Medical Officer Diaries

“Can’t you stay back in Dhaka?” An old patient asked me during my Ophthalmology rotation when I was in medical school. I politely answered, “I have so much work to do in my country.” While sitting on a chair in my two-bedded room in Dhaka, I had always dreamt about working in Nepal and making a difference for my people. Ever since my arrival in April, I have been trying to make that dream come true. It is very easy to give other people advice or write about how one can make a difference but it is indeed very challenging to implement your values and principles.

We, humans, are subject to greed, comfort and leisure and that pushes us back at a time when we have to make radical decisions in life. When one wants to jump into a road never taken before, one has to think about a whole lot of things, and usually, one comes to a conclusion that life is better when you have loved ones around you. Why leave the comfort zone?

The work is the exact directory of what we were taught in medical school but it comes with politeness and behavior. It requires you to show your dedication on a daily basis and it rewards you accordingly. The shortage of Medical officers is a new uncharted topic that most people never touch upon. It is hard to find people who decide to work after completing their medical school. It is a huge commitment plan that doctors make on the basis of various statistical data and family pressure. Earning a degree and not working is considered worthless in the eyes of the society. A medical officer learns how to follow a consultant and how to stay in a boundary. There comes a point within a month and year when a medical officer starts rejecting the peers of being the third in line to treat a patient.

How can a hospital tap a medical officers potential? Well it depends on the institute they work for. Medical college hospitals try  as much to utilize the capability of their medical officers whereas private hospitals just make them their mediators between patients and consultants. Education wise you need a specialization to survive and avoid any insecurity about what and how you can make a difference.

Competitive examinations carried out in Nepal are not sufficient for the larger majorities of graduates. With just hundred seats in IOM and five thousand applicants it is less likely you will be hitting the jackpot with insufficient studying capacity. The learning curve studied in com med class is not helpful at all as it keeps reminding you to learn at a tender age before its too late or is it? When my senior suggested that he worked as a MO for four years before he tapped a major examination is worth reconsidering. Writing has always pushed me to become a better person and yet this is might push me achieve the dream that I evolved over five years.

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What To Do Next? Part -I

 

“The best time to plant a tree is always twenty years ago. If for some reason, you did not plant it then, the next best time to plant a tree is now”.

I had involuntarily shared my interest to become a doctor to Kitty. She was a replica of Anne Frank diary. Most people obtain habits from influences with human relationships; I made my influences limited to books and novels. I tried to be regular at it, but often had to apologize to Kitty when I exceed a week or two.

This winter break when I got the opportunity to flip through those pages again, I realized that at 16, I had decided what my next 20 years would be like. At 16, I was locked in the boundaries of Saudi Arabia. Inspirations were showered through the Indian system of knowledge and I thought I would attain the highest attainable degree in the world like most of my friends, who discussed and shared their higher level of thinking in the lunch hour.

Two years after I departed from Saudi Arabia to finish my junior school, I was lost. I was not sure what I wanted in life. My dreams were fading and I was drifting. My dreams were not nurtured and motivated to that level. Then by the grace of the Nepalese Government, we decided to move to Dhaka. “Med school is cheap in Dhaka”, is what they said. People around me motivated me after that, they helped me to map out my dreams and they enhanced it with “pride” and called it a “great respect for our family” if I decided to go to a med school.

Plans are meant to be thought, processed, assimilated, digested and beaten up until something new emerges. That’s called life. You can’t map out your life like a building block but, you should have the courage to dream big, no matter what people have to say to you. Dreaming is your right and no one should rob you of that.

Turning into a general physician was my goal and after nearly two decades of unknowingly what life direction I would go, I completed it. But even after completing one goal, I am hungry for more. Life right now seems so undirected. I need a goal and a new direction. Where would I go, what would I do?

I cannot limit myself to just a “general physician.” I want more! Most people decide to choose London or Canada for under graduation. But I choose Bangladesh with full cooperation and with hundred percent certainty that my life would be different, if I choose to stay in a third world country. I would turn out to be humble and I would stay ground to earth if I choose to feel the pain and suffering of the normal people. I still remember how I had to convince my parents that leaving me in Bangladesh would one day make them proud parents. “Let me suffer today” I said and later on, I can get all the happiness in the world. Plant your dream today, who knows ?,it, might come true. I don’t write to Kitty anymore but she played a very crucial role in my life.

Typical Medical Student In Dhaka

I am just speaking out for all the medical students who come to Bangladesh to accomplish their dreams of becoming a doctor. It’s my final year and I know how things work here, through and through. So here’s a list of things that you will end up doing, especially when you study in the capital city.

