Book Review: ‘When we left Cuba’ by Chanel Cleeton

I learnt about the Cuban Missile Crisis all those years ago during GCSE History which is one of the reasons why I picked up the book, that and the rare occurrence of female spies.

The novel is set mainly in Palm Beach in Florida where the Perez’ family, having fled Cuba, try to integrate themselves into high society and marry off their daughters. Beatriz, who’s story we follow is a rather likable character – strong willed and unwilling to bend to familial pressures to marry well.  The only word that I am able to label her with is that she has a deep sense of ‘hiraeth’ which is a Welsh word transcribing the fact that she is missing something – for her it is of a different time, a time where she was in Cuba. This seeped through the pages and made me notice the similarities between how she felt then and how we live now. We are so interconnected through technology and have the ability to travel so far away from our roots that we are able to settle wherever we please without sacrificing relationships and yet perhaps ‘hiraeth’ is woven into our soul.  We seek mountaintops and sunsets to feel something but when we physically leave a part of us never leaves, not completely.  We see it in our mind when we dream, when we feel sad or lonely.  We all seek for some sort of utopia where have have all our favourite things in one square mile.

Although the mild scandals and occasional breath-taking kisses make for a good historical romance, it feels a little lacking in the espionage sense.  Nerve-racking spy scenes are built up but fail to deliver as they are glossed over quickly in order to connect little communist threads together for the final scene.  What disappointed me was that Beatriz had such incredible conviction in her determination to help change Cuba by taking down Fidel Castro but this energy was dissipated in the detail lacking spy scenes.

Saying that, she is a complex character and is a refreshing change to others which become house/trophy wives.  She remains true to who she was in the beginning and makes a life for herself, becoming independent of the men in her life.  It has a strong ending conveying legacy and heritage and the promise of change to come in a way that says that we may not have seen the last of the unconventional Beatriz Perez.

MPharm: Second year Placements

It may shock you to know that pharmacy students get very few placements but thankfully Cardiff University are trying their best to get us some, starting with a week in community pharmacy and two days in a GP practice for second year students.

As I have worked within community pharmacy for a few years now I knew how the pharmacy runs and what to expect. It takes years to figure out the pharmacy but there are other students that had never stepped behind the counter who had to learn the ropes in just five days…good luck. I was allocated Well Pharmacy in Llantwit Major, and I’m naming the pharmacy cause they were absolutely BRILLIANT! I had expected to be on the counter all week, bored out of my mind; but I’ve been so busy and learnt so much it has been incredible.

Volunteering to do something goes a looong way when you’re out on placement.  I hate just standing around so I asked if I could date check, which allowed me into the shop team’s good graces throughout the week.  Even just being in the shop really made the think about processes within community. I have only worked for one community pharmacy company but seeing how Well pharmacy did things it does make you wonder why everyone isn’t doing it that way.

At home, after items are dispensed, they’re placed in a plastic bag and hung by surname alphabetically, and since this is Wales when it comes to finding John Jones’ prescription it takes about an hour to go through all the ‘J’s. Off Site Dispensing (ODS) was also bought in during the summer and patients regularly complained about the 2-3 plastic bags that they were given each month, with the company saying that plastic was used for confidentiality reasons etc. With Well, it’s a little different. And it just makes perfect sense.  All items, including ODS are packaged in paper bags, closed shut with stickers.  Then the bag is scanned with a little hand scanner and allocated an an area to live until its picked up e.g. F9 (shelf F, 9throw down).  Therefore, when John Jones comes in for his prescription, the staff type his name into the scanner and it tells when exactly where it is, so they only have to shift through like 8 other bags to find his. So beautiful, brings tears to my eyes. Plus, environmentally friendly, unlike plastic bags.

On Wednesday afternoon I was allowed into the dispensary and dispensed away the afternoon.  I made a few dispensing errors but the ACT was lovely, and didn’t like condescend me about how I should know better or whatever.

We were given a booklet to complete during our placement and I had thought that I would just be left to fill it in myself but the pharmacist there has been proactive in helping me learn as much as I can, questioning me, making me look up interactions, and allowing me to sit in on consultations.

Before this placement, I was adamant that I was going to avoid a career within community. The daily repetition of checking prescriptions and all the paperwork just…(visibly shivers). I know that I want to become an Independent Prescriber and in my mind I thought that I’d have to specialise in something along the lines of asthma or hypertension but that pharmacist at Well had just qualified as an independent prescriber in contraceptives.  This is an area that I have a strong interest in and suddenly a future where I held clinics within community pharmacy seemed not so bad. I was lucky enough to stand in on a consultation of the ‘morning after pill’ supply.  The pill cannot just be handed over.  Questions must be asked to determine its suitability – how many days have passed since unprotected sex, when their last period was etc.  In this particular case a copper coil was more suitable and so they needed to attend a hospital sexual health clinic.

In some rural areas, taking time off work etc in order to wait for hours at a sexual health/contraceptive clinic which may only occur once a week just isn’t as easy option and so observing such a consultation has shown just how much community pharmacists can help with ease of access to services.

The following week I was at a GP practice and it is only recently that pharmacists have infiltrated GP practices.  They first began as cluster pharmacists – being shared between a group of surgeries but were quickly snapped up due to practices seeing a huge improvement in the management of medicines.  They have quite a varied role and it depends on the skillset of that particular pharmacist.

A new concept that was introduced to me during this placement was that having such a diverse team allowed the practice to triage patients so that they are matched to the healthcare professional which is most qualified/competent for their issue. For example, GP’s were only required to do medicine reconciliation and reviews – something that they (a) don’t have the time for with increased patient lists and pressures, and (b) didn’t know enough about.  Introducing a pharmacist for this role meant that GPs can tackle more complicated patients, leaving the independent prescriber pharmacist to sort less complicated cases, and those related specifically to their medications.

As we are an aging population more and more of us will be on medication, which leads to polypharmacy – a patient won’t just be on one blood pressure medication, they may be on three and a statin and they may need something for joint pain and for bone weakness and type 2 diabetes.  See how quickly patient end up with a shopping list of drugs? This means that its the pharmacists job to decide what is absolutely necessary for them to be on.

We shadowed a nurse while there and she was absolutely incredible.  In pharmacy we are taught things by the book, but in community pharmacy things don’t really work that way.  But this nurse did consultations by the book – she gave all the details to the patient, educated patients on signs of sepsis, and gave resources for patients to help them with their condition. Completely blew me away, AND during consultations made time to explain to us the more intricate details and prescribing issues.

Such experiences deeply enhance student education and allow us to see how knowledge gained within workshops and lectures arise within practice and how they are dealt with.

Book Review: ‘Mr Penumbra’s 24-Hour Bookstore’ by Robin Sloan

In only 288 pages, Robin Sloan manages to capture the essence of quintessential bookishness.

Clay Jannon begins to work the quiet nightshift at Mr penumbra’s 24 hour bookstore, which worryingly, has few books to sell.  The rest of the books are stacked three stories high in toppling bookshelves available to borrow by the strange patrons that visit.

I adored this book as it combines the old timey view of bookshops and libraries with a Lemony Snicket worthy secret organisation.  The characters reflect this style of writing with tweed and scarves and sweaters; outfits worthy of academics and librarians alike. One of the things that I was impressed with the book is how it managed to entwine two very different worlds – old knowledge which lies quiet on dusty bookshelves, with coding and scanning and software to solve one of the greatest mysteries known.

