My First Rotation

On Tuesday, I had my first rotation. And if you haven't been keeping up with my blog…NO I am not in my Clinical Rotations yet! Our school just calls it a rotation the first time you go spend a day at the hospital. I was picked up around 8 AM with about 20 other classmates and driven to Princess Margaret Hospital (PMH for short) in Roseau, which took about an hour. First off, I must say that the drive to PMH is a lot easier on the stomach in comparison to the one to the airport. The drive to Roseau is actually quite beautiful because it follows the coast pretty much the whole, plus there are long stretches of straight roads, which is always a plus here. Once we got there, we were shuffled into a meeting room where we were all assigned to a doctor and specialty (Ob/Gyn, Surgery, Pediatrics, ENT, etc.). Much to my surprise I was assigned to follow a doctor in Geriatrics. Much to my surprise again, my day would not be spent at the hospital, but instead at the Dominica Infirmary. So I, along with a couple of other students, were piled back into a van and driven to the Infirmary, which was 5 minutes away. Once we got there, we were kind of shocked just to the see the facilities. I guess it was nothing like I had expected. It was basically a square-shaped building with a large courtyard in the middle and 4 different Wards that made up the sides of the square. I estimated that it probably had approximately 200 residents. Once we took in the scenery, we met up with our assigned doctor and promptly saw our first patient.

Since this was our first time doing something like this, I didn't know what to expect. But I found out quickly. The doctor gave us a brief rundown on the patient's medical history and then we began a discussion. For example, the patient had hypertension. The doctor looked at me and said, "Tell me everything you know about hypertension." Gulp! That's the sound of me taking a huge swallow after being put on the spot like that. So I told her everything that I knew at that moment pertaining to hypertension. After rattling off tons of stuff about it, we moved on to its clinical signs, followed by it's treatment. Then we examined the patient's signs for hypertension like taking their blood pressure and so forth. That's how things went. We brought up one of the patient's problems, talked about every aspect of that problem and then examined the patient for that problem. This carried on to about 12 o'clock noon, when we were dismissed for lunch.

I and my colleagues got into the van and immediately told the driver to drive us to PIZZA HUT!!! Yes, there is a Pizza Hut on the island and it's located in downtown Roseau. For three semesters now, I have seen 4th Semesters coming back from their rotations in Roseau carrying boxes of pizza for themselves and their friends. This time, it was my turn! Except, I only got a 10" personal pizza for myself and ate it in about 10 minutes. It was fun and delicious while it lasted! Subway and Pizza Hut….that's all we have for American food here. Since we were allotted 2 hours for lunch and it only took like 30 minutes to eat lunch, we walked around Roseau for a little bit and enjoyed the view of a huge cruise ship (AIDA, a German cruise) in the bay. Then we returned to the Infirmary.

Our afternoon session ran a little differently than the morning. Instead of working so closely with the doctor like in the morning (which was more of a learning/quiz session), the afternoon was meant to complete a full history and physical exam on a new patient on our own. By the time that was over with, it was 4 o'clock….time to leave and meet up with the other students at PMH to drive home. The whole day lasted from 8 AM to 5:15 PM. I only saw two patients. By any doctor's standards, I don't think that would be classified as being very efficient. And yet I was completely exhausted. I slept well that night. 

Fourth Semester

Well, it appears as if I haven't written on my blog in over two months….one month that was very busy and one that was not. The last time I wrote was during the first week of November and a tremendous amount has happened since then. First of all, we finished the 3rd block of last semester, Cardio & Respiratory, and then took Mini III. Soon thereafter, we took our Clinical Skills & Competencies exam and then about a week later we took our Final Exam of the semester. Even though I was able to sum up the rest of Semester 3 in a few short sentences, that in no way reflects how much studying and effort it took to get through those last few grueling weeks. Nonetheless, I made it and was rewarded with a month-long winter vacation.

And wouldn't you know it, the trip from Dominica to Orlando this past break was the first time here at Ross making it home with no travel delays or missed flights. Someone was looking down on me that day! Once again, it's tough to do much on break besides enjoy the complete relaxation. I always go home with the mindset of doing some studying, but it typically never happens. Nevertheless, it feels good to come back to the island for 4th Semester rejuvenated and looking forward to starting my last semester here. Our first block this semester is Nervous System & Endocrine System. It should be very interesting learning all of the pathological and physiological abnormalities that go along with these systems.