  • You will spend a lot of money on food. You will either spend most of it on fast food chains or you will end it on junk food for your “while you study” regimen.
  • Dhaka is no place for partying or drinking. Alcohol is prohibited and the only alcohol that you smell is at the airport lobby before the final immigration hassle. So forget about how much you enjoy you Gin and Tonic and try adjusting to “Tang Juice “and “Prawn mango “drinks.
  • You need a serious wardrobe change up, no low cut vests and you can say good bye to your shorts and skirts. Because here, people like to see girls all dressed up from head to toe, despite the scorching sun and heat. It actually depends on how you handle the wardrobe change in your life, I have seen girls dressed in the usual clothes that we wear in Kathmandu and they do get the blunt stares but somehow they dare to manage it without much fuss. For me, I personally like to dress in “Salwar Kameez” when I go out or I wear the “Kurtes” the rest of the time. You should be comfortable in what you wear and thats my fashion statement.
  • Trying to adjust with the fact that most of the books that you just bought are photocopied versions of the original and move on with it. I think the fake ones are better than the original ones and money-wise it saves me half the amount that most med’s have to pay in other parts of the world.
  • You need to learn “Bangla” fast, like within a week or two because most of the stuff happens in this very language, its mostly like Nepali but the old Sanskrit version of it. It’s easy to understand but you need time to work on replying back. No matter how much one glorifies a college, most medical schools teach in Bangla at the very starting and end of the lectures. But no harms done when you can understand what they say.
  • It depends on which college that you go to. Mine, well literally forces the balls/guts out the students to study so basically when I am bored to death and wish I was not a medical student, I still would be studying or giving an exam. There is no way out of this mess of items, card finals, ward ending exams, block finals. So, you repeatedly get beaten up, mentally of course to study all your life, as long as you are in Dhaka. You life becomes a mess when you can’t balance the pressure and fun.
  • Coming to the part, “Fun”. What’s the fun part about being a medical student here? Well, none, besides that fact that we spend half our times obsessing about how our fellow med students in Nepal are having all the fun that we did not get. And the rest half of the time goes into studying excessive theory, seriously, like as if we are giving the PG exams the next very day and we stay focused, because there are no distractions, except when you fall in love, but that’s rare.
  • Is Dhaka the right place for you? Yes, if you can learn to cope up with new changes in your life, starting off with eating, living and defining fun, all together, if you need some seriously studying to be done with less distraction for the rest of the five years and six months then this is the best place for you. Once you make a group with a bunch of people that you like hanging out, you will always find ways to have fun and satisfaction in life in ways that you could not have imagined.

History Writing in Medicine

Starts from the moment when the patient enters the room (only possible in outpatient department), what’s the gait of the person? Does he/she have an abnormal walking pattern, use a stretcher? Etc

In, in- patient department starts with a smile and a general handshake. Be as polite as much as you can and introduce yourself. There are three things that just happened, you visualized his/her face and shook his/her hands, and these two gestures tell you more about the disease. The smile, well it helps to establish the rapport.

One of the most important factors, in history writing; understanding the patient, being empathetic and noting down the key points that he /she describes. Also, one of the most difficult aspects of communicating with the patient lies in comprehensibility. Does he/she understand what you are trying to ask? For example, if you ask an old lady from the village, if she has diabetics, she would not understand and she might utter an insignificant answer like Yes / No and later on, complications might occur when you start treatment. For this case, the most appropriate question would be; has the health worker warned you about avoiding any sweet food?

Going to their level, understanding them and treating the patient as the centre of your attraction are the key ways to deal with history. If you get a call in the middle of the history, (try keeping your mobile’s at silent mode or more appropriately turn it off). The more you treat your patient like your girlfriend or boyfriend, the more you can succeed in becoming what you have worked so hard all your life.

There is a gap between the doctors that are made today and the regular patients. My point being, in order to get an MBBS degree, you need minimum 15 Lakh taka or rupees and the parents who can afford this money hail from a middle class family, who have raised their children well enough to avoid any hardships in life. So there is gap between what the patient’s try to convey and the student/doctors who try to understand them, especially in the South Asian countries and that’s when the patients complain about how med students and doctors misbehave with them.  Well, it’s a matter of practice and human nature that we are dealing here; best way to avoid this gap is to deal with as many patients as you can.

History helps you make a provisional diagnosis but the true diagnosis or definite diagnosis comes after some investigations and if the senior in charges says so. You can never have a perfect history without practice and the cooperation of the patient. Treat your patient well, they can pass you or they can fail you, it entirely depends on their co-operation and if some patient passes a comment like “I think you will become a great doctor, I will pass you!” your efforts and your sacrifices are worthwhile!

Depression In Medical School:

“I don’t feel like studying, I don’t want to be a medical student “, this is one of the most common sentences that one uses in med school where depression lurks around very often.

One of the most common problems that one faces in med school is depression. This is an oppressed topic because no one wants to accept the fact they are going through all  that and also the fear of stigmatization makes it difficult for students to ask for help.

Most med students are sleep deprived individuals who are constantly asked to make the daunting task of memorizing different facts. They are credited, categorized, marked and judged by their ability to present the facts to the almighty teachers. When one fails to present facts with precision, they usually become victims of taunts and constant pressure.

Most med’s experience depressive phases especially before the examinations. It’s also called the most venerable period. Med students try to become like robots during that phase, constantly memorizing facts, making acronyms and mnemonics to learn as much they can from the textbooks. They have three purposes in life at that time, to study, to eat and to poop.

