Uganda Healthcare Expedition Part III & Other Musings

It feels like the last couple of weeks have been a little ‘strange’ to me, since coming back to Leeds. There have been days where I was so driven to do things, but there have also been days where I haven’t been quite as motivated. For a while, it felt like time was going so slowly and I was feeling rather blah about things…and it’s only been two weeks!

The first weekend I spent since coming back to Leeds may have been a productive one. This is despite having many movies running on at home, probably too many to count. I was able to sit down and literally brain storm ideas on the whiteboard, for the cervical cancer screening programme I am organising in Bwindi-the objectives, statistics, equipment, screening and treatment options, current infrastructure, collaborators, funding organisations, questions to the hospital, the list is endless.

Despite taking a solid weekend, it felt like for the first time, I was able to create a vision in my head of what the programme should encompass. I have already sourced the equipment in Uganda instead of in the UK as I originally planned, and am looking into funding options for these. I have also been in touch with the Royal College of Obstetrics and Gynaecology, Manchester University and important charities who have expertise in this field of medicine. I’ll admit some responses have been slower or less helpful than others, but I do have some direction of focus. If there’s anything that I’ve learnt, it’s that you should keep going until they tell you no.  I’ll give you an example…

In my previous blog post on the expedition, I mentioned that I was in contact with a gynaecology registrar at the hospital. Unfortunately responses from him thinned out, to the point that I directly made contact with the Royal College itself for advice and about a potential staff training course for the healthcare workers. It was useful to know that this is a pilot, in which they require more information from the hospital. At least I knew this now and in my mind, this still wasn’t a no.

The beginning of last week was probably not one of the best ways to start the week off…my uncle passed away.  I received a flood of text messages from my family asking me to ring them back, and this was unusual for them. Though we weren’t very close, I was still upset. He was my uncle, and every time we made trips to Sri Lanka, he was always there.  I took a couple of days off work though weirdly enough, it felt like I wasn’t present most of the week. However we’re managing to carry on. I found it weird how every time my family asked if I was ok, I actually felt worse. I don’t know if that’s normal, maybe I just wanted some space for a bit.

This week almost feels like things are a little bit normal again. I’ve been trying to get on with things-marathon training (which I recommenced today), chasing jobs for the expedition, reading and establishing a routine again. Yes sometimes I like normal. Normal is trying to keep yourself busy and occupied with something, wanting to wake up in the morning to do it. Its important, it helps you get through the not so nice times, and it can help you feel a little less blah about yourself.

Live Your Life

As I head back to Leeds on the train again, I reflect on how I spent the last few days in my home city, London. I use train journeys as a golden opportunity to recollect the good memories we made at home. It’s always something I can come back to.

I hadn’t been at home in just over two months, and hadn’t seen my family since I did my exam. It was nice to actually spend a few days with them, not just a weekend. In addition to getting a hair cut, I took the opportunity to meet my cousins. A couple came over to see us and I met up with a close one in the city.

I always enjoy going to central London, and this trip was no different. I love the fact that it’s literally a 30 minute trip on the Underground to get there. I met my cousin at around 5pm in London Bridge, at a fresh Italian Pasta restaurant called Padella. Despite the early dinner and neither of us being particularly hungry, we somehow managed to consume 3 pasta dishes, a chocolate torte and a bottle of Prosecco between us! I hadn’t seen her since Christmas, so there was a lot of catching up to do.

After having our meal, we walked across the city centre. Starting at Borough Market, we made our way along the River Thames and passed many London landmarks-Shakespeare’s Globe, the Royal National Theatre, London television centre, the London Eye, Sea life London Aquarium, Dungeons and Dragons, skateboarding sites, the list was endless. Streaks of sunlight were seeping through the clouds still, yet nobody was cold. Everybody looked happy and was in a good mood. We said our goodbyes on London Bridge at around 8.30pm and we went home our separate ways. My understanding is that the London terrorist attacks took place two hours later.

The following morning, after waking up to numerous Whatsapp messages to check people were safe, I went to a barbeque my sister was organising for me and my parents. We were joined by one of my old family friends who I hadn’t seen in almost a year, and her American cousin who I briefly met at my sister’s wedding. I won’t lie, I thought I had felt a little awkwardness between us, maybe because I hadn’t seen her in a long time or maybe because they were guests. However I think it settled…my sister showed us wedding videos (some of them I knew I’d seen before) and we chatted again like old times.

After the barbeque, we drove to my friend’s house where she was staying with her parents, whilst she was back in England. Her house always reminded me of happy childhood memories and the days we used to hang out there. Her cousin was a medical student and talked about the medical school system. He also invited me to come to America. Yay! My first American friend! It was even more lovely seeing her parents again. Her father is a retired GP and I had the utmost respect for him. He had a very good work ethic which my mother always talked about when I was younger, and I’d like to think  that he was proud of me. Hilariously he exclaimed, “ahh Chitra, you look like a 10 year old!”, and we had an energetic conversation. We talked about the hospitals I worked in and he was happy that I can do LPs, (lumbar punctures), stating “yes, you’re a doctor”.