The schedule for this semester is a little different than past semesters. In the past, we usually only had 4 hours of lecture a day 5 days a week, but this semester consists of 8 hours of lecture per day 3 days a week. This may cause some sort of change in my current study habits, but we will see. The other  two days of the week are filled with Clinical Skills & Competency activities. This Tuesday is my first planned activity and I will be spending the day completing a rotation at Princess Margaret Hospital near Roseau. I don't have too many details about what I will be doing yet, but I'm sure I'll have some things to talk about in the next blog. I'm glad to be back in Dominica and back on my blog once again! See you next week!

https://www.youtube.com/watch?v=d6tlZzkqfHw

The Banana Suit

I know, I know... I missed writing a blog last week. I should have never spoiled you the week before last with such a terrific blog. I got your hopes up last week and you woke up Monday morning disappointed. I'm sorry. But as you were too busy being disappointed, I was busy studying my butt off for Mini II on the Heme, Lymphatic, & Musculoskeletal Systems. It was 101 questions long with an allotted test time of 2 hours and 11 minutes. And believe me, every second was precious during that test. I don't know how some people do it, but I'm one that always takes up the entire amount of time to take a test. During Mini II, someone got up and turned in their test with 56 minutes remaining. I couldn't have even read the entire test in that amount of time, let alone have time to think about each question sensibly and pick the correct answer. Crazy.

It was interesting celebrating Halloween in Dominica this year....or should I put it, not celebrating Halloween in Dominica. The majority of people just pretended like it was any old random day, but every once in a while you would see someone dressed up. As you can probably guess, Halloween was just another Thursday night studying for me. I don't know if I have said this on my blog before, but "classroom studying" is, how should I put this, a strict activity. When you study in the classroom, you have to be quiet. And I mean really quiet! We are all here studying to become doctors, each with a ton of pressure and stress on us, so the last thing we want is people distracting others while they are trying to study. Occasionally a cell phone does go off or someone doesn't realize that their headphones aren't properly connected to their computer so we can hear them listening to the "Barbie Girl" song (mildly embarrassing for that person), but really, the only way you are supposed to communicate with one another within a classroom outside of lecture hours is by whispering. As you can imagine, Halloween was no exception and everyone in the classroom was being respectfully quiet. I can't remember what I was doing (I mean, I'm fairly certain I was studying), but what I do remember was faintly hearing... a song. And not just any song...I'm pretty sure it was Michael Jackson's "Thriller". It was! So I turned around....and what did I find??? Someone dressed in a banana suit, walking from one end of the classroom to the other, dancing, while holding a cell phone playing "Thriller". They didn't say a single word. Actually, nobody said anything. The banana just exited the classroom through a door on the opposite side and they were gone. Never to be seen again. At this point, everyone just kind of looked at each other with the look of "what did we just see". And then...the classroom erupted with laughter. I don't know who it was or why they did what they did, but the person in the banana suit provided me, and I'm fairly certain I can speak for others, a small relief of stress that was much needed. I'll never forget that.

A new block started on Wednesday: Cardiovascular & Respiratory. It's supposed to be a doozey. I hope that I'll have the time to keep you guys updated.

And I think it's mandatory that I leave you with this:

http://www.youtube.com/watch?v=ZEHsIcsjtdI

RCSA Clinic

Today I participated in a clinic just outside of Portsmouth and as part of an assignment I had to write a reflection on my experience. Instead of just rewriting everything in the form of a blog, I'll just share with you what I wrote about for my assignment:

"On Sunday, October 27^th, 2013, I participated in the RCSA Health Clinic that was held in Toucari, Dominica. I, along with approximately thirty other schoolmates, left early in the morning to set up for our clinic outside of St. John and St. Lewis Church. The clinic featured stations for HPI, blood pressure, blood glucose, height and weight, vision, as well as a station for heart and lung examination. After setting up, the entire group of Ross students attended mass with the local congregation. Afterwards, about 75 patrons of the church attended the clinic.

            Since this was the second community clinic that I have done during my time here at Ross, I came into this clinic with some preconceived ideas about how it was going to go. But much to my surprise, most of those assumptions were wrong. The first clinic that I attended at Ross was located in Dublanc, which featured a much larger population than Toucari. During the Dublanc clinic, I worked at the HPI station and remember being busy the entire three hours that the clinic was open. It didn’t provide me the opportunity to get to really talk to people and listen to their health concerns, but instead forced me to move quickly through the HPI and shuffle the patients along to the next station. I suppose this was due to the sheer amount of people waiting in the line for the clinic. On the other hand, the Toucari clinic was a much more relaxed atmosphere and I think it was mainly because there were less people waiting in line for our service. But less people wasn’t necessarily a bad thing; in fact, it gave me more of a chance to talk to each individual patient and elicit their concerns. For the Toucari clinic, I worked at the blood pressure station. Blood pressure is not something that I am completely 100% confident in doing, so that’s why I signed up to work at that station. As everyone always says, “practice makes perfect”, and practice is exactly what I needed.