Although the ending was not what I expected, with no adventure to defeat dark powers which oppose the secret organisation, it had, in some way, a more realistic ending; trying away the characters to positive futures where we don’t need to worry about their fate.  Allowing us only to ponder on the revealing of the mystery.

Immortality is mentioned in many fiction books, and for good reason.  We want to be remembered, like the Kings and Queens of history.  We want a distant ancestor to leaf through the marriage records of a draughty stone church and hassle the historians of archives and exclaim that what an extraordinary life we led.  Books give us an immortality at no Elixir of Life can give us.

“The nature of immortality is a mystery,” he says, speaking so softly that we have to lean closer to hear. “But everything I know of writing and reading tells me that this is true.  I have felt it in these shelves and in others.”

I don’t believe the immortality part, but I do know the feeling that penumbra is talking about.  Walking the stacks in a library, dragging your fingers across the spines-it’s hard not to feel the presence of sleeping spirits.

Book Review: ‘War Doctor: Surgery on the Front Line’ by David Nott.

Picture from Panmacmillan.

We have grown up desensitised to the horrors around us.  The news reel shows us billowing smoke and crumbled buildings, airstrikes and screaming civilians.  We watch unfazed.  This is life for us.  But all this hate around us has given us moments of lucidity where we have an unexplainable urge to drop everything and save the world before we sundown once again.

Dr David Nott is a consultant vascular and trauma surgeon (who is Welsh, might I add) who spends some of time in war-torn countries and his extraordinary account allows us hours of lucidity, and the hope that we can make a difference.

I didn’t understand what people meant when said that something was ‘raw’ until I read this book. 

It tells us of the horrors that the medical professionals faced regularly in areas of conflict such as Gaza, Aleppo, and Kabul, to name a few – the aftermath of snipers and barrel bombs on civilians, the amputations and blast injuries, and the attacks on hospitals. His detailed cases are enough to both satisfy any medical drama addict who loves all the gory surgical bits, and repulse them of how cruel individuals can be.  But it also shows us another side, the moments of fragility of these superheroes. Moments where Dr Nott admitted complete fear in a situation, and his belief that his life was about to end.

I highly recommend this extraordinary account of humanitarian aid to all individuals who are in need of a lucid moment– those who have a need to do something more, but are not decidedly so of the how and when and where.

Its a bit short but its my first book review so I’m sorry.

Until next time.

The Rowing Club Journal: Novice Edition, 1

Starting my second year, I knew I wanted to try some form of sport.  I had been jogging before work during the summer holidays but the sun was rising later and I had no intention of jogging around the park in the dark.  I was keen to try my hand at a water related sport – either sailing or rowing, and since I didn’t manage to drag myself down to Cardiff Bay for the sailing GIAG, I stuck to rowing.  

Here is part 1 of my time as part of Cardiff University’s Rowing Club, Novice Women’s team.

Why Rowing?

It was all because of a book – ‘A Discovery of Witches’ by Deborah Harkness. Diana Bishop, a professor at Oxford rows early in the morning (definitely not an Oxbridge stereotype) to release some pent up adrenaline and she found flow within the rhythmic strokes of the scull.  It was something that I desperately needed, a few minutes where my brain can switch off and I can breathe in the salt of the sea.

What’s training like?

I do not go to all training sessions – I’m not in this to win it and so I go to ERGs practice twice a week, a circuits session, and then once a week on the water (my favourite part).

The Diary Bit

I hadn’t really used an ERG before and the one time I did use it in school, no one told me how to use it.  They kind of just let us loose in the gym ‘cause they couldn’t be bothered to teach us anything. The first few sessions of ERG practice is just learning the technique.  Believe it or not, there is so much to think about and as you increase your rate you have to make sure that your technique is on point.

25/10 – Multiple 1000m, first one starting at rate of 26s/m, going up to 30s/m.  The best speed I had was a split of 2.15 (a split time is how long it takes you to row 500m) and I nearly died.  It just felt like it dragged and so as a result it felt draining instead of exhilarating.  I need to figure out a flow strategy where I go into my happy place and my body takes over using muscle memory.

02/11 – Water session was cancelled.  Why did I think it was a good idea to try and row in Wales?  The weather hates us here.

05/11 – Tuesday mornings are endurance sessions and I can’t believe my body can produce so much sweat. We had to do 15 mins at 20s/m, break for 3 mins, then do the same thing again. Three freaking times.

However, before starting we did an exercise where we had to push off from catch position and lift our backsides off the ERG while our partner moved the seat so we didn’t land on the bar part. It was weird and it was a hard bumpy landing but when I was doing the 15 min session I realised why we did the exercise – I really gets you to engage your muscles and push off with your legs instead of pulling with your arms/upper body.  It means that the only time you should be using your body weight is in the back position when you’re leaning back a little.

16/11 – Was finally allowed out on the water again, blame the weather. Slight problem though.  Previously, two seniors had been plonked in the back of each boat to help steer and get us going but this time, we had no seniors and a newbie cox. We were zigzagging our way along the Taff.

Since we’re only learning, we don’t row continuously, and instead in pairs so we can get used to the change from ERG to boat, and since for most of the time I’m just sitting quietly, I’ve been having problems with my hips while in the boat. Its like my hips freeze and lock and the pain lasts for about 2 days later (which is not good, I know).  We were about 10 minutes into the water session and I was in so much pain I was tempted to ask one of our coaches who rides along next to us in a speedboat to let me get out.  If you’re thinking about rowing but know that you have tight hips, you might want to join yoga aswell.

19/11 – Three sets of 2500m at rate of 20s/m and its only now, two months in, that I’ve finally got the hang of what they mean by intensity.   Each time I’m on the ERG I’m going the same number of strokes as everyone else but I’m always the last to finish. A higher intensity means that each stroke looks slower but you push off from the catch much quicker, using all your energy in the first section of the stroke.  It takes so much of your energy and I’m incredibly weak which makes it all the harder to increase my intensity.  I managed to complete the first 2500m alternating between a higher intensity and the very low intensity which is how I’m used to doing it. Its just so difficult and I feel like I’m sweating buckets while doing a poor job while everyone else is barely breaking a sweat and getting amazing split times.

7/12 – I signed up for sculling, what I thought was being in a wobbly boat by myself, hence why I tortured myself with putting in contacts cause I way no way risking falling in AND losing my glasses in the Taff river. I got to the boat house and turns out sculling is when you have two oars instead of one, and there were four of us the boat.  Panic over. Once you get used to the hand positions you can easily slip into a flow state and it feel so much more like rowing as compared to being in an 8 boat with one oar each.

Well, here it is, its finally the end of the term.

Its been an incredible experience for me to be out on the water and I’m slowly gaining confidence, hopefully enough so that I can complete next term.

Until next time.

The Old Land of my Fathers – discovering my agricultural heritage.

Image from The Telegraph, credit to Martin Pope.

As a child I would wake up every morning to the sounds of the cows waiting to go into the dairy to be milked; throwing open my curtains to see escaped cows destroying our garden.

I remember the rich, sickly sweet warm smell of the milk formula given to the calves in winter; the smell of silage in the summer.

You don’t realise what you have until its gone.

I don’t remember them going, that’s the problem. They were there, and then I remember that they weren’t.  I don’t remember having a conversation with my parents, I don’t remember the trailers coming to get them. We had cows. Then we didn’t.

