I sit and type from my lonely hotel room in Pursat, a trip to Bakan Hospital down and a meeting in Phnom Penh to come. It has given me the free time and the headspace to reflect on my first few days in work.
I have written a list of questions from first impressions that I'd like to explore more with the URC doctors and find some answers. It looks something like this;
If a patient with a GCS of 4/15 isn't an emergency that warrants a bedside blood glucose, who does?
How can you determine if a patient is anaemic and the cause of anaemia with only a haematocrit, when the lab definitely does Hb & MCV (I've checked!)?
Why have none of the patients had observations for the ward round and why are the charts filled in retrospectively at the end of the shift?
Why are there no drug charts and why do nurses transcribe the prescription everyday instead?
Why does everyone wear a paper mask and surely washing them can't be good?!
Why does every patient get a IV cannula and fluids except when they are in septic shock?
What the hell am I doing here and what can I possibly do to make things different?
I found myself today sat in a clinic case review questioning the difference between decorticate and decerebrate posturing, what is in my head was different than the powerpoint presentation. When I questioned it afterwards I was told it was right because it was off the internet, I knew it wasn't but the medical culture shock has triggered a whole new level of self doubt in me.
And by culture shock I mean nearly stepping on an enormous black scorpion on the ICU medicine ward round, hospitals with no essential drugs list but TVs in every staff room, sinks installed to improve infection control being stolen at the weekend, beds with no mattresses (BYO mat), intermittent Xray & USS services, mixed gender wards with no screens and audience through window, patient presented to me with set of incomplete blood results but no history, examination or management plan.... oh you know what I mean, it is all a little bit different here!
But before you all think you've won your bet and I'm coming home early I should add it's all a brilliant adventure and certainly never ever dull. When in the UK do you have a working lunch where the food provided is rice with ginger as a vegetable, guess the chicken body part and blood balls? Exactly, wouldn't swap it for the world.
Can I add as a post script that I LOVE it when a Cambodian finds out you speak a little bit of khmer, they are soooooooo happy and although they want to practice their english with you they insist that you speak back to them only in khmer, truly I LOVE that. What a warm (in many senses of the word), friendly, beautiful, crazy place this is and it is home for the next 2 years.
I have written a list of questions from first impressions that I'd like to explore more with the URC doctors and find some answers. It looks something like this;
If a patient with a GCS of 4/15 isn't an emergency that warrants a bedside blood glucose, who does?
How can you determine if a patient is anaemic and the cause of anaemia with only a haematocrit, when the lab definitely does Hb & MCV (I've checked!)?
Why have none of the patients had observations for the ward round and why are the charts filled in retrospectively at the end of the shift?
Why are there no drug charts and why do nurses transcribe the prescription everyday instead?
Why does everyone wear a paper mask and surely washing them can't be good?!
Why does every patient get a IV cannula and fluids except when they are in septic shock?
What the hell am I doing here and what can I possibly do to make things different?
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| visual gag - worth repeating |
I found myself today sat in a clinic case review questioning the difference between decorticate and decerebrate posturing, what is in my head was different than the powerpoint presentation. When I questioned it afterwards I was told it was right because it was off the internet, I knew it wasn't but the medical culture shock has triggered a whole new level of self doubt in me.
And by culture shock I mean nearly stepping on an enormous black scorpion on the ICU medicine ward round, hospitals with no essential drugs list but TVs in every staff room, sinks installed to improve infection control being stolen at the weekend, beds with no mattresses (BYO mat), intermittent Xray & USS services, mixed gender wards with no screens and audience through window, patient presented to me with set of incomplete blood results but no history, examination or management plan.... oh you know what I mean, it is all a little bit different here!
But before you all think you've won your bet and I'm coming home early I should add it's all a brilliant adventure and certainly never ever dull. When in the UK do you have a working lunch where the food provided is rice with ginger as a vegetable, guess the chicken body part and blood balls? Exactly, wouldn't swap it for the world.
Can I add as a post script that I LOVE it when a Cambodian finds out you speak a little bit of khmer, they are soooooooo happy and although they want to practice their english with you they insist that you speak back to them only in khmer, truly I LOVE that. What a warm (in many senses of the word), friendly, beautiful, crazy place this is and it is home for the next 2 years.
Sounds like Taunton, except for the scorpion.
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