Do as I say not as I do…

Doctors make the worst patients. Period.

Whilst I would never tell any patient not to take anti-malarials or not to adhere to any advice that would make their trip safe and successful, it is only after a telling off from my family that I agreed taking important travel precautions would probably be a very good idea.

I do try to live by the rules and advice I give to others on a daily basis, but truthfully, my love for red velvet cupcakes and Cadbury’s dairy milk can sometimes get in the way of that!

In the spirit of planning, it turns out I will need a lot more than just a passport and a toothbrush. For as long as I can remember all my worldly possessions have fitted in one small suitcase. During medical school we were packed off on peripheral attachments to all parts of London and the South East of England and even Charles University in Prague. My elective afforded me the amazing experience to traverse the mighty Himalayas where I spent 3 weeks camping and treating the underserved populations in remote areas of the Indo-Tibetan Borderlands.

My foundation years took me to the West Midlands where, after a few tears, I arrived knowing no-one; I found myself a place to rent the week before I was due to start and soon called it home. The other junior doctors became my family and the bright lights of London were quickly replaced with the buzz of Broad Street in Birmingham. My GP training brought me back to London, and this was a really happy moment for me because I finally felt I could start putting down some roots.

The way our jobs are allocated means you have to rank every single area in the country. My way of tackling this was to make myself a nicely brewed cuppa, get very comfortable and ensure there was an unlimited supply of cake on hand. I then proceeded to look at a map of England and started by ranking from the bottom up. My least desirable areas were those furthest away from home, and those in the middle were decided literally in order of distance by mileage from my house. My most desirable area was London, and whilst I was lucky enough to be allocated this for my speciality training, I then had to rank all 29 schemes within London from Ealing to Enfield, Bromley to Barnet and everything in between. Where you would actually end up remained a mystery until a few months before you were due to start!

So as a person who isn’t much of a planner, I sit here chuckling to myself at my attempt at being organised and writing a ‘to do list’. Although with only a few weeks to go, some would argue I am totally leaving things to the last minute! Alas, you have to start somewhere!

Pri’s Uganda to do list:
1. Lonely Planet
2. Anti-malarials
3. Dioralyte
4. Paracetamol
5. Ciprofloxacin
6. Sun cream
7. Ibuprofen
8. Insect repellent
9. Anti-histamine
10. Imodium
11. First aid kit
12. Torch
13. Post exposure prophlaxis (PEP)

All the above are essentials and it is only the beginning of what is looking to be a very, very long list…! I shall not bore you all any longer, however any suggestions are most welcome!


Expecting the Unexpected…

5450896108_93cdda258cAs doctors we are trained to manage risk and uncertainty. Given the variety of patients we see on a daily basis very little surprises me now, and even less shocks me. Just about anything can walk through your door, every 10 minutes, and you have to be prepared.

During my registrar year I have been so fortunate to have had Dr Daniel Goldwater to mentor and train me to deal with challenging clinical encounters. At times, we have spent hours debating what we have seen and learnt from our patients. We often use the ‘prospectoscope’ as a tool to look forward to decide what the best management plan should be. This means looking at all possible outcomes (usually along the lines of what if they have a heart attack and die) and then deciding how we can do the best for our patient. This is then backed up by ‘the sleep test’ whereby if we can go to sleep at night with a clear conscious then as a doctor you won’t go far wrong.

There are 2 rules in the Goldwater house – “tell no lies” and “always tell the truth.” This transparency and strong moral compass, which I also identify strongly with, has allowed me to develop my own thoughts and opinions in very positive environment. As I look onwards to my own life after GP training, I’m not sure where I will be working or what I will be doing, but with a solid foundation, I feel ready for what lies ahead.

So it did indeed surprise me when I actually started to feel a bit nervous about going to Africa. I really have no idea what to expect. Most medics will agree that because you have to be such a control freak at work, your personal life can often be left in somewhat of a mess. I feel a little bit like that now. My tickets are booked, but that’s about it!

But I think that’s half the fun, all I really need is my passport and my toothbrush right?!

Swotting Up…!

simple-47526_150Before leaving on my mission, I wanted to better understand some of the health care issues facing Uganda.    The overwhelming statistic that resonated with me was that the average age of survival in Uganda was 59 years compared with 82 years in the United Kingdom.

I found this rather shocking and it made me realise perhaps how much I had underestimated the challenges I may face when I am out there.