My best memories of childhood are on the farm, amongst the animals and machinery. The land is in my blood. The whole family farms yet I know nothing about the land & livestock and I feel quite ashamed of how absolutely clueless I am.

I’ve never really done ‘New Year’s Resolutions’ but I think that this is an important one for me to try.  My father learnt from his family how to manage a farm but I don’t have that option, therefore, I am taking the academic road and giving myself two years to read my way to ‘Farmer’s Daughter’ title. I will wear my muddy wellies with pride.

Every two months I plan on tackling a new area of agriculture and after each rotation I will upload a blog telling you everything that I have learned. My knowledge will be inaccurate and incomplete and the farmers out there will laugh.

But at least it’s a start.

CluedUpp Cardiff: ‘The Latest Krays’ Review

We set off in the late morning for Cardiff Bay, jumped out of the taxi, then aimlessly walked around the Millennium Centre, hoping to find a suspect.  None of us quite understood what we were doing and were expecting to find an actor shivering in the harsh November weather of the Bay ready to tell us their statement. But alas, CluedUpp functions in a rather different way.  An app on your phone shows you where the suspects are on a map and when you arrive in that location, a notification pops up and you must solve a puzzle before it lets you read the suspect/witness’ statement. 

A part of me was a little disappointed – at £45 per team, the pictures on the website led me to believe that it would be a little more dramatised, that there would be actors, and a white tent over the ‘bodies’, and a little room set up to look like the pathologist’s lab. But I guess that would lead to queues and higher production costs. After you got over that, the app was a fun way to rush about.

We quickly got the hang of it and soon we were exploring Mermaid Quay, desperate to acquire statements to find out who killed the Krays.

As a student living in an unfamiliar city this was a great way to explore a part of the city that I had never really been to, and so I highly recommend it for Freshers who want a chance to explore and bond with their housemates simultaneously.

We followed suit of mystery TV detectives by taking a break for a quick lunch and a chat about the case where we re-read statements to eliminate suspects (and to figure out who was lying to us – the cheek of them!). At this point we had a prime suspect in mind but we still needed to cross off others and so we set off again to ‘meet’ out last few suspects/witnesses to corroborate statements.

I’m happy to announce that we caught the murderer and as an Agatha Christie fan, this outdoor murder mystery was a blast and a great was to explore the city.  It was a laugh seeing teams dressed up, shouting riddles out loud in hope that an answer will somehow appear before them. I only hope that CluedUpp release more challenges across Wales and in varying levels of difficulty to satisfy my crime-solving urges!

Avoid the Overdraft: A Guide to Living on a Student Budget.

Why is budgeting important? Student bank accounts are great as you can get fee-free overdrafts but that shouldn’t be an excuse to blow your loans and grants.  Budgeting means that you won’t have to go into your overdraft in the first place and you won’t have to sacrifice little luxuries.

Budgeting isn’t as difficult as it sounds and this blog will show you just how easy it can be.

Is there anything I should do before going to University?

YES. The first thing you need to do is apply for Student Finance. For Welsh students, you are entitled to £9,225 each year of study – the split between loan and grant depends on your parents’ income.  This is an invaluable sum of money which will cover your living costs but there are other things you can do which will help.

Getting a part-time job during that long summer between A Levels and University will make your life a lot easier come September. Last summer I made around £3,000 over the summer – I worked hard but it now means that I can put some of it away for something special, like funding a placement abroad.

The most important thing about budgeting is making sure that you actually have money in the first place which means that if you’re trying not to rely on your parents to keep you afloat, you may want to reconsider those private luxury halls.

Before you go away, grab a notebook, slap a big bold ‘FINANCE’ sticker on it and start calculating your living.

  • Start with your income – any loans, grants, summer earning, and savings if you have any.
  • Subtract cost of University halls and other payments such as phone bill (unless you’re like me and have managed to get your parent to foot that one), Netflix, Spotify etc.
  • Set aside a maximum average weekly spend of around £40.
  • Allocate some money for Freshers and for 2ndyear deposit (£500 max.).

What to do during Freshers

Freshers can be quite an overwhelming time since you’re constantly meeting new people and figuring out friendship groups.  The problem is that everyone want to go out, all the time. The FOMO syndrome is at its prime but you will have to exert some restraint and either say no or suggest alternatives.  You need to remember that most of you will be in the same boat and so if you suggest a cheaper alternative to something such as getting to know each other by going to a GIAG or a picnic in the park, you might be surprised to find out that others will want to do the same to avoid the dent in their bank account and the hangover that lasts a week.

It may sound unfair but just a little restraint can go a long way and it can mean that you can treat yourself on little things throughout the year without feeling guilty.

What can I do throughout the year to help my finances?

Your weekly grocery shop is something that you need to figure out how to do very early on in the year.  My tip is to learn how to cook and make a meal plan.  I will have blogs coming up on quick and easy recipes to try but for now I cannot stress enough how important it is to make a meal plan and make your shopping list from that.  It’s so easy to just go into Tesco or Lidl and fill your basket with everything you think you’ll need but at the end of the week I’ll guarantee you that you’ll have food going to waste.  The saying that eating healthy is expensive is a myth – having roasted vegetables and salmon is actually surprisingly cheap and is also so much healthier than ready meals which have are high in salt and saturated fats.

Top tips:

  • Take out ~£40 in cash each week and only use that money.  Your food shop shouldn’t cost more than £30 at an absolute maximum and so any spare can go into a pot in your room where you can dip into when you want to go out for a meal with our friends or want to buy a new pair of jeans.
  • Try to look out for student discounts.  UNIDAYS has great offers from technology, to clothes, to restaurants.
  • Those delicious looking sandwiches in your course building café are nibbling their way through your bank account. Get creative with your own lunchbox everyday.
  • Say goodbye to daily coffee/tea runs and hello to flasks. £2.10 per cup of tea at a chain coffee shop is an overkill. Stash some tea bags in you bag and take a flask with you.

First Year Pharmacy Course Modules

First year is finally over and so, here I am, giving those of you who are thinking about applying to a pharmacy course, or have already applied, a little insight into life as a first year pharmacy student.

PH1000

This is a non-examinable module that must be passed in order to progress to the second year and consists of calculations and a placement.

  • Calculations

A few workshops which include homework, and then a test at the beginning of December. The two books recommended are ‘Practical Pharmaceutical Calculations’ by Bonner & Wright; and ‘Introduction to Pharmaceutical Calculations’ by Rees, Smith, & Watson. Before you think, that’s quite a lot to get through if we only get ~4 workshops, well, you only go through the first few chapters in your first year. It’s not too bad but make sure you revise and fully understand how to work through problems.

  • Placements

We were the first year to undergo placements at Cardiff and Vale Hospitals and I’m afraid to say we were misled on what we would be doing. We were under the impression that we were shadowing a pharmacist for 2 hours every 3 weeks for 9 sessions. As quite a few of us had experience within community pharmacy, this would have been an incredible opportunity to become familiar with hospital prescriptions, common drugs, etc. 

However, this was not the case.

The staff were unsure of what we were supposed to be doing and so in pairs, we would sit in an elderly care ward for two hours talking to the patients. The patients were reluctant to speak with us leading to long awkward pauses in dragging conversations. This was of no fault of their own – our placements had been scheduled to that we would see patients immediately after their lunch and would cut across visiting hours. Most patients just wanted to rest, sleep, or have some peace and quiet.

