What was intended to be a short chat turned into a whole day affair with Mitch and I having to pause multiple times for food, coffee, laughter, ambient noise, coffee, passers by interrupting the recording…. did I mention coffee?
It was an absolute privilege and pleasure to be able to share my life changing experiences with Mitch and his audience and have a good laugh with someone I consider a genuine friend and colleague.
Amazing: The one word I would use to describe my life over the past month since finishing school.
I can honestly say that I haven’t stopped smiling. The freedom to pursue my interests and the time to spend out in the real world has just been, well… amazing!
Backtracking a bit; Over six months ago I discovered the Chisang Clinic whilst searching online for medical volunteering opportunities, and since then have been readying myself for the adventure. I am honestly ecstatic to be spending this December in rural Nepal working with the staff of the Clinic in providing ante-natal and general medical care to the local population. After this I’ll be travelling via Bangkok to Israel to volunteer for 6 weeks with the Israeli Red Cross – ‘Magen David Adom’ who are the national Emergency Medical Service over there.
It’s almost surreal to think that this time tomorrow I will be well over halfway to the Village of Bhuanne where the clinic is situated!
There were assuredly barriers along the way in organising this trip but they were really very minor; a few issues with bookings, internet problems, banking stuffups – the usual. Honestly I’m just excited to be getting on my way, with a vague idea of what lies in wait for me, especially in remote Nepal: its hard packing light when you aren’t sure what to expect! Interesting? yes.
Taking enough toilet paper for a month is definitely something I’d consider interesting! The Beautiful Nepali people preferring to use squatting toilets and cupped water over our western bowls and paper – scrunch or fold doesn’t really come into it!
Besides the stuff for me: hiking boots, pants, jackets, thermals, toiletries… the usual, I’m also elated to be taking with me a portable ultrasound for obstetric scans – it will be the clinics first portable ultrasound and after skyping with the clinic founder, Dr. Debendrah Karki phD, a Nepali National with postgraduate training in new Zealand and the US, it became apparent just how much impact an ultrasound would have.
Just the story of getting this Ultrasound, a Sonosite180, deserves a post of its own so I’ll be sure to share that story with you during one of my free evenings in the village.
Besides the Ultrasound machine, I’m also taking with a fully stocked bag to leave at the clinic, complete with birthing equipment, neonatal resuscitators, BVMs, wound dressings of all shapes and sizes, gloves, cannulas, tubes….. Whilst packing I swear my room looked like a hospital ward had exploded inside!
I should mention that Hatzolah of Sydney – a community first responder agency were extremely generous in donating out of date and used supplies that, although not technically permitted to be used in Australia, are still in fantastic condition and will make a huge difference to ability of the clinic to provide emergency care. Specialised dressings for burns or abscesses which are a few months past their use-by-date, and so unusable in Australia, will mean the difference to Nepali families who otherwise couldn’t afford them, and to our non-for-profit Clinic who normally might not be able to purchase them.
So, its T-36 hours till I leave.
The last few weeks, as I mentioned have been phenomenal!
I spent a week observing orthopaedic surgeries and anaesthetics in theatres – it’s almost becoming a past time! Although the surgery itself is somewhat a beautified and sterile version of carpentry, watching the team operate is like watching a symphony. It’s an organic process where there’s this deep seated understanding of exactly what is occurring, and what needs to occur. The team barely speak to each other in more than a few words when giving instructions or messages, the conversations revolving around engagements of friends, dinner that night (it was lasagne in case you were wondering) and interesting advances in the field. Then there’s my gradual developing of an understanding of the dynamics and physics behind the reconstructions, joints and repairs which are fascinating! The innovations and advances in the field, as well provide for some seriously interesting learning.
Of course, there is my favourite bit– the anaesthetics! The drugs are cool, the monitoring is cool, the airway devices – again cool… I think I might be a tad infatuated with anaesthetics!
I can’t quite put my finger on it but there’s just something awesome about understanding a local change that is part of a whole systemic balance where drugs and reactions and responses all play together in such a monstrously complex way, yet it’s also almost intuitive. The ‘feel’ of knowing an extra bolus of saline will get the BP up just that little bit more to the perfect level, the constant tweaking and adjusting, it just makes sense, and yet there’s so many layers and levels of physiologic complexity to each mechanism.
Most of all though, I think the art of the anaesthetist lies at the end of the procedure. Knowing when to remove the airway at that golden moment between sedation and consciousness where the patient is asleep enough to tolerate the plastic tube down their throat without retching, yet awake enough to keep their own airway open – I’m still yet to understand the artistry and intuition, as well as clinical acumen that comes with that decision.
