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My Summer Experience- Ingersoll and Tillsonburg MedQUEST

Posted on 01 May 2012 by Caitlin VanDeCappelle (Meds 2014)

It took me 11 minutes. Only 11 minutes to drive from my front door to Alexandra hospital in Ingersoll, and yet I had never been there before. At first glance the hospital seemed small and very different from the hospitals I’d been to in London (the free parking may have had something to do with that!). Over the course of my next six weeks in the MedQUEST program, the small town and its people became friendly, warm and welcoming.

Ingersoll and Tillsonburg were looking for physicians, like many other areas in Southwestern Ontario. It wasn’t until my experience in MedQUEST though, that I came to know the strength in a small, tight-knit community when it came to getting something they needed. I had dinner with the mayor, was given a tour of the local CAMI automotive plant, and even got a free library card. Continue Reading

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International Elective in Argentina

Posted on 23 March 2012 by Keegan Selby (Meds 2014)

The following is an excerpt from my Journal Entry taken during the summer of 2011 on an international elective in Argentina.

Wednesday July 20th 2011:
Our bus rambled its way down the dirt road and finally pulled into the bus stop at 9 pm. Outside, our host was waiting to direct us to what would be our living quarters for the next few nights. We jumped into some cabs and drove in darkness to the former hospital, which had been converted into dormitories for Argentinian clerks. I say in darkness, because the power to this part of town was currently out, an occurrence that was actually commonplace in this area.

We had seen the rich tourist areas of the ski resort city, Bariloche, and the provincial oil-rich capital of Neuquen…but this was rural Argentina. The town endures predictable rolling blackouts and only the main couple of streets are paved. Most houses have their own rain barrels for water and fire stoves for heating and cooking.

We dropped our backpacks off on our bunk beds, formerly an old surgical or examination room, and walked over to the current hospital to get some dinner. All our meals were provided by this small hospital and made by a group of elderly woman who treated us like their grandchildren. The staple of their meals was usually cheevo meat (a small goat-like animal), and the food they prepared was delicious and plentiful.

Thursday July 21st 2011:
Our first day in the rural hospital…apparently people don’t eat breakfast down here, just white bread and matte (a strange green tea like drink). Oh well, we will have to take leftovers from dinner tonight!

Mauricio, the paediatrician here, is hosting us and he has been very hospitable and a superb tutor. His motto is, “I show you the first time, you do it the next time”. Under his guidance I observed 12 pediatric cases today. He taught me how to do some basic dosing calculations as well as well-baby checks on kids that were less than 24 hours old. This included checking all reflexes and the normal anatomy of each child.

The absolute highlight of the day, even of the two-month trip, was when Mauricio told me there was a woman in labour and I would be catching the child. What happened to the “I show you first, you do it next time”?? But, there comes a time early on in each medical student’s education where one must step up to the plate, even though it is their debut game in the Majors versus the Yankees. Plus, I had to learn at some point.

I scrubbed in a little shakily, and was rushed by the nurses because it appeared the delivery was coming quicker than initially expected. Sure enough, I ripped the first pair of gloves because they were too small and the nurse didn’t speak English so she didn’t understand my request. Yes, I should have asked in Spanish but with all that was going on I could hardly begin to translate. I was given a larger sterile pair again. “Vamos,” they pleaded, ”Vamos!”. I pulled on the new pair of gloves and in my haste ripped my right glove as well…no time for another pair though. We ran into the delivery room just as the baby decided it was time to poke his little head out.

This was the first time I had witnessed a birth of any type. What an incredible experience it was and to have it occur in Argentina will ensure that I never ever forget this place and what happened here. I can’t overstate how incredible it is to see a new life brought into this world. When the child was pulled from his mother, I must confess, there was a moment of shock and fright. What if there is something wrong with the child? Will I be in the way? Is it supposed to look that way?

I kept the towel pressed warm up against my scrubs as I waited…and then caught little baby Abraham from the gynaecologist. The child was completely bluish-grey when it first came out and didn’t make a noise…wasn’t it supposed to be pink and angry at the world for being so bright?! The baby and I were rushed into a small heated area beside the delivery room where I proceeded to rub little Abraham all over to stimulate breathing. A few gurgles later and the first cries of life miraculously emerged from his tiny mouth. He simultaneously turned from bluish-grey, to pink and healthy looking. He was beautiful.