At the end of each placement we had to you complete a reflection page on a site called ‘Mahara’. The reflection was based on what you had learned that session – talking to patients does not constitute as ‘learning’ which meant that we had to be ‘imaginative’ in our reflections. Each short reflection must also linked to the skills used, e.g. ‘Talking to a patient who had experienced a fall which had shaken their confidence’ This page could be linked to actively listens, provides clear and accurate information to patients, and exhibits suitable levels of confidence when communicating.

An example of a reflection:

Click to access example_records_for_revalidation_for_pharmacy_professionals.pdf

Tip – complete a Mahara entry straight after each placement otherwise a) the sessions will blur into one and you’ll have forgotten what you did and b) you’ll spend three days doing Mahara right before the deadline. Don’t put yourself through it. Just don’t.

PH1121

This is quite a ‘waffly’ module which gives on overview of the drug development process. The January exam contributes to 80% of module grade, and the other 20% comes from a presentation on a plant which has medicinal properties. Our assigned plant was ‘Rawolfina serpentina’.  The presentation is delivered in front of the whole year and considering this fact, it was marked quite harshly. 

* Don’t forget about the practical that you did in this module – it is examinable material!

https://bestpractice.bmj.com/topics/en-gb/337 describes paracetamol overdose which is covered in the module. The paracetamol overwose workshop was fun since the lecturers had set up a hospital bed with one of the taking robot dummies which would suddenly start groaning and seizing.

PH1122

This module was probably my favourite as made me feel like as had finally enrolled on a pharmacy course. The main part of this module of the RTS workshops (Responding to Symptoms). In the first year there is an RTS session roughly every two weeks which focuses on OTC conditions and treatments. To get the most out of the workshop you will need to do some pre-reading, which is just to read (+ learn if you haven’t had any experience in community) a chapter from Rutter (2017) Community Pharmacy: Symptoms, Diagnosis and Treatment. This is a great book and is available as an ebook from Cardiff University Library.

At the end of each workshop you will work in pairs or threes to complete OSCE style questions – one patient, one pharmacist and one marker.

Something that I liked about the workshops is that if you speak Welsh, they will place you on a table with other Welsh speaking students. Arriving in Cardiff I thought that I would be speaking Welsh everyday like I did at home, but I found that very little Welsh was spoken. When you go shopping, the person at the till usually doesn’t speak welsh, and very few of your lecturers do (which was a big change from secondary school where all my teachers spoke Welsh). Therefore, these workshops were a lovely way to feel at home.

Close to the end of the year you will have a workshop led by OSCE actors. Seeing a ‘Communication’ workshop in my timetable filled me with dread and thought that it would be a waste of time. That workshop was one of the most important workshops that I have been to. It is held after the mock OSCE and they will pick up things that students did during the mock.  For example, they showed how we knocked on the door, walked in, head down, sat down, then introduced ourselves (guilty). It looked hilarious when they acted out what we did and they gave us lots of tips of how to speak to patients. The actual OSCE was nice and a bit more realistic as compared to the workshops. In the workshops you get a set of symptoms, you diagnose and treat. Community pharmacy doesn’t work like that – you get patients asking for a certain medication, or they want to know which one is the best, therefore you need to know the effectiveness of medications.

Top tip: MAKE NOTECARDS. I rarely used notecards in A level, but in this particular module it’s a great way to test your self on the treatments and referral criteria for OTC conditions.

  • Clinical Knowledge Summaries (NICE)
  • ‘Community Pharmacy: symptoms, diagnosis and treatment’ is the go-to book for this unit. Everything you need to know is in it.
  • Non-prescription Medicines by Nathan, A. 2010. I didn’t know about this book until recently, and by that I mean after the exam…I love know how medications work not just ‘this is the condition and this is the drug used to treat it’ and the book explains how the drug acts within the body to target that condition.

The ‘POP’ classes are useful which gives you an introduction to dispensing such as how to check the legality of a prescription, and how to label. However, for those of you who are planning on doing a community pharmacy placement in the summer, in reality, dispensing is quite different.

The exam was quite straightforward, especially since I had experience within community pharmacy. I always go into an exam expecting the worse and so had expected scenarios where patients had a long list of medications that they’re on with multiple interactions, but in fact, only a few were on other medications and they were also quite obvious ones.

PH1123

This is the module that will probably make you re-think why you’re on a pharmacy course. The practicals involve making and spreading agar plates, looking at the type of bacteria growing etc. and it just doesn’t feel like what you signed up for.

The first assessment you will have in the MPharm course is in this module. The assessment is released in three parts and so I suggest you do them as soon as you get them, other wise you’ll find yourself trying to do it the week before and finding out that its actually not that easy. It is a series of questions, and each has a word limit. I found this difficult as 25 words is not enough to answer a question. 

  • Oxford Handbook of Infections Diseases and Microbiology, Chapter 2, Antibiotics.

For the first year you don’t need to know the names of most drugs (which is great as in one of the first microbiology lectures there’s a few slides with just names of antibiotics and you’re a bit like ‘do I need to know this?’). However, you do need to know the names of antivirals and antifungals.

Towards the end of the module you are taught Glycolysis + Krebs Cycle, and oxidative phosphorylation in more detail which is quite interesting. This leads to my next point – there is a lot of detail in the module which needs to be learned for the multiple choice exam and it can make you feel annoyed as maybe one MCQ will come up on e.g. the whole of glycolysis and Krebs which took you a whole day to learn.

PH1124

This was another of my favourites as it gives a more in-depth look that the human body.

The module is graded through an exam and essay. I always expect the worse and so I thought that they’d give us something really sciency as an essay topic but its quite nice and vague e.g. healthy eating, smoking, etc. They also give you PLENTY of time to write the essay with about a month and a half over Christmas for the first draft, and a month for the second draft.

Useful books and website which apply to all units:

Unit 1 is self taught and covers basic principles such as the position of the body.

Unit 2 – Nervous, Integument, and Skeletal System. Some of the NS parts have been covered in A Level such as the action potential. This is one of the heaviest units, as you come across so many terms that you’ve never heard of before. This means that it will take you ages to learn and so I’ve gathered a few things that might help.

  • Cranial Nerves – you need to remember their names and a little about them. I struggled to remember the order so I made a sort of story/sequence in my head.

I’d point to my nose (olfactory), then eyes (optic) then bridge of my nose (oculomotor), ear (trochlear). Now here’s the story. I imagine I’m walking down the street in a beautiful low cut dress which shows of a beautiful necklace which has three gemstones in it (trigeminal). Someone notices the expensive gems and they attempt to abduct me (abducens). I struggle and I get punched in the face (facial) which causes my hearing to go all skew iff (vestibulocochlear). I retaliate hitting them in the chin, causing them to bite their own tongue (glossopharyngeal) and they start choking (vagus). They fall to the ground, landing on their back (spinal accessory) and I walk away, not before I stick my tongue out at them (hypoglossal) like the mature adult I am.

For whether or not they are sensory/motor/both, our lecturer used the following sentence – some say marry money, but my brother says big brains matter most.

https://bmc.med.utoronto.ca/cranialnerves/

https://www.orthobullets.com/basic-science/9009/fracture-healing

Unit 3 – Cardiovascular and Respiratory introduces some complex pathways such as intracellular signaling which comes up in a few different modules and units and so I’d recommend spending some time to learn the basics (https://en.wikipedia.org/wiki/Second_messenger_system).

