• The ethics of inadequacy

    “I think we should transfer the patient to CT with capnography” “Excellent Idea” agrees the registrar Call consultant. “Unfortunately we do not have capnography on our portable monitor, we know this is not ideal.” I transport the intubated patient without this. This is a decision we are faced with everyday in any stretched healthcare system. To continue operating with resources that are inadequate or to stop doing what we are doing entirely? As an interloper from a mildly stretched healthcare system into an extremely stretched one I can see the inadequacies more acutely and feel them more heavily. In that moment, the decision was not a particularly difficult one. It…

  • Casual Competence; First impressions from medicine in a South African township.

    Cape townians are a relaxed bunch. In fact some of the most consistently chilled folk I have met in my life. This attitude did not changed when faced with life-threatening emergencies, many many life-threatening emergencies. After attending badem conference about a year and a half ago I had been itching to come and work in South Africa, an increasingly common choice for British junior doctors wishing to expand there experience beyond what can be offered by U.K training. After a head banging extensive administrative process, putting my life on hold and selling my motorbike I had made it here, to Mitchell’s Plain District Hospital; which serves a community of 350…

  • Lessons from the cape

    A things the U.K can learn from south african EM, and a couple of things they could learn from us. Get your numbers up After seeing the casual competence with my junior colleges here can undertake procedures which can make a registrar nervous back home the only answer to gain these is doing the procedure lots and lots of times. This requires time spent in hospital. It is a unglamorous and annoying conclusion but you just have to do your time. Sort your patients out fully The

  • Refugee medicine; suffering and hope.

    When I was eighteen, I left home backpacking, as is the norm for many young Britons. I naively proclaimed I was seeking out the best and the worse that this world had to offer. I had forgotten all about this until one of my colleagues said the same phrase to me as we drove home after a typically tough shift in Moria Refugee camp. It is truly the worst and best place I have ever been. The bad 12 000 people in a camp designed for 3 000. That was bad. Then it started raining. The lucky were in overcrowded boxes, the unlucky were in leaky tents and the rightly…

  • Refugee medicine; the difficulties.

    All medical jobs are on a gradation of difficult. The are moments when working in British emergency departments seems an impossible task, however, there are several things working in Moria refugee camp in Lesvos, Greece particularly difficult. The language Most of our patients are Farsi speaking, originating from Afghanistan, with a few Arabic speakers from Syria and a smattering of french speaking Africans. Unfortunately my Farsi doesn’t extend much beyond “loftan bishi” (sit please) and “salam, esmam “( hello my name is ) therefore we rely on our volunteer translators, who are refugees as well as complete legends, giving up their time for entirely altruistic reasons. Getting across some subtle…