First day of work! Everyone was up bright and early, at 6:30 am, because we were all super-stoked to be diving into our placements. We looked pretty sharp, if I do say so myself. Except that we were maybe slightly less impressive after walking about 30 minutes to the BUP office, with the majority of us in heels, trudging through gravel and dirt. We’re smart kids.
As soon as we reached the office, those of us assigned to Princess Marina Hospital (PMH) turned right back around the way we came, since we had passed the hospital on our way to the office. The hospital was much bigger than I expected, with probably more than 15 buildings spread out across extensive grounds. Most of the buildings, especially the wards, are only one story, which makes it very confusing to navigate. Also, covered walkways connect the buildings, so patients actually get to see the sun and smell fresh air as they get transported from place to place. Kind of neat.
Met up with Dr. Shiang-Ju Kung, the paediatrician (that’s how they spell it here) + general medicine + asthma/allergy specialist that I’ll be working with here (yeah, she’s got three specialties… she’s kind of a genius). First, Kat and I went with her to the office Kat will be working in next to the A & E (Accident and Emergency, not the TV channel) ward. Note to those of you who know me as Kat: there is another person on this trip who goes by “Kat,” I’m not just referring to myself in the third person. Ran into a few glitches loading the software that Kat will be using for her research project, which she unfortunately had to go back to the BUP office to resolve.
Then Dr. Kung and I went to clinic. Twice a week, on Tuesday mornings (900 – 1300, theoretically) and Wednesday afternoons (1100-1600, again, theoretically), Dr. Kung runs an allergy/asthma out-patient clinic out of PMH. I already thought she was brilliant, but now I have even more respect for her: she runs the clinic almost entirely herself, scheduling her own appointments, keeping her own patient charts, she carries a separate phone just for patients and lugs her lung function testing equipment (including computer) back and forth with her every day, and somehow still manages to have a balloon and sticker for every patient and remember each of their names and histories! She also spends more time with her patients than I may have ever spent with a doctor in all of my lifetime visits to doctors combined. OK, that may be exaggerating, but seriously, new patients get a full hour, and follow-up visits 30 minutes. She conducts a thorough history on each patient, and with one new patient who had been experiencing problems for several years, she spent 45 minutes just getting the child’s history from the parents, then did a full 17-prick skin allergen test, plus physical exam. In all, it ended up taking over 90 minutes just for the one patient. Even though we started the day late, she never rushed the patients. As if that’s not enough, Dr. Kung is also an excellent teacher – she did each exam first, listening to the lungs, checking the ENT, etc., but then she had me repeat everything, drawing my attention to anything abnormal. She also took a moment after each patient to talk over the case with me and explain why she asked certain questions, or what a given medicine was for. Basically, she’s a goddess, and I love her and working PMH!
Work conditions are not exactly ideal, but it’s certainly not like we’re in a tent in the middle of nowhere, either. Dr. Kung has to provide much of her own equipment, and as she put it, unattended things “tend to grow legs,” so you have to be careful. That said, however, the hospital has X-ray and CT machines (though the CT is currently down), and government medical aid covers medications and testing for many families (usually there is only a 10% co-pay, if things aren’t completely paid for). Also, interestingly, patients are responsible for maintaining their own medical records, and standardized folders contain notes from every doctor they see, which makes it easy for specialists to see the care their patients may have received in the A&E, etc. It’s a neat system, especially because most of the time the Dr. doesn’t have to write a separate prescription that the patient might lose – they write it directly into the chart, which the patient takes to the pharmacy. Their new appointment times also get written there, so that (theoretically) they don’t forget when to come next. This all assumes that patients don’t lose the charts, but of the five patients we saw today, all of them had complete charts, plus lab results and x-ray films, in a few cases.
Medications have different names here – for example, albuterol is salbutamol, so I feel a bit like I’m learning two new languages here. Dr. Kung has a fabulous South African accent though, so I’m content to sit and listen to her all day long (why couldn’t I have been born South African/British and/or Australian?).
Once we had seen enough patients, Dr. Kung showed me the way to the cafeteria, then went to pick up her son from school. Typical hospital caf. I brought my lunch, so I just sat and ignored the “International News Station” (is that even a real thing, you ask? Yes, and it’s just as annoying as all the other news stations) while I staring into space and pretending that everyone in there wasn’t goggling at me. Only had one person ask me where I was from, and how they could get a job with UPenn.
Found my way back to the A&E office at the appointed time to meet up with Dr. Kung and Kat, but they got held up, so I drifted back and forth between the ambulance bay outside and the A&E waiting room. Chatted with a paramedic studying for his Master’s in psychology at UB, who asked if I had FB. Africa myth # 213, debunked.
Got to see the pediatric ward where I’ll be working with Dr. Kung when she goes on call for the in-patient side next week. There are no private rooms, but everything seems quite cheerful, and families go in and out with food and laundry. There are no computers for charting – for example, every new patient is registered by hand in a giant 2’x3’ log-book kept at the nursing station. Their entry may or may not contain their medical record number, age, sex, nationality, admission and discharge dates, admitting diagnosis. It pretty much depends on how busy the nurses are, and whether their handwriting is legible. And lucky me, the first part of my research project is going to be taking a list of children admitted for respiratory illness between April 2009 – September 2010, sifting through the old logs, and finding their medical record numbers so that we can request their charts. Ma, I think I’m going to need glasses by the time I get home!
Dr. Kung very generously gave us a ride back to campus, thankfully (we were both exhausted). Stayed in, did some boring things, then went to bed early. CAN’T WAIT FOR TOMORROW!
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