It covers topics such as blood pressure, control of cardiac contraction (which I found very complicated and did not learn. Inotropy, chronotrophy, and lusitropy mechanisms involve secondary messengers), cardiac action potentials, haemostasis, gas exchange.

http://www.frca.co.uk/article.aspx?articleid=100096

For both unit 2 & 3 I’d recommend trying to read the chapter the night before just so you can begin to get your head around it.

Unit 4: GI system was quite a new unit for all of us as only digestion is covered in A level. It doesn’t go into that much detail so it’s a relatively short unit.

Unit 5: Immune System. This was another difficult one and the lecturer may be unaware of how little immunology we had done previously. Some parts are quite nice such as the cells involved in immune responses but again has quite a few new terminology that you need to grasp. I remember sitting in the lecture about the classical complement pathway and none of us had any idea what was going on. The lecture kept saying different variation of numbers and letters such as C4b2a and how that is the C3 convertase which forms the C5 convertase C4b2b3b. You could feel the confusion in the room and everyone was looking at each other wondering if they were the only one that didn’t understand. They weren’t. However, if you make a poster flow chart the complement system becomes much easier to understand and learn.

Unit 6: Endocrine – a very interesting unit which covers things like the hypothalamic-pituitary axis and insulin/glucagon.

Unit 7: Kidney and Urinary system– short unit which mostly recaps A level stuff.

Unit 8: Reproductive Hormones – again covers A level work.

This exam was quite nice and was composed of MCQs and eight 5 mark questions. I had expected the long answer questions to be very scientific such as ‘describe muscle contraction’ where I had to give all this terminology, but it was quite nice.

PH1125

For this module I would recommend you to bring your A Level notes with you to University as it covers many of the same concepts including organic reactions, acidity, kinetics, and isomerism. Towards the end of the year they organize workshops which give you a chance to work though exam style questions. I found them very useful but in the end the exam was still very difficult.

Overall:

  • They print off handouts – buying a printer was useless as I could just go to the library to get my notes printed.
  • Exams are different to A Level – most are multiple choice and the questions are not designed to trick you. They will be straightforward such as ‘Describe…’
  • I typed up my notes and expended on some concepts that I didn’t understand. I highly recommend making your own notes, even if it is very time consuming as at the end of the year you will have a 40 page (back to back) display folder of PH1124 notes to study instead of ~2 lever arch files worth of handouts.
  • I have uploaded my flashcards for PH1124 under the name MTFarm on Quizlet (MPharm1).
  • No past papers (with the exception of PH1125) which means that you may be going into your exam blind.

Hope it helps.

Pharmacy Placement in the Philippines, part 2

NICU

It 5:30 in the morning on a Monday, my second week here. I’ve just had my breakfast and it’s still chucking it down. Most of us were up during the night due to the torrential rain and thunder and so my 5am alarm didn’t sound quite so ghastly. Its weird to think that waking up at 5am seems like a normal time to get up…oh how times have changed.

NICU shift starts at 7am and the first task is to deliver medications to the NICU. Before going into the NICU other HCP must have the relevant PPE – mask, gown, slippers, and a hair net. Something that I have noticed is that in the PHP their paper-trail is excellent. In the pharmacy, outgoing NICU meds are recorded, and meds received by the NICU are recorded when entering. The powders for injections are prepared in the NICU by the pharmacist (it just means that the pharmacists fills an injection with a diluent and adds it to the vial).

When you think of babies you think pink and pudgy and laughing their little heads off but in the NICU it’s a different story. I have only seen NICU babies on Greys Anatomy, and I knew that they were going to be small and scrawny but nothing prepares you to see it in real life. They are premature with a low birth weight and have big chunky masks covering their faces helping them to breathe. It can be uncomfortable at times to be in there, however, medicine and nursing students love it there since they spend more than just a few minutes there, allowing them to sit back and cuddle babies all day.

On return to the pharmacy I was allowed to help with producing the daily charge slips, which records the medications given to the baby and the price. I was shown how to calculate the price and I was actually correct!!!

I also observed the pharmacist making doses. Let me explain. I don’t think this is done in the UK, but in the PHP, especially with NICU meds, capsules can be split to make smaller doses. The capsules are opened and the powder is poured onto a glass plate. It is then split evenly to produce whichever strength the baby requires and each dose is packed in a little tissue paper square. e.g. 3 capsules of 50mg Tramadol was used to make 6 packets of 25 mg Tramadol. There was another instance where a capsule (or a few capsules, I don’t remember) was used to make twenty smaller doses. Its so stressful as its not an accurate method and it takes everything you have not to shout ‘STOP!’ and rush to get weighing scales. This however, is a great learning opportunity to discover how other countries who have fewer resources cope with not having that range of drug strengths as we do have in the UK.

We then went back the the NICU after the doctor had completed her rounds to review the charts and amend the pharmacy records so that new medication can be added and old ones can be removed. The medications for the next day was prepared and I was allowed to label them (with small post it notes instead of actual printed labels – this also didn’t stress me out at all…).

In the main dispensary, medications are not checked (as most of the staff are qualified pharmacists) and so when I labelled the incorrect medication it was terrifying as there is no safety net there for you like there is at home. It was also an issue later on in the day when I helped out by dispensing medications and putting them in boxes for different wards. The slip that you are given is the typical doctors handwriting and so I had to be a right pain and ask that each item was, as other wise I might as well have just picked the first drug that I saw with that began with that letter. It wasn’t easy either to differentiate between vials and tablets on the list. This is a key difference between the UK and the PHP as prescriptions or labels or whatever have to be specific – paracetamol in community can be in tablets, caplets, capsule, suspension, or suppository. It probably wouldn’t be suppository but with tablets/capsules/suspension you have to make sure that you’re giving the patient the right formulation, therefore prescriptions have to be specific.

During the evening we went to a place called Merimart which was a strange experience. One of the girls is originally from the PHP and so knew about cheap places such as this one. I was bored and decided to tag along. Its weird cause its like a huge, relatively modern shopping center which is quite maze like. But the stores there aren’t your normal shopping center stores. Most of the spaces are occupied by small businesses selling counterfeit products, and they all tend to sell the same things. There was a power outage while we were there and all the little shops put on lamps. It was quite an experience. I was tempted to buy a Cath Kidston purse which matched the bag I had with me, but if felt wrong, like it was betraying the original. Sounds strange but its how I felt.

AMS

Today I became a shadow to a pharmacist in the Antimicrobial Stewardship team which was responsible for the OBS & GYNAE wards. Their job is similar to that of unit dose pharmacists, as they go through all patients notes, but they focus on the antibiotics prescribed.

If a doctor needs to prescribe an antibiotic they must fill out a form which allows them to give seven days worth of antibiotics from their list of ‘monitored antibiotics’. If they need an antibiotic from the ‘restricted list’ that form must be approved by a member of the Infectious Disease team. They must record patient details, the drug and dosing regimen, and the indication for use. This means prophylactic / empiric / definitive, along with some other points and results. As WV is a tertiary hospital most of their patients are referrals (with the exception of ER and outpatient referrals) and so patients have already had empirical (broad spectrum) antibiotics and require a culture & sensitivity test so that they could have definitive antimicrobials.

