning and hopefully improve patient care.
 

Royal Orthopaedic Hospital Birmingham

The second part of my elective was at the Royal Orthopaedic Hospital (ROH) in Birmingham as I was keen to experience surgery and anaesthetics. During my time with the ROH I learnt to do spinal anaesthetics as well as honing my cannulation and airway skills - all of which will serve me well in the future.

In terms of surgery I assisted in a variety of operations from knee replacements to laproscopic rotator cuff repairs. I improved my suturing skills and by the end of the placement I felt much more confident assisting in surgery.

Whilst at the Orthopaedic Hospital I met specialist trainees. One of the trainees volunteered at the West Midlands CARE Team.  This is charity operated in the West Midlands in which volunteer doctors, nurses and paramedics deliver enhanced care to seriously unwell or injured patients in the pre-hospital setting. I spent a day as an observer out with the charity. This was a fantastic experience that I would recommend to all students particularly those who have an interest in pre-hospital medicine.

Although my elective took a different route than originally planned, I had a fantastic time in both locations and experienced a wide variety of medicine in two very different health care settings. I was lucky enough to receive a bursary from the Kidderminster Medical Society when I joined medical school and I qualified this Summer and I am now working in Derriford Hospital, Plymouth, as a Royal Navy FY1 Doctor.

I must once again say a huge thank you to the society for the support I received. It makes trips and experiences like this possible and enhances students time at medical school. 

Kathryn Olsen
Graduate entry Bursary Report

I would like to start by saying thank you for awarding me the bursary. It has supported me in my first year of Graduate Entry Medicine at the University of Birmingham and is very much appreciated. I came to study medicine after working as a nurse, and had originally intended to work shifts on evenings and weekends to fund the course. However, with the support you have given me, I did not need to do this and so could concentrate fully on my studies.

Last year was incredibly intense. There was so much new information that I had to learn, including subjects that I had not covered before when I studied nursing. I really enjoyed learning all the new subjects and grew in confidence as the year went by. I also learnt how to manage my time effectively, which was essential last year. I am pleased to say that I passed all the exams for the first year and am now in year three of the undergraduate degree. I am now out in the hospital talking to patients and practicing my skills. I have been really enjoying being out in the hospital as I am able to put the theory from last year into context.

Over the summer break, I undertook some work experience with the liver research unit. This was extremely interesting, as I got to see what happens in the labs and how the research is translated into practice. The bursary I received meant that I was able to undertake this research experience over the summer, as I did not need to spend the time working instead.

Kathryn Olsen