But if that wasn’t great enough, I had one of the best days of my life last Thursday.
After connecting with A/Prof. Cliff Reid from Sydney HEMS over twitter through the #FOAMed Online space, I almost dropped my Iphone when he invited me to come down and see the ‘Sydney Helicopter Emergency Medical Service’ air ambulance base at Bankstown airport. The Base is home to the Doctor/paramedic teams that fly out in an absolute Beast of a helicopter to rescue and transport the critically ill across New South Wales.
And there I sat, little me, just having finished HSC three weeks prior, amidst a dozen registrars in Emergency medicine from around the state, all there for the ‘Registrar Training & open day’ to attract potential candidates for employment in later years.
Suffice it to say that it was ‘amusing’ experience for all involved when a high school student is learning about the benefits of thiopental and osmotic diuresis in neuro-critical trauma from an ED registrar in the back of a helicopter on the tarmac.
To say I felt like I was home would be a serious cliché – but to be quite frank I don’t think I’ve ever so thoroughly enjoyed a day like that before and in that same way- It was everything I loved and pursued learning about in emergency medicine and critical care.
Surrounded by the proselytization of Ketamine and Rocuronium, the quazi-worship of RSI Checklists, and a solid understanding of Human factors; all wrapped up in a gorgeously rich dose of Critical-Care-Awesomeness!
Yeah, I guess you could say I felt like a kid in a candy store.
I had intended on live tweeting clinical pearls and tips from the day as I listened to the lectures from clinicians the likes of Karel Habig on thoracic trauma, but the content was so rich and captivating that I ended up just taking down pen and paper notes (archaic I know!!) to tweet later so that I didn’t miss anything!
These were really well received by the twitter #FOAM community, one on RSI in Pelvic Trauma in particular getting re-tweeted quite a few times.
The day was simply fantastic and the people warm, friendly and passionate to the point that they inspired within everyone a similar adventurous yearning to do what they do – retrieval medicine.
Many thanks to Cliff, Karel and the team for having me.
To top it all off, I spent a day a week later from 9 til 5:30 watching obstetric and foetal ultrasounds in a maternal foetal medicine unit- with a bare 15 minute break the entire day might I add!
It was a roller-coaster experience, every illness and disease taking an exacerbated emotional toll on the families and myself; to a far lesser extent. Yet I refuse to wipe the smile off my face as I recall the moment a late second trimester baby stretched out its arms and motioned, as if to grasp at something, its face turning to the side and coming into plane and out again whilst two loving parents sat in glee watching the live screen of their wiggly baby – THAT was special.
My absolute gratitude goes to E. (anonymity preserved), the wonderful senior sonographer
who took me under her wing that day. The experience transformed what I will be able to do over in Nepal assisting the team in the clinic. Before Tuesday I had a purely conceptual understanding of obstetric pathologies. Today, I feel somewhat confident in my ability to do the most basic of scans, using the Sonosite to calculate rough scores and plot them on Hadlock graphs.
It’s at this point that I encountered an interesting, though morbid conundrum. Although the Sonosite is a great machine, it’s not exactly the ‘latest’ model, the model being over 10 years old and thus it cannot compare to the massive 4D machines in western hospitals today. Foetal echocardiography and fine scans to detect abnormalities that are easily accomplished in Australia just aren’t possible with the basic functions of the machine I’m taking. Yet when I considered this, it was both reassuring and depressing to conclude that even if I could detect a fine abnormality like a septal perforation, a valvular abnormality, maybe an endocrine agenesis – there’s actually nothing that can be done.
Nepal simply doesn’t have the facilities to allow for every baby with anatomical abnormalities to be operated on and kept in intensive care units, least not the impoverished villagers of the countryside who could never afford such care.
“Focus on the basics and do them really well” was the advice given to me by a very senior paramedic when I began learning about pre-hospital care.
And that’s exactly what I intend to do in Nepal.
The Basics. Really, Really well.
The fancy stuff is fun, but simple things like teaching good hand washing, promoting oral health, safe sex, breast feeding of newborns– all of these will have immeasurably more impact than any procedure or diagnosis that I could make for one person.
To be able to screen for severe abnormalities and refer these women to tertiary centres is probably the most powerful thing that I and this ultrasound can do.
Something as simple as screening for Placenta Praevia – where the placental sac lies in the way of the baby and the outside world, can save lives if the mother is referred for a caesarean section well before her labour begins.
Right now Its late at night, I’m waiting for my laptop to finish downloading a manual of guidelines from the WHO on maternal medicine and newborn care.
And I’m truly excited to begin my adventure.