If they require more than 7 days there is a similar form they must fill in which the doctor must state any previous antimicrobial therapy the patient has had and the relevant microbiological results.

AMS pharmacists are also allowed to complete ‘dose optimization’ forms which means that they can advise the doctor to increase or decrease the dose depending on the lab results.

? Should we give antibiotics as a prophylaxis in this day and age with the rise of resistance and fewer new antibiotics produced?

?Why have AMS pharmacists? It basically means that you have two clinical pharmacists per ward and so a waste of resource.

OB & GYN

The obstetrics ward accommodated 45 patients, but as the hospital has a no refusal policy it has over 90 patients. Half of the beds hold uncomplicated normal births which means that beds are for up to 5 babies – not for the mothers to have a rest. Mefenamic acid (NSAID) and co-amoxiclav 625mg was a standard procedure after a normal vaginal birth here. The volume of antibiotics given was strange, but as I had not observed obstetric practices at home I had nothing to compare it to. However, now that I am home and have access to the internet I have found that WHO does not recommend routine antibiotic prophylaxis – why is it standard treatment in Iloilo then?

A quarter of the ward was for Caesarean sections and the last quarter for complicated cases, mostly eclamptic patients. It was disenheartening to hear that the c-section mothers would share beds so that two babies would have a bed and the mothers would sit. Meaning that they would not have proper rest after their ordeal to recover. The lest section was occupied by preeclamptic patients.

MATERNAL MORTALITY

Maternal mortality rate (MMR) per 100 000 live births was 114 in 2015 (1) – to put this into perspective the MMR of the UK is 9 deaths. Why is the Philippines well above the worldwide average of MMR?

  • Only 84% of births are attended by HCP, with only 65% of women from the poorest quantile (2) ’why? Giving birth is free in the UK, pay in the PHP. “In the Philippines, in addition to Administrative Order 2008–0029 articulating policies for delivery by an SBA in a health facility, some local government units have issued local ordinances banning home births; some have imposed fines on women delivering at home, or on the birth attendant, or both.”(3)this means that women may opt for traditional birth attendants which are usually older women within the community which assist during delivery.  This may sound like a much friendlier birthing situation as compared to hospitals but the risk of such practices severely outweigh their benefits. Yes, they are substantially cheaper then going to the hospital, but the hilots have no formal training (4). The study really shocked me because it showed the practices of the respondents – such as having a poor performance in referring mothers for complications, and for the encouragement of immunization.
  • Poor reproductive education & unavailability of contraceptives  = “unplanned pregnancies & unsafe abortions?
  • Once again, my point of reference is Grey’s Anatomy and so I thought that oxytocin was used only to induce labour, but is also used to reduce postpartum haemorrhage. Oxytocin is recommended by WHO for all births which explains why I saw it in most charts (if not all, I don’t remember!).

? How does oxytocin work to prevent haemorrhages?

Obstetrics have their own section of the hospital with a family planning clinic, OB-OPD (out patient department), their own ER, and something quite incredible – a human milk bank. Patients and staff are recommended to donate milk to the bank, which is then pasteurized and given to NICU and c section babies.

  • Why do c-section mother struggle to produce milk?
  • Does the implementation of a human milk bank improve NICU outcomes? 

It reduced neonatal mortality and significantly increased exclusive breastfeeding rate from 34% to 74% post implementation (5).

  • ? What does this mean? This coincides with WHO guidelines which recommends breastfeeding but it does not necessarily mean improved outcomes – human milk (both the mother’s and pasteuised has fewer nutrition and so there is slower growth in neonates as compared to formula (6) this is an area that id love to do more research on, especially since going to many supermarkets in Iloilo where they have a special designated area for formula (similar to how we have a pharmacy area in some large supermarkets in the UK).

A few of the WTW students have had placements within obstetrics and what you hear from them is quite harrowing. I understand that it’s a a different culture and that we’re supposed to be open minded but when you hear such stories it’s difficult not to judge. In the UK deliveries can take time but here mothers are rushed (this was something I had noticed while flicking through charts – most mothers had been given oxytocin). There are no epidurals and mothers are not allowed to scream while giving birth. If the baby takes too long then, I’m not sure what it’s called, but some sort of chest compressions are given to push the baby out. I have also heard from students that they do not wait for the baby’s shoulders to get out, they kind of just pull at the head.

CONTRACEPTIVES

Condom use rate is low in both the UK (7) and the PHP (8) which is surprising considering that sexual health classes within schools in the UK only talk about male condoms from what I can remember – not about the pill which has the highest rate in both countries.

? What percentage of males within heterosexual relationships are willing to use a condom?

? Why is the use of the pill so high?

HIV/AIDS

HIV cases have dramatically increased, but what is the cause? Since males who have sex with males make up the largest proportion of HIV cases, a study on HIV prevalence gives light on the behaviours regarding safe sex (9):

  • 85% of males having sex with males (MSM) have never been tested = low testing rates.
  • Low condom use rate – 41% did not use condom during last anal sex and 64% had multiple sex partners. Looking at both of these statistics is shows that the risk of transmission becomes much higher due to poor barrier use – if individuals do not use barrier methods and have had more than one partners in the past 12 months and do not get tested for HIV then surely transmission risk is high?

In response the the HIV epidemic, the PHP have a target that 90% of those who are living with HIV should be on anti-retroviral therapy (ART) by 2020 (8), currently only 32% of PLHIV receive ART. Just think about that. Nearly 70% of people who live with the stigmatized virus are receiving no treatment. Why is this happening?!

ONCOLOGY

At Cardiff University were are lucky enough to have an aseptic suite – I have not been allowed in yet, hopefully I will within the second year. The oncology department of the hospital does not have one and it nearly gave me a heart attack. I know that having an aseptic suite is expensive and so I wasn’t expecting a huge suite but I definitely didn’t expect what I saw. I have to admit it is a genius move and excellent use of resources but still, kinda shocking. 

Their aseptics unit is a NICU incubator that has been adapted to become a laminar flow unit.

Like I said. Nearly had a heart attack.

The lack of funding for such basic resources is clear within oncology and I have to applaud whoever came up with the idea as without such contraption chemotherapy would not be a possibility for patients at the hospital.

I was allowed to observe a doctor give chemo to a small child. I was so excited that I could see a spinal tap being performed that I shocked myself as as I heard the child screaming, I had forgotten that these are actual patients, not just cases used to learn about. 

BORACAY HERE WE COME!

I had a 4am start but since I’m so used to waking up at 5 here, waking up an hour earlier was like ‘yeah whatever’.  We had rented two vans (1000 pesos each, return) to take us to Boracay and we reached there at around midday. We had to stop a couple of times as everyone had suddenly become travel sick. Its quite amusing being among med and nursing students as the second anyone is ill its like an OSCE. They want to know how exactly you feel, if you already tried so and so anti-sickness tablets…ah okay what about these ones?

The second part of the journey was via boat to Boracay itself. I was quite queasy at this point but the sea breeze made it all okay, plus it was only a short ride of like 20 minutes. The sea is this beautiful blue that no only exists in travel magazines and it kind of makes all the queasiness go away. 

We were greeted there and was taken via a mini electric jeepney (how environmentally friendly!) to our hotel which was called the Turtle Inn. It’s super cheap, especially with four of us in the room, allowing us to spend more on shopping and activities. There’s like a little terrace outside of the rooms which have deck chairs and a table where you have your breakfast. The hotel is quite small but the staff are so lovely and you get a complimentary drink when you arrive.