            Besides practicing my skills of actually taking blood pressure, talking to patients and discussing their health lifestyles was a successful component of the clinic for me as well. I tried to ask the typical questions you normally do before taking blood pressure and it was interesting to me that I always received similar answers. For example: when I would ask, “Do you have a history of high blood pressure?”, most people would respond by saying something like, “Just barely” or “It’s just a little high”. As you probably already know, the majority of local people here in Dominica do have high blood pressure, which is a result of many factors including their diet, exercise habits, and culture. With that being the case, I was able to do a lot of counseling. I was able to tell many of my patients about what the blood pressure measurement actually means and how everyone has the tools to control it, mainly through diet and exercise. It’s one thing to measure a blood pressure and report a number, but it’s a totally different experience if you can analyze that number and give advice to others on how that number can change. I guess that was the biggest difference between the two clinics that I have participated in thus far. The first was more about completing the task and moving people along, whereas the second clinic centered around the idea of helping people change their lifestyle. The Toucari clinic was one of the first times in Dominica where I have felt more like a teacher than a student. And that was a good feeling.

            Overall, I think the clinic was very successful. It’s just astonishing to me to hear from local individuals that our student-driven health clinics are sometimes the only medical attention they receive all year. I find that a sad thing to hear. However, in their eyes, our student health clinics do mean the world to them and can influence their lives. One aspect of the RCSA health clinics that I find absolutely empowering is the fact that we attend mass with the local congregation. It’s one thing to put on a free health clinic for random people, but it’s a totally different experience when you worship, sing, laugh, and pray with those individuals. I think that aspect of the RCSA health clinic makes it all the more special. One thing that I won’t be able to forget about this community clinic experience was when the congregation made us Ross students stand and they began to sing to us. They sang a song that said, “We love you and we mean it from the bottom of our hearts.” I don’t think I’ve ever been more humbled in my life."

Until next week.

Soggy Shoes

As most of you faithful readers already know, there was no blog last week. Last Sunday, I was finishing up my studying on Block 1 material in preparation for Mini I, which took place last Monday. It's always a little difficult to write a blog the night before a big test, so unfortunately writing this blog takes a back seat to studying...I hope you can forgive me. With that being said, the test went well and the results showed off all the hard work that I put into it. Mini I was 157 questions long with an allotted testing time of 3 hours and 21 minutes. That doesn't seem too horrible, except for the fact that I had to take the test with soaking wet shoes.

So before every Mini, each student gets an email from the Testing Center saying when the test is, which students take the test where, and the breakdown of the number of questions per subject. This time, students with the last names A-L were assigned to take Mini I in the Annex. That's me. Now, I'm not sure if I've mentioned the Annex before, but it is the only classroom that is not on the main Ross campus. The Annex is about a block away; so to get there, you have to walk.

Long story short, as I was putting my backpack and other belongings into my locker (on the main campus) before the test, it began to downpour. So I quickly grabbed my two pencils & ID, along with my umbrella, and began the treacherous walk to the Annex. And to describe things even more precisely, when it downpours in Dominica, it never rains straight down. It rains sideways. So as you're walking down the street shielding yourself from the rain, you look more like a Spartan soldier going to war than a medical student going to take a Mini. And of course, an umbrella only covers so much of my body, so naturally my feet got soaked. Next, as you probably guessed, I was faced with a dilemma. To take the test with my wet shoes on OR take my shoes off? In other words, make myself comfortable with dry feet and risk my feet smelling awful when I take my shoes off OR just suck it up and wear the wet shoes? I ended up just wearing the shoes. One thing is for sure, once a Mini begins, you sort of forget about everything else around you...yes, even the fact that you are wearing wet shoes. And, as it turned out, wet shoes might even be my good luck charm. I might even try it for the next Mini!

