Iron-man for jerks

I know it hasn’t been that long since i was there, and that there isn’t really all that much different between us except that i started school a year before them, but lately everything term 1s do seems extremely annoying. Including studying at the same table as me, quietly doing anatomy questions together.

On a related note, exam time is a great time to reflect on how irritable and cranky of a person you can be. It’s like competing an iron-man and realizing you had it in you all along, but for downers. On the upside, it’s good practice for trying to stay aware of feeling annoyed, and keeping perspective. Emphasis on the practice. Having appropriate reactions to situations can be hard!

Tomorrow’s my Clinical Skills practical exam. We dress “professionally” in white coats and see our standardized patients. 6 days until the Path exam. 13 days until home and Christmas break. Whew.

How doctors learn to do pap smears and pelvic exams

Stephanie: in lab the other day
Stephanie:  we did our first pelvic exam (ie genital!)
Stephanie:  but on models
Stephanie:  but the vaginal model was kind of weird to watch classmates do
Stephanie:  feeling around, rectal exams pap smears and feeling uteruses
Stephanie:  our model wasn’t working right so our tutor had to stick his hand in it to work it properly
Stephanie:  and he had his arm up to the shoulder in this fake lower body model
Stephanie:  and then my friend had his hands in the other end
Stephanie:  it was just kinda weird
Ktown: oh myyy

Ktown: you must get quite comfortable around each other
Ktown: so the model like looks and feels real?
Ktown: i guess that is a silly question
Stephanie:  it looks real
Stephanie:  and kinda feels real
Stephanie:  but it’s not flexible, it’s kind of rigid
Stephanie:  so when we were trying to get the speculum in for pap smear
Stephanie:  you had to really force it
Stephanie:  and it seemed really violent, painful
Stephanie:  or pulling it out, people were like wrenching it out
Ktown: ahhhhh omg
Stephanie:  then it fwapp’d back
Ktown: fwapp’ed?
Stephanie:  the noise it made
Ktown: i wont even ask

Stephanie:  you’re supposed to inspect the rectum and the vagina at the same time at one point
Stephanie:  like have two fingers on the same hand in both
Stephanie:  it’s basically the shocker
Stephanie:  and did you know there’s a special order to which finger you take out first? (the vaginal one)
Stephanie:  and my friend was too shy to say vagina or anus
Stephanie:  so he was trying to describe his finger that was in the anus the longer one
Stephanie:  to avoid saying anus
Ktown: oh my

Ktown: youve shockered a fake girl!
Stephanie:  it was for science!

Ktown: why must you do both at the same time?
Stephanie:  it’s to feel the septum between them
Stephanie:  it’s supposed to feel like the webbing between your thumb and first finger
Stephanie:  (i bet you just felt it! because i did in class when i heard that)
Ktown: i see
Ktown: felt what?
Stephanie:  the webbing on your hand
Stephanie:  nevermind i was wrong!
Ktown: i was thinking about feeling my finger webbing
Ktown: then i read that and freaked
Stephanie:  it’s hard not to. I’m just curious!
Stephanie:  (i was anyway. In class i tried to hide that i was feeling it. I don’t know why i cared!)
Ktown: i keep thinking your talking about the other one

Everyone is an expert

In front of me in the study hall, two term 2 students are giving two other students advice on term 1 exams (“Biochem is the great equalizer.  They use it to weed people out”).  Everyone always has lots of advice, and I suppose at some point everyone else is looking for advice too.  But inevitably, the advice turns into rants about the class and you wonder who the advice-giving is helping more.

Not exactly…

Thinking back to memories from Year One back in the UK, and when I was helping the Global Health Committee host Dr.Paul Roux for a Global Scholars Lecture Series on Pediatric AIDS in South Africa.  A great talk.

One of the best quotes from the night was from a pre-lecture chit-chat with Dr.Roux and the rest of GHC.

So why does Grenada need so many doctors?

 

A look back on Healthy Grenada, launched!

Ready?

 

Who's the fastest?

 

Grade 4s at Grand Anse RC race for the title, at the first official Healthy Grenada outing.

Soccer comics for development and peace

United Nations Sport for Development and Peace comicbook!

Soccer stars and their fans are stranded on a deserted island and work together to survive.  All while addressing the Millenium Development Goals!

Such an awesome comic.  A shared this with me.  We found a new school to work with for the Healthy Grenada project, and after a few trial runs we’ve decided to start working with Grade 6s.  This is something we could totally use.  So good!

Rickets in sunny places

© 2011 Nucleus Medical Media, Inc.

A few weeks ago, I wrote about seeing kids here with Rickets, and wondered why they’d have this condition that’s classically linked to low vitamin D, which is a vitamin produced by exposure to sunlight.

Well I wrote my Nutrition final this morning, and we covered it a little more.  So-called African Rickets is common in developing countries, despite the sunniness.  Bone health is a complicated thing that’s not just Vitamin D.  It could be a lack of calcium in the diet, which would increase the release of calcium from bones, weakening them over time.  This makes sense since calcium’s involved in a lot of really important functions, some which are more important than bone strength (e.g. nerve and heart function).  So the bones go in order for more important things to continue to function.