Packing tips – bikini and rash guard clothes (many people just wear the rash clothes out and about), dry bag.

If you do need to buy anything there are plenty of bikinis and beach wear shops around (even a CROCS shop!) there are lots of cheap souvenir stalls but make sure that you go around them first to get a good price instead of just buying things at the first stall you see. I didn’t realize but you can haggle at these stalls and a friend got 500 pesos off her purchase which is CRAZY! I’m way too scared to haggle plus it feels sort of rude – imagine going to TESCOs and haggling at the till for your groceries.

One of the things that I love about Boracay is that all the shops and restaurants are lined up at the beach and there are so many different cuisines available. We don’t have that much choice of cuisines where I live and we don’t have take aways at home so I joked that if I had the metabolism for it I’d do a ‘food crawl’ of Boracay instead of a pub crawl.

We settled for a Japanese restaurant called HAMA for supper and this was the first time I had had proper Japanese food – I wasn’t to only one inexperienced with chopsticks but we managed it. I had chicken udon teppan which was AMAZING. The second I got back to the hotel I was looking up recipes for when I got home. I try to collect recipes from restaurants so that when I go back to University I have lots of things to try my hand at.

I couldn’t sleep and so banished myself from the bed for a mini yoga session outside. Doing yoga on a gritty balcony wasn’t quite what I had in mind but maybe one day I’ll manage to go to the beach on a warm morning once I’m home and do some sunrise yoga. 

Breakfast was included in the price of our room – it isn’t much just either eggs or pancakes just its good enough.

We went island hopping which cost about 600 pesos. You stop after a couple of minutes to snorkel and most of us went in without life jackets. That was a mistake. The second I was in the water I found it hard to breathe. Thought that I was just a bit nervous since I hadn’t been swimming for years ad that I would breathe normally once I got used to it. Yeah…no. I think maybe three or four of us got caught up in the tide and I was trying to swim back but my breathing was reallyfast and shallow (I think that’s what’s called hyperventilating? Could have been a panic attack, who knows) and I felt like I was going no where – each stroke I took toward the tide went over my head and pushed me five back. I’m sure I looked pretty bad as one of the girls was like ‘are you okay? I’ll go get a life jacket for you’ and rushed off. So yeah, fun times.

! If you can afford it, get a GoPro. Two of the girls had bought one in Iloilo for the trip and the resulting photos and film was amazing! 

We then stopped at this beach which was a great opportunity for a photo shoot, had lunch, another snorkel and split up once we got back to the beach. I had opted for just plain old sunbathing – my stomach was feeling the effect of the boat and getting thrown about on an inflatable being dragged by a speed boat would have ended me.

I haven’t had much experience with sunbathing – when I’m abroad I’m always rushing around all the sights and so when people warn you that you need to reapply suncream often, I obviously didn’t think that that rule applied to me.

That night I looked pretty bad. It looked like someone had punched me where my zygomatic bone was, my stomach was red (and was red for the following three weeks) and I had tan lines on my shoulders.

We’re all talking about how we’re going to miss it, and the non-humid heat, and the white sands and the clear water. I completely understand why it’s a popular honeymoon destination.

The road taken to and from Boracay it terrible. Winding roads with half of the journey on bumpy surfaces due to so much construction going on. We were speeding away (going quite fast which was a bit worrying), getting thrown when a collective feeling went through everyone – something was not right in the front. We pulled over at a café. One of the girls in the front had lied, staying that we all needed a pit stop to refresh – she had seen the driver nodding off and instead of saying that he needed to stop, just sped up.

CLINICAL PEDIATRICS

I woke up at 5am since pedia rotation starts at 7am. Its weird since when I’m at home I absolutely hate getting up early, but here I am bouncing out of bed at 5am.

Disaster struck.

Clinical pedia doesn’t start until 9am so now I’m floating around the pharmacy for two hours. Could have had two whole hours extra of sleep.

The pharmacist in charge of pedia is also responsible for the neonatal unit, ASU, and MICU. In neonatal some of the common admitting causes were:

  • Meconium aspiration,
  • Neonatal sepsis,
  • Neonatal pneumonia,
  • Respiratory Distress Syndrome,
  • Neonatal jaundice – In a big posh medical term it’s known as hyperbilirubinaemia. If you break the word down, you’ll find that essentially its when there is an increased level of bilirubin protein in the blood.In the neonatal unit I saw a teeny tiny baby undergoing phototherapy. I had always thought that jaundice was just something that happened to preemies due to underdeveloped livers but actually it’s a lot more complicated – it can be caused by quite a few different conditions and its something that I’m desperate to read more about. This was a difficult ward for me to observe as in one tiny ward, roughly 25 ill babies and their parents were squished in like sardines in a tin. There was barely any room for me to walk around and so if anything happened to one of the babies and they needed urgent attention, there would be some delay. Hospitals need space.

There was also no permanent nurse observing the babies – only their parents. Unqualified parents. One parent was manually bagging their baby. They looked so small and scrawny, some with cotton wool over their eyes.

UNICEF found that the PHP have a 15% preterm birth rate (10), which is 7.5% in the UK (11). Prematurity was found, also by UNICEF to be the highest cause of neonatal mortality at 32.7%.  Even though I am not a baby person I find neonatology incredibly interesting and so my ‘light reading’ during lunch at the supermarket next to the hospital tended to be WHO recommendation documents – a good one to look up if you do decide to do a placement in the neonatal unit is the ‘WHO recommendations on interventions to improve preterm birth outcomes’ as it can tell you whether or not they recommend a course of action depending on the quality of the evidence they reviewed.

Placement tip for clueless first years – make spider diagrams during ward rounds. Grab a patient’s notes after the pharmacist gone through it, state the admitting diagnosis and then add the drugs used to treat it. Keep adding drugs to the diagram form different patients and when you have the time you can look up the drugs and how they work.

Since passing the dengue ward on induction day I have wanted to know more about this neglected tropical disease. Learning about this condition is relevant for my community pharmacy learning due to travel advice and vaccination services offered.  Malaria is commonly talked about and so the general public is aware of mosquito bite preventions but advice on dengue is lacking – maybe due to its lack of chemoprophylaxis or that its not often seen in popular UK destinations – Europe and North America. As we were not allowed into the dengue ward I didn’t think I would encounter any cases but turns out, in the pedia ward dengue is prevalent – more so during the rainy season when I visited due to more stagnant water around for mosquitoes to breed. I have learnt of the disease’s forms – dengue and dengue haemorrhagic fever/dengue shock syndrome, and how it is treated here in the PHP – with only IV fluids as it turns out.

Other conditions seen in this ward were febrile seizures (which are caused by fever) and pneumonia.

As the pharmacist was taking inventory of the drugs in pedia I tagged along with two other WTW students who were accompanying a doctor on her rounds. I was only able to stay for three patients but the last one really hit me. A child had, what us in the UK call advanced, retinoblastoma but the doctor said that this is a common sight and they can me much worse (common meaning that they see a few advanced cases come in). Look it up and you’ll see how bad it was for this child. In the UK someone would have called social services or something but nothing could have been done here in the PHP and it was all because the lack of money. The child was going to die.