Others med’s deal with depression during the hospital rounds. When they deal with the clinical aspect like when they face patients and the grief that is attached with them. One also face’s depression when they are asked to give constant oral examinations.  Humiliation severs two purposes during orals, it either encourages you to study more for a test or it cripples you to the floor.

It’s always the test scores; right from the beginning one compares the result with each other. Everybody in your class is a competitive master, when one fails and the other passes; there is an automatic division between who studies well and who studies average and who do not seem to care anymore. Other factors that lead to depression are the failed relationships, the lack of commitments that one shows for med students.

It’s the inability of med students to balance fun and study.  One can easily balance both if they search for fun in their studies. There are different methods other than the normal act of opening the text and memorizing. Encouraging and participating in regular discussion with friends can also give the same input. Other methods like learning by doing, meaning writing down whatever you learned can also be useful. “It’s easy to forget, it’s hard to remember and it’s even tougher to implement.” But Rome was not built in one day and you have to start and finish what you started.

Depression has its several manifestations, while most med’s deny the fact, some openly agree to the fact they get depressed by the test score. People have their own way of dealing with it. Some med students hide it behind heavy alcohol consumption, some by behaving recklessly with life and some behind the world of social media.  No one wants to seek medical advice because of the stigmatization of the disease and the social pressure that one has to go through.

Even if med students wished to seek medical advice they are sent back with beta blockers for anxiety and asked to attend classes as per schedule. Psychiatrics think that med students use malingering as a tool to get leave from class. They are no statistics for the rate of suicide attempts in Nepal especially for those that happen in med schools. But looking at a statistics based for United States, the rates are high enough for one to ponder on this issue.

Giving student’s responsibilities like dealing with primary prevention of disease, giving them credit despite their inability to perform well in class and appreciating them for the fact that they have chosen this profession for the betterment of humanity, might make the situation much less dramatic. What med schools especially in the South Asian Region, needs right now is to set up physiatrist advisors for each students so that they can discuss and deal with any kind of depression that comes their way.

First Day Of Med School !

BMJ(British Medical Journal) has a small unit called Doc2Doc, last week they had asked all the medical students around the world to describe how their first day was as a med student and the winner could win up to 1000 dollars worth credit, the offer was tempting but I just passed out the offer because I have a much longer story to share and it does not only involve the first day.

There were many people who did not want me to join this profession, they shared their guts out with me, and they described their painful days of studying night over night. But at that moment, I just had this stubbornness which was beyond anything. I was not compelled to get into a med school. Nobody understands the reason why I joined this profession; people still think that it was because of my dad and his post here in Dhaka at the time. In fact my parents were not much up with the very idea but I was reluctant and I was lucky. I got a seat in Bangladesh’s most Sophisticated and Respected University.

I still think about that day when I took my mom to the emergency room at the Teaching Hospital in Kathmandu, she was suffering from UTI (Urinary Tract Infection) at the time, she was having excruciating pain. We had to wait for the culture reports to come and at that moment I observed something that changed my life forever. Doctors were passing from one room to another, with their white aprons and stethoscopes. The sight of doctors brought so much awe in me; I developed respect for their profession. My mom’s saviors! I told myself silently: I am going to be there for my family when ever this kind of situation comes. I made my mind before my dad got transferred to Dhaka. I eventually became a nerd after tenth grade, pushing every moment to get better grades. I was told that they did not take any exams for Foreigners for entrance exams. Achieving a GPA score of above 8.0 was all that I wanted at that time, so I was a social outcast at that time, gave my friends less time and lab work and tuition the first preference.

The first day was rather a surprise for me, all of us were placed in the Lecture Hall, the Vice Principle clarified that our college was a government one and was directly under the Ministry of Defense. People often ask if AFMC is a government or Private College. Later onwards we were taken to the dorms, we had to share a room with four other seniors.

Most people would expect heavy ragging instead we were treated with chocolates and we were told some rules about how to behave in front of seniors. I was quite perplexed about this; we were supposed to say “salam walakum” to each senior that passed by us, which were followed by some other rules about senior respect. This still is a huge factor in AFMC, Respect and I guess this college did teach me something about that, It’s not that my parents did not teach me this but this college , enforces it in our day to day life.

We had to go through one tough month. We were practically grounded in the college dorm for a month, and we did physical training everyday followed by Drill and Games in the evening. We were constantly active and we had to adjust to the circumstances that we were in, complaining was not an option but compromise became the new word for that. The first one month, we did not do any regular classes, but did some introductory classes on Anatomy, Physiology and Biochemistry and Etiquettes. We were rewarded with Epaulette after the first heavy training in a ceremony.

Life goes on as a medical student. I had many low and high days and still do. I always fret before giving an exam. It’s tough and it becomes tougher as the boards near. The Journey which started from Jan 2007 had many bumps in between but I guess I was too optimistic to let the bumps slow me down.

The most memorable moment that I ever had till now was when I was in my third year. I was in Medicine Ward when I was examining a patient; I was palpating his lymph nodes of the Axilla (armpit). Another patient next to that bed, an old man said that he will pray to god so that I become a great human being/doctor one day. That day was a remarkable day for me. I feel blessed to have joined this profession!

Happy Deciding People!