I definitely enjoyed my time in London, I always do. I love trying to make time to see old friends and family, because I want to be reminded of my roots when I tend to forget them. This trip back to London will probably stick to me more, because of what happened in London Bridge. Last time I met up with my cousin was around Christmas time last year. We met up later in the evening and I came home later. What if we decided to meet up at a similar time this year? It’s almost terrifying to think that, and I did lay awake that night thinking about what could have happened.

My mum mentioned that I should stop going to central London often (as if I go often!), and brought up many a time, how I encouraged her to take trips there that very evening, before we heard the news. But really, should something like this stop us from carrying on with normal life? According to her, it almost felt like she believed that. Yes maybe I’ll be a little cautious, but I won’t be living in fear. We have a life to live and we should live it.

We are Family

I managed to accomplish another task on my list of things to do this year.…I passed my first GP exam 🙂 Having kept a close eye on the website (might I add all day), the results came through this evening, as I was naturally happy. It was a hard exam and I didn’t know which way it could go.

I got home and spoke to my family back home in London. Unfortunately, I received some strange responses:

“So you’re almost there now, you can be a lazy GP”

 “You can write out prescriptions, send out x-ray requests and patients to hospital, while drinking tea”.

Was I hurt? Well no at first. I was still trying to let everything sink in.  However after hanging up, I reflected on that conversation…why were they being so negative? Why did no one stand up for me? I couldn’t tell if they were being ‘haters’. Yet these are the same people who are constantly calling me up for informal advice.

A few days later, I brought up this conversation with my family, and how I didn’t appreciate some of the things they said. They apologised, and expressed that they were supposed to be jokes. Maybe it’s me, I heard it too often, and it sticks with you. I did forgive them however and we moved on. I haven’t told them about what else I’m trying to achieve in my list (point 4 to be exact). They don’t even know what’s coming.

Handbags and Gladrags

Having worked in this psychiatry post for almost a month now (seriously, where does the time go?), I realised that I’m still trying to adapt to the things and to the people around me. I’m very slowly getting used to the idea that in this job,  you run your own diary, and your own show. As sad as this sounds, I got very excited when I created my own list of patients(!). This maybe the first time in four years, that I feel like a ‘grown up’ doctor.

I tried to think why it is that all of a sudden, I feel this grown up. Two ideas came to mind:-

-Working in a community orientated environment does mean you’re basically in charge. In previous hospital jobs, particularly A&E and stroke, you’re definitely not in charge.

-I’m surrounded by older psychiatrists!

So now that I realised this, I pictured myself amongst the others. I definitely didn’t look grown up. I noticed that my colleagues owned things I didn’t have, such as:-

  1. A diary (not your personal day-to-day diary, but one for home visits etc)
  2. A flask  (there’s a lot of tea drinking!)
  3. A bag

In point 3. I actually mean a proper work bag, one that makes you feel mature  and sophisticated. I’m afraid my rucksack doesn’t quite cut it..I look like a twelve year old with it!

I therefore decided to do a little shopping. In addition to my weekly grocery shopping, I also purchased these extra things. Funnily enough, when I treat myself to something (which is rather rare!), I subconsciously tend to spend less on my other shopping. Halfway through purchasing however, I thought to myself-am I doing the thing that I told myself not to do, am I conforming to the others’ expectations?  I couldn’t tell which was worse, conforming or realising that I might just be getting a little bit older.

Express Yourself

I officially started working in community psychiatry this week. It’s VERY different from any ward I’ve ever worked in, because you’re basically your own boss. You review the patients that are allocated to you-and that’s it! You choose when you want to run your own clinic to see them, and plan your own home visits-there’s no fixed times!

I share a nice large office with one of the senior psychiatrists. I thought about making my area a little bit homely.

img_3352

I always stick a little post-it note just in front of me, with my personalised list of important numbers. So far it only has the IT number! Do you like the background picture I chose? I like clouds! 

      img_3351

Now compare this photo to the one above-unfortunately THIS is what my computer looks like. The first photo shows just an enlarged picture of what I wanted displayed as my desktop background.

Yes, whilst I tried to personalise my work station a little bit, I found that the system actually wouldn’t let me change my desktop background, it was forbidden! I’ve had to shade bits in white in the second picture for confidentiality reasons, but it’s not exactly pretty still.

It made me realise that there’s a limitation in how people are allowed to express themselves, or just be themselves, especially while they’re at work. For one reason or another, they’re expected to conform to the look of the job. This probably doesn’t apply to a lot of organisations, but regardless it happens. I don’t think there’s any harm in expressing yourself, be at work or elsewhere-because it’s just who you are. As Gandhi states:-

“I want freedom for the full expression of my personality”.