A few key facts on Uganda:

Full name: Republic of Uganda
Population: 35.6 million (compared with 64 million people in the UK)
Capital: Kampala
Area: 93,072 sq miles
Major languages: English (official), Swahili (official), Luganda, various Bantu and Nilotic languages
Major religions: Christianity, Islam
Life expectancy: 59 (World Bank 2012)
Monetary unit: Ugandan shilling
Main exports: Coffee, tea, cotton, copper, oil, fish 
GNI per capita: US $510 (World Bank 2011)
President: Yoweri Museveni 

After spending time learning about the burden of disease in Uganda, I feel I should reserve any comments until I have spent some time on the ground gaining first hand experience and then report back.

My reading revealed types of conditions or problems I may encounter would likely include:

– Tuberculosis
– Malaria
– Maternal Health – women in pregnancy, child birth and the post partum period
– Child Health
– Family planning

But as promised I will keep you posted…

Trust me….I’m a junior doctor!

So it’s only fair I tell you a bit about myself. Overall, over the past 5 years the transition from the first day on the wards as a doctor to the present day has been so great, I barely recognise the girl that was.

I don’t think any doctor ever forgets their very first day. I think a mixture of fear, delight and awe at those who make the job look anything other than impossible pretty much sums it up. You learn VERY quickly. The smell of the hospital soon becomes homely, you are not bothered if a patients bodily fluids ends up on your new pair of shoes because you have stopped buying expensive ones, and most importantly you no longer pray to not be the first person who turns up to a cardiac arrest or medical emergency because you can actually save a life.

And medical emergencies happen, all the time. Whether it is 4am on Christmas morning or 2pm on any other Wednesday, you can guarantee something will be going on. Noone can really prepare you for life as a doctor. The long days, weekends and  nights on call make your friends and family often believe that you are a phantom existence. It is not a job, it is a lifestyle and it can be bloody hard work!

You see people at their most vulnerable, and you invest so much of yourself in doing the best for them. You see many injustices, bad things happening to good people, and you are the person that has to convey this news to them. You stare death in the face  more often that you allow yourself to admit. Even to this day, no matter how often I am asked to certify death in someone that had passed on, I always take someone with me for fear of being alone. It is these small things that keep you human.

I have gained a broad range of experience from General Medicine, General Surgery, Psychiatry, Obstetrics and Gynaecology, Paediatrics, Infectious Diseases, Genito-Urinary medicine and, of course, General Practice. The life experience is immense,  you cannot not be changed by what you see. You never know what is going to walk through your door. I often think to myself that if I have learnt so much from my patients in such a short space of time, the wisdom of more senior colleagues is unfathomable to me at times. I am just starting out, and whilst I have the basics down, life throws new and exciting challenges at you and the patients you serve daily to keep you on your toes.

It is definitely not glamorous, but it definitely is worthwile. If there is one thing I have learnt, life is short, one must live it, and I plan to do just…

Hello, I’m Doctor Pri!

I am a graduate of the Guy’s King’s and St Thomas’ School of Medicine. It is here, after being interviewed by Dr Dipak Kanabar, I started my journey fresh faced and starry eyed at the age of 18.

Now, I find myself after 11 years of training, standing on the edge of the unknown. The notion I may actually become a member of the Royal College of General Practitioners seemed almost unreachable at points, and yet this week, those words ”competent for licensing” appeared before me. It’s a strange and humbling feeling, being fully entrusted with peoples lives, and it evoked a lot of unexpected emotion.

My greatest realisation, however, about coming to the end of training, is that it is actually only the beginning of absolutely everything! At which point it dawned on me, that I have spent so long trying to get here, I haven’t really thought about what comes next! Fortunately for me, I was not the only one feeling like this, my trusted colleague and dear friend from medical school, Alka, felt exactly the same way.

It is no secret that the face of General Practice is changing, everything is in a state of flux, and whilst I was so proud to read just a few weeks ago that the NHS was voted the best health care system in the world, unfortunately at times, you can feel you are being pulled away from what drove you to medicine in the first place.

My mother was born in Jinja, Uganda and my father attended Makerere University School of Medicine, Uganda. They, like all the Asians’ were expelled under Idi Amin’s rule in 1972 and fled to England. They have never been back to The Pearl of Africa, but it is somewhere I have always wanted to visit.

I decided this natural break in my career would be the perfect opportunity to use the invaluable clinical skills I have acquired and combine it with a visit to a country very close to my heart. After emailing everybody around the world with any links to charitable projects in Uganda, I had just about lost hope, when I was put in touch with Dr Dipak Kanabar. It seemed like fate. As a man who took a chance on me all those years ago, he is also a man who has a love for his home town of Jinja. Within minutes he had put me in touch with Dr Debbie Singh Ahderom, an Australian GP living in Jinja and our plans had been made.

As I undertake this personal and professional adventure, I look forward to sharing my thoughts, feelings and experiences. Please do join me in discovering what lies ahead.