 

The new father watched through a tiny square window and I could see the pride on his face. He took photos as I clamped and cut the remaining umbilical cord and gave an injection of vitamin K and other needles into each of his squirming legs. He was a beautiful little kid and perfectly healthy. I ran my hands over his head and clavicles, ribs and abdomen for broken bones or tumours. His perfusion was normal and anatomy from head to toe was as it was meant to be. I picked him back up and he weighed in at 3360 grams, and we also checked his length. There was some blood on him from when I had cut the umbilical cord so I next bathed him in the sink beside the pediatric station before giving him back to his mother to be held lovingly. The mother wept as this new life from her womb was pressed against her cheek.

It would be an understatement to say I was amazed…even though this child was not mine, even though I had never spoken a word to this mother and did not know her life or her story. Even though I wasn’t her family, her friend, or even her doctor…a tear came down my cheek and in no way was I embarrassed.

When we leave this small Argentinian town I will be taking with me the highlight of my medical school career thus far. This highlight was not a rare disease or case presentation, nor an intricately complex surgical procedure in a posh operating room. It was an event that occurs almost 250 times per minute around the world, but being a part of just one has made me more aware of the miracle of life.

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My Summer Elective experience

Posted on 23 March 2012 by Dan Myran (Meds 2014)

This summer I spent one month in Northern Ontario on a medical elective. Over the month I was given considerable autonomy to practice my clinical skills and interviewing, and was granted a unique view of complexly foreign part of the country. The following patient encounter was one of the most shocking and influential events of my elective.

My preceptor for the day had assigned me one examining room and given me a third of the patients. After seeing each patient I would give her a summary, discuss a management plan, and we would then go in to see the patient together. I grabbed my first chart of the afternoon, a 16 year old female patient was presenting to the clinic with what she suspected was a Chlamydia infection.

I knocked on the door, walked in and introduced myself to a nervous looking girl who seemed far to young to be worrying about STIs. We started talking, she had a previous episode of Chlamydia 6 months ago (the reason why she was so certain it was Chlamydia again) which another doctor at the clinic had treated. She had been sexually active since 13, used the birth control pill for two months when she was 14 (she stopped because she could never remember to take the pill) and had since used no forms of contraceptives. At this point alarm bells were ringing in my head and I asked her when her last period was. The answer was informative to say the least: over 7 weeks, and it had not occurred to her that she could be pregnant. To complicate matters, the patient normally drank several drinks a day, and I was seeing her the Monday after Canada Day Weekend, where she had been drunk for most of the weekend. At this point I obtained her consent to test her for STIs and pregnancy, and then made a beeline for the doctor’s office.

I summarized the patient for my preceptor and to my surprise didn’t bat an eye – it was a fairly standard story I guess. One urine dip later and my preceptor turned to me and said, “Ever told someone that they are pregnant?” I replied with a shaky no and then injected slightly more confidence into my voice and said that I would like to be the one to tell her. So tasked with relaying this all-important news, I went next door, with my parting instructions to break the news and find out if she wanted to have the baby.

I entered the room, and said, “I have some big new. You’re pregnant.” I gave her a moment, and then asked her how she was feeling. She said she was shocked. Now the tricky part – the key would definitely be in the phrasing. I cleared my throat, collected my thoughts and blurted out something wonderfully awkward along the lines of “Do you want to carry this baby to term?” She beamed back at me – the answer was a definite yes. The rationale was certainly not to my liking: Dad was in jail, not speaking to the young girl, and she wanted the baby to remember him. But it was her choice. The clinical encounter wrapped up quickly: my preceptor came into the room, we treated her Chlamydia infection (a single dose of 1 gram of Azithroymycin given orally, for those who are curious), gave her some general prenatal recommendations, and set up a follow up appointment.

The patient left the office happy, but I was left with some serious doubts. Aside from being concerned about her prospects for the future, two nagging issues stood out to me. First, this young girl was a high risk pregnancy with significant risk to both mother and fetus (mainly Fetal Alcohol Syndrome). I was aware of it as was my preceptor, but it is unclear how adequately we relayed that message to the patient. It is possible that the patient was unaware of her risk. Should we have directly laid out the risks for the patient before asking about having an abortion? Would it still have been appropriate to discuss risks and offer alternatives after her expressed desire to have the baby? Does pregnancy count as a “medical procedure” for which complications, and alternatives must always be discussed and then offered to the patient?

I was also struck both by how preventable the situation had been and the clear signs that this patient needed help before she showed up at the clinic pregnant. After this “routine” event, there was no discussion of how to adapt or alter the practice, and I am quite positive that similar outcomes will continue to occur. I learned considerably from this encounter, and even more from my time up north, but left my elective cognizant of enormous gaps in our health care system, which unfortunately have no easy solution.

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