I’m Listening

Having worked in the stroke wards for 6 months, this was the week where we moved onto our next rotation in the training programme. As of now, I’m working in community psychiatry, a somewhat different specialty!

Over the past few days, we’ve been having induction. This mainly consists of lectures, IT training and something called ‘Breakaway Training’ i.e) how to safely defend yourself, when confronted with a patient who poses a threat.

frasier-frasier-crane

I’m afraid we’re not working in psychiatry of this nature, but I do love Frasier -‘I’m Listening’

I met the other 15 or so doctors who also joined, mainly consisting of GP trainees and new psychiatry trainees. They all seemed friendly and approachable, all with varied experience. In my mind, I was trying to categorise where they came from and what their backgrounds were, just out of pure curiosity. It turned out that I was one of two people from the group, who hadn’t done a training programme prior to GP (or was married!). Coincidentally, that made me the youngest of the newbies (which I hope is a good thing!).

By incorporating all of the above, I found that the trainees had almost formed their own social groups (I mean, how many can you form in a group of 15?!). However, they were able to do this by relating to their backgrounds-previous training programmes, previous career options,  marriage, kids, not wanting kids. I heard someone say ‘we didn’t know whether we wanted a dog or a child first..so we went for the dog!’ Talk then switched onto psychiatry, in particular from a psychiatry trainee.

I suppose the whole time through these conversations I thought to myself, why is it that we always talk about the same thing? It’s either about work or about life’s expectations we’re supposed to conform to (dare I say so myself…the wishes of my mother, who wants me to ‘settle down’, like others she knows). Maybe I am inexperienced in these things still, but at the same time I wonder…why the same chit chat? Was it because we’re all new to eachother? Was it because of such similarities in the older trainees, it was all that was spoken about? Or was it because there isn’t anything else to talk about?

Workplace workforce

As I almost finish my 6 month rotation in stroke, I start to reflect upon my time there. It has definitely been a whirlwind experience…but needless to say I did learn a lot, on a clinical level and on a personal level.

One of the jobs junior doctors are required to do are discharge letters, where we write a summary of a patient’s admission, on the day we send them home. For some reason, everybody gets so worked up about them. One day when I walked onto the ward, not two seconds into washing my hands at the entrance, did the ward clerk ask me..

‘Has the eDAN been done?’ (aka electronic discharge summary)

I replied politely and informed her that I’ll do it today. The patient was going home in the afternoon, so I had time to do a ward round and see some sick patients I was alerted off overnight (which was MY priority). After washing my hands, I join the ‘safety-bundle’ meeting with the nurses, where one of them asked me the same question. I just gave her the same answer (so that’s two people in 15 minutes). Halfway through the morning, after seeing the patients I wanted to review, I wrote my letter. As I was about to make my way to let the nurse know that I’d done it, she came up to me to ask if it was done, to which I replied yes (that’s three people, and I thought that would be it).

After lunch, an occupational therapist asked me if the letter was done. I was somewhat baffled at this, because number one, I hadn’t realised that they are involved in the discharge letter, they don’t write them and they don’t sort out the medications. Number two-I already did it! And told someone that I did it! I was getting frustrated inside and I replied ‘yep’, and that was it. That was 4 people. You would think that would be the end of it (well actually you would that would be it after I told the nurse before lunch) but believe it or not, I was approached by the discharge coordinator, asking if it had been done. Are you kidding me?? I felt myself about to lose my temper, at something so trivial. I think I said something along the lines of ‘it’s been done’, and I walked out of the office.

FIVE people came up to me, all demanding the same thing. If there’s one thing I’ve learnt, it’s that there’s no trust in the organisation. If working on this ward for 6 months hadn’t earned their trust, what did? The CEO of the cosmetics company LUSH,  Mark Constantine, came up with a wishlist for his employees, where they can request one thing from him. One employee asked if he could pay for their wedding in Italy…and he did.

You can trust your employees to work for you, recognise how hard they work and reward them. No I’m not requesting a wedding in Italy! But to have that level of trust in a company, or any sort of organisation is invaluable, yet at the same time you feel valued. That day I felt undervalued more so (which is unfortunately not uncommon for junior doctors). In my previous rotation, I was a victim of bullying…where for the first time I raised this sort of issue with senior colleagues. It’s all sorted out now (and according to my trainers, the department was genuinely terrified of me afterwards!). Following another similar incident in this rotation, I didn’t raise it until much later (because though it was really bad, when comparing to the first incident, it wasn’t that bad…if that makes any sense?!).

I’ve started to believe that if you can love yourself and cherish yourself, give yourself some sort of worth, you don’t allow people to treat you in any other way, except in a way that is loving and healthy. I realised that in the future, if I was to start some sort of organisation, I would only have people who I would want to be my bosses, work with me. We would keep the trust, because how else can you work in harmony?