The following day, Tuesday, marked the beginning of Block 2 - the Heme & Lymph & Musculoskeletal System module. It seems pretty crazy, but we are almost at the halfway point of 3rd Semester. Time sure does fly!

http://www.youtube.com/watch?v=Bm5HKlQ6nGM

Trying To Beat The Heat

Thus far, 3rd Semester has been pretty cool in terms of weather. Of course, it's usually somewhere in the 90's, but it hasn't been as humid compared to the last two semesters. As long as you can walk in the shade and stay inside the classrooms for the greater part of your day, the heat won't really affect you. Like I've said before, my apartment does have air-conditioning, but, proudly, I haven't even turned it on for the entire time that I have been on the island...for multiple reasons: (1) I barely spend any time in my room unless it's to sleep (2) it's kind of expensive and (3) I only have wooden planks and screens on my windows (I don't have actual glass), so I don't feel much like air-conditioning the outside world. But, for the most part, the fan gets the job done...until it doesn't. And when I say it doesn't...I mean my fan broke...again. It's always a nice surprise when you come home from a long day of studying only to find a palpable warmth in your room that, without a fan, you can't get rid of. I don't know what it is, either the poor quality of fans that they sell down here or some sort of corrosion to the electrical wire caused by the nearby saltwater, but nonetheless, it's an inconvenience. Luckily, I have nice enough friends to borrow me an extra fan until I have time to go to a store to buy another one.

The only other time that I really get overwhelmed by the heat is when we have to dress up for school activities, which is pretty much every Monday and Thursday this semester. This past Monday I had to dress up because I had my first community clinic! Three other classmates and I were assigned to make a visit to St. Joseph's Health Center in a town called St. Joseph's (Duh!!!) about 40 mins from Portsmouth. So basically, we showed up at 7:45 AM at our meeting spot, school officials ushered us into our respective transports, and some random Dominican driver drove us to our destination. When we got to the health center, we were greeted by the friendly nurse who gave is a tour of the facilities and a brief history of the area. Now, when I say "health center"...it's nothing like what we have back in the US. Not in the least bit. It's more like an entrance room (about 20 feet X 10 feet), one office room (about the same size), and one hospital room with two beds. That's it. The nurse told us that it was actually the largest "health center" on the West side of Dominica (not including the hospitals in Portsmouth or Roseau). Regardless of its size, it was functional and clearly sufficient to get the job done. At that time, us students were divided and assigned our own patients to interview. Yada yada yada. After our interviews, we then met with the local medical doctor at St. Joseph's and reviewed each of our cases. It was a really cool experience working with the local MD and seeing her own viewpoints and assessments of the patients that we saw. She also critiqued our interviewing techniques and gave us a lot of helpful advice, so all in all it was a worthwhile experience. After debriefing, we drove back to Portsmouth and went on with our day. Over the course of this semester I will do two community clinics. One down...one to go.

Third semesters now have one week left before our first test, Mini I. So I'm sure it will be a long week of studying and making sure that all of the information that we have learned thus far is cemented into our brains. We will just have to wait and see.

Anyway, that's it for me. I'm glad the Big Bang Theory is back on TV! (Sorry, I didn't mean to rhyme)(Ok maybe I did). Have a good week!

http://www.youtube.com/watch?v=lhTSfOZUNLo

Bugs & Drugs

If you needed a recap of the entire week that us Third Semesters have just gone through, you can read it in the title. That's really it. Like I have said before, Third & Fourth Semester are all about describing the processes in the body and our ways to adapt when things go wrong. And apparently, as we found out this week, those adaptive processes are initiated by a lot of viruses and bacteria (that we pretty much need to know everything about...size, shape, color, favorite foods, hobbies....ok maybe not all of that). But it is a lot of detail and takes a tremendous amount of memorization and time. On top of all of that, we had a huge list of drugs dropped into our lap this week all dealing with the autonomic nervous system. And since that pretty much involves the entire body, you can imagine how many effects and sides effects those drugs have with their administration. Ok, it's not all that bad! Even though it is a lot of work, it is still very interesting and I am just shocked every single day at how much I am learning.

Besides the schoolwork, nothing too much has changed. The basketball season started on Friday and team "Hoops! I Did It Again"  and I won our first game in our 3rd season together. It was a great game for us (not so much for the other team), but just the beginning to our quest to win that ever elusive championship. 

Subway is still Subway. 

I tried spinach and eggplant pizza the other day. I know a few of you reading this are probably shocked, since I would never have done that in a million years in the US because (1) I'm not that adventurous, (2) they probably don't have it in the US, and (3) US pizza restaurants never run out of EVERYTHING ELSE! All in all, it wasn't too bad. I might even have it again.

Tomorrow is my first community clinic where I will go with a small group of classmates to interview a few patients and maybe watch some procedures at a nearby health facility. It is Ross' way to get us, not only involved with actual patients, but working alongside actual MD's in a real health clinic. It should be really exciting!

Hasta luego

http://www.youtube.com/watch?v=Wo4GJ6YdDeY