Cow’s milk isn’t too expensive at supermarkets here (at least, not the strange long-shelf-life kind that is imported from Europe and will likely be on this island longer than I am), but the fact that cow’s milk has to be imported from Europe suggests how important it is in the Caribbean diet.

Another thing could be fruits and vegetables.  Surprisingly, they also impact bone health.  Fruits and veggies have a lot of potassium which helps to decrease the acidity of your body.  Without the fruits and veggies, the acidity goes up and bones will tend to “de-mineralize” (i.e. dissolve).  Not sure why there’d be a lack of fruits and veggies in the Caribbean diet.  Maybe it’s just individual kids personal preferences not to eat them, or maybe it’s a greater emphasis on starchy foods when kids are weaning off breast milk.

And that’s that!

Kids in the garbage

Leaving Frond’s place just after midnight a few nights ago, I saw a boy carefully and slowly untying plastic bags in the trash bin.  There was an older boy, early teens maybe, doing the same in the bins for the apartment building across the street.

What is going on?

Middle income

Middle income households back home live pretty comfortably.

Grenada is a middle-income country.  Meaning it doesn’t quite qualify for a lot of international aid programs, in some ways is doing quite well, but still has pretty dire poverty in many places.

The other night I slipped out of Frond’s place to head to the gym, hopping out quickly to try to keep mosquitos from coming in.  I saw the silhouette of two little boys, maybe 10 or 12, drinking cartons and rummaging through the trash bins outside Frond’s apartment.  Not wanting to embarrass them, or maybe embarrassed myself, I started walking towards school as if I hadn’t just seen two kids looking for food in my trash bin.

I had seen them before, one time during the day.  It was a few weeks ago and I was backing out of the parking lot.  I noticed them lingering around the garbage cans and I wondered what they were up to.  Something shady, I thought.  One boy, the taller one, was acting kind of like a look out and the other littler one was fiddling with his backpack behind the fence that the garbage bins sit next to.  I thought maybe they were drug lookouts or maybe they were child thieves.  They had backpacks and clothes without holes and shoes.  They looked like regular kids, except a little shifty eyed.  I’m not sure what it says about me that my first suspicions were that these young boys were part of a drug ring rather than that they were hungry and waiting for a chance to look for food.

I remember going through primary and high school continually hearing how lucky we were to be living in Canada.  I thought maybe they meant no war, clean water, no dirt roads.  I heard it so many times that it became kind of a cliche.  But Grenada is a middle income country.  On a scale of all the countries of the world, Grenada is average.  If you just arrived to the planet and asked to see how an average country lives, Grenada could be an example.

I still don’t really comprehend fully how lucky I am to have grown up where I did, but I think it’s a step to realize that you don’t really know.  It’s like realizing you don’t really know what the rest of the world is like, even what most of the world is like.  I’ve been raised in a bubble and it’s almost ridiculous how safe and easy it is there.

 

Stories from the Female Reproductive Tract

Heard in class:

“Last week I realized how little I know about the female vagina.”

“You really had to specify that it was female, huh.”

We just finished the female reproductive system in Pathology and I have to say it has got some freaky stuff going on.  It’s hard to conceptualize for many (I’ve heard a lot of guys complain that they just don’t get it because they don’t have ovaries, tubes, uterus, etc.. but it’s not like it’s something women can just open up and look at on themselves), but it’s really cool when you step back from it.  The whole process of ovulation and menstruation is so messy (Eggs rupturing out of the ovary!  Layers of the placenta breaking down and falling out!) and the pathologies you see in the female tract are so different from anywhere else because of the cells that are there ready to develop into a new person.

Mature teratomas

A cancer of the (unfertilized) egg where it starts to grow random bits of body like hair, skin, teeth, even brain.  Although it’s a cancer it’s totally benign and won’t spread or cause any trouble.  What might though is the skin that develops from it, which can sometimes turn into a skin cancer inside your ovary.

Endometriosis

The endometrium, the part of the uterus that is sloughed off every month in your period, is a sneaky bugger.  Sometimes it can start to develop outside the uterus, in places like the ovary, the fallopian tubes, even the lungs and in bone or in scars of previous surgeries (laprotomies and C-sections).  Even though it’s in an unusual place, it keeps functioning like normal every month i.e. bleeding in time with your period.

Partial Hydatidiform Mole

This is a kind of abnormal placental growth that’s caused by abnormal fertilization where a normal egg is fertilized by two sperm at the same time.  The embryo ends up with one and a half times the normal number of genes, which doesn’t stop it from developing at least a little bit, but then dies.  The woman will think she’s pregnant but after 3 or 4 months, she might be wondering why her tummy isn’t getting bigger anymore, and may go to a clinic when she notices she’s passing out tiny grape-like structures.  Instead of a developing baby, she has some normal placental parts, plus some abnormal grapey placental parts, and some embryo parts as well.