I didn’t realize that medical ICU was a thing and I was expecting a room full of comatose patients, but that may be the surgical ICU. It’s a small unit with only 5 beds in total and were occupied by severe dengue patients. I was also expecting a large stroke unit it since this is a tertiary hospital but it was composed of only three beds. The country’s major health problem keeps popping up all over the hospital and this ward was no exception – hemorrhaging stroke secondary to uncontrolled hypertension.

ORTHOPEDICS

Hash browns and scrambled egg for breakfast – literally the best. I waited for an hour and a half for the pharmacist to come and fetch me before someone told me that the GEOS ward pharmacist was busy and didn’t want a shadow that day. Super. 

However, it did means that I got to choose which department I went to and chose ortho. The pharmacist I was with was SUPER lovely and covered two wards – the Santa Monica ward which was for female Medicare and the orthopaedic ward.

The first ward we went to was the Santa Monica ward which is a small ward of about maybe 15 beds? Don’t really remember how many. Some conditions of the ward were – cardiovascular disease, alcoholic liver disease, chronic kidney disease, anaemia.

We then went to ortho which had roughly 45 patients and is a ward definitely worth doing a whole 9-5 shift in.  It’s a great ward if you like being busy and on the go but to get the most out of it I think you need to know some stuff like classification of fractures and anaesthesic drugs. There’s a lot of broken bones (obviously) and I actually made a tally chart while going through the charts and found that just under half of the patients in the ward were there due to fractures secondary to a vehicular accident. That’s crazy. But it does make sense since the roads here are a bit crazy and many people have motorbikes. When you get off the jeepney to go back home you have to cross quite a busy junction and since my road safety is abysmal I fit in with the pedestrian culture. There is no traffic lights or pedestrian crossings which means that you just have to walk across the busy junction and hope that everyone stops for you.

ICU & GENERAL

7am start with an AMS pharmacist. We started off at St Vincent ward which had only 11 patients. Role of the AMS pharmacist is the reduce error in antibiotic usage such as if there is a missed dose at the ward they must follow it up to find out why. Each ward has a daily census of patients which has the total number of patients and the number of any transfers or admissions.

Our next stop was the MICU and she explained that since they have no infectious ICU so they would only accept infectious cases such as pulmonary TB after 2 weeks of antibiotics and pneumonia after 3 days of antibiotics.

The Acute Stroke Unit is one of two departments which are allowed to administer Actilyse (generic = alteplase), the other being the ER. They called it the wonder drug as within 24 hours it is able to reverse some of the effects caused by the stroke.

We then went to the male medical ward which was situated in one of their shiny new buildings. It had four different sections – renal, gastrointestinal, cardiovascular, and other. It had a total of 56 patients. Cases seen – acute haemorrhaging stroke, hypertensive CVD, alcoholic liver disease, anaemia, hypovolemic shock.  There were a lot of nurses around and the second I sat down ready to flip through some charts I was bombarded with questions like ‘Do you know David Beckham?’ or if I had seen any of the Royals and if I like Robert Pattinson and Tom Holland (the answer is yes, obviously, who doesn’t?)

SICU was the next ward. I didn’t get to see many of the charts (not that they had many patients). And lastly St Jude’s ward which is their psychiatric ward. They had security at the entrance and there were posters listing all the things you couldn’t take in like iced tea and chocolate. The nurses station had bars on the window, patients had no mattress and the bed frame had holes in the side in case the patients needed to be tied up. Patients also had to have a family member or career present at all times during their stay (except for three allocated slots where they could leave for an hour to have food etc). I didn’t get to spend much time in this ward (as there were no antibiotics prescribed) but it seemed like an outdated way to teat patients with mental illnesses – it was something that I expected in a Victorian asylum with no comfort or anything to suggest that they were anything but prisoners.

ER & ONCOLOGY

7am start at the ER today. I’m not sure what I expected to be honest but it wasn’t this. The ER was overwhelmingly busy. There is no place to turn and if there was an emergency they would be wasting valuable time trying to move patients to get to the one in need of assistance. The ER has its own little satellite pharmacy and the pharmacist goes around the ER checking what drugs everyone has – the patient or their guardian I responsible for keeping the drugs safe and they are not kept in the nurses station like every other ward.

This was my first time in an ER and I always though that an ER was kind of like a sorting office. Patients come in get treated and then are either admitted to another ward or discharged. But in this ER it didn’t seem like the case as the pharmacist was ticking patients and drugs off her list – the list that she had made yesterday morning.

I have been open minded about the hospital here in the PHP but just an hour in the ER was shocking and it makes you so frustrated since you can’t do anything or help and you’re just stuck there like a little ball of anger.

I say an hour as the pharmacist who’s in charge of the students here was like ‘come back to oncology today’ and swapped me with another student. I saw four chemotherapy patients today and sat there for hour staring at the floor – fun times. The oncology section is made up of three rooms – a consultation room, chemo room, and a room with two beds in. 

We were also told that privacy regarding patients was different to as seen at home and I saw this during my two days in oncology. In the UK, even in community pharmacy, there is a private consultation room for patients to discuss matters but in oncology there was one consultation room where a patient would be talking to the doctor and there would be patients sitting right behind them, waiting for their turn. 

As I have only completed my first year I had no idea about types of cancers or drugs used but it was the department that I got to do some pretty cool things for a first year student. I was allowed to assist in preparing chemotherapy pre-medications such as ondansetron and dexamethasone! 

BBQ was awesome yet again and stuffed myself on roast potatoes, crispy shrimp, and a whole load of pineapple and a large chunk of pineapple upside down cake.

The kareoke was quite funny as they decided to split us up into four teams and the losing team would have to try balot. The guy who normally mess around actually took it seriously as, I quote, “they threatened me with duck foetus, I’m going to take it seriously”. No one can remember if it’s duck or chicken embryo. Nasty.

HOME

Flight is at six so it’s a long day of doing nothing. I had lunch at Jollybee’s cause rice and gravy is just about the best food combination ever.

I’m just sitting with two of the girls, waiting. It’s currently raining, not too bad but I’ll miss it since it’s not cold rain like at home and it’s quite calming to watch.

There was a lot of traffic on the way to the airport and it started to absolutely chuck it down. We were worried that our flight would be delayed as other airlines had cancelled flights but we were lucky. There was a huge queue for Qatar airlines at Manila but a travel tip for you – if you already have your boarding pass (and you will since it’s a return flight) you can go to the online check in queue which was way shorter. Asking someone for help at the airport saved us probably over an hour.

Its 4:15 in the morning – about to land in Doha. At home I don’t notice light pollution but when you’re in the air it looks quite magnificent, an ethereal orange hue around the city.  Half eight in the morning and I’m bored. Few hours to go before my flight. Something that I love about DOHA airport is how healthy it is. Smoothies, fruit, fresh juices, and wraps the size of burritos. They had a Del Monte café – why can’t we have this many healthy options in the UK???

And that’s the end. To say that its been a life changing experience has been an understatement. If you would have seem me throughout my school year, I would have been the least likely to go to the other side of the world, by myself, for a placement. Its been an absolute dream and I’ve learnt so much – from tropical medicine to the culture over there, and I’ve met some amazing people from many different backgrounds.

Take a leap of faith and maybe you’ll find out that even though you’re on the other side of the world there are other students just like you – who want to travel, and try new things, and learn. You won’t be alone.

References

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