by Work the World

One of the main things students feedback to us about their placements is how interesting and different the cases are.  Whether it is the handling and treatment of patients by doctors, the frequent appearance of diseases that have been largely wiped out of the UK, tropical diseases that do not occur at home or just how far progressed pathologies are before treatment takes place, an overseas placement is both fascinating and a great learning environment for students.

This week we asked our students what the most interesting case they had dealt with so far was. The replies were wide ranging...

In Arusha, Sarah found the story of a child of 13 months touched her. "The child was very underweight and found to be malnourished. He also had a heart murmur and was diagnosed with tetra logy of fallout which is a rare condition requiring heart surgery. The mother does not work and is single so must find a sponsor to get the child to India for surgery. In the meantime he remains on the malnutrition ward where he’s regularly fed. The pneumonia is now resolved”. For Candace, it wasn't so much the unusual cases as the common. "On paeds placement in the States I’d see a handful of burn parents over months. Here there were about twenty kids in with severe burns. One had fallen into a fire head first and all of the skin and hair was gone and he was covered in blisters. It was fascinating how common burns are for children here and how composed the families of the children were. I look forward to visiting the floor again and leaning more about treatment process and plans of care”. Daniel found that the cases that interested him also involved the culture of Tanzania. “The most interesting case I have encountered so far was partly because of non-medical reasons. It was a thief who had been violently attacked as a result of “mob justice”. The attack resulted in bilateral forearm and left tibias fractures. I found this interesting because of the associated social issues, and wanted to know why he was held in such extreme contempt by the public and health professionals (one passer by said we should let him die), and why “the mob” felt it necessary to administer such a beating”.

In Ghana most of the students work in the same hospital and have seen all sorts of interesting cases, ranging from conditions common in the UK but managed differently in Ghana (such as strokes, diabetes, chronic renal failure) to conditions rarely seen at their home countries (malaria, tetanus and severe malnutrition). Lauren tells an interesting case of a young boy who was brought to the hospital in a very poor health condition. "The child presented classical clinical signs of protein energy malnutrition such as hair loss, hair colour changes, cheilosis, skin pigmentation changes, edema etc. And though the medical team refered the parents to a nutritionist, the problem was the inability of the parents to afford the proper nutrition for the child". Talking about children, May indicated how a 2year old boy with status epilepticus secondary to cerebral malaria, who in the UK would have been transferred to NICU, was managed at the ward. "Due to limited medication available and lack of monitoring equipments, there was little that could be done for the child- yet this child survived. I didn't expect that".

As in most of our programmes, the Obs and Gynae wards always present interesting cases. Tania found the case of a woman who had been raped an interesting comparison to home. "The woman only received a brief vaginal examination. I asked why and the doctor explained that because of the lack of a forensic system for investigation, all he could do was to inspect for laceration and provide her with a prescription for emergency contraception, antibiotics and a blood test for HIV screening. At home it would have been very different". Laura found that the advanced pathologies provided her with a chance to witness real skill by surgeons. "Fibroids are  a common problem for Ghanaian women and one 40year old female patient had an abdominal mass the size of 34inc pregnancy. It was firm, mobile and non tender, and she had opted for surgical operation due to the severity of the pains. I followed her case from clinic to surgery and when the abdomen was opened and the uterus mobilised, it looked like 20 apples in a pink bag- it was a three and half hour operation and over 20 individual fibroids were removed, ranging from 1cm to 10cm in diameter. This operation was done without any complication except wound infection, which I thought was really interesting because although resources and facilities are basic and limited in Ghana, the skills of the surgeons and the respect for a patients culture, was second to none".

We were keen to hear from our Nepal students as this is a new programme for us. The extreme poverty cropped up - "there was this lady who's whereabouts were unknown, a bus just came dropped her in front of the emergency door and left" Adrian said. He also found treatment of death very different. "A man was brought in the emergency unit by his friends but unfortunately he could not be saved and died there few hours later. It was quiet unusual to see how they handle a dead body. Everybody was coming to see it - there was no privacy. The doctor made a death certificate and the relatives just took it away. That's very different to the UK". Patients also are a lot more involved in what is happening with a patient - nothing seems hidden. Sunil told us that one of the students witnesses "a young lad who had had a urinary blockage due to a stone formation inside. He had a catheter fitted under his belly and the doctor was trying to blow the gland inside to fit in the pipe. Usually, with such cases, a small amount of urine has to come out so that the pipe can be slid in. The doctor did not do this though and just pushed it in. There was blood all over and the wife was wiping it up."

Next week the question for the students is "how are you finding the public transport"? Check back next week to hear the answers.


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