Office work, expertise and ultrasound

I have spent most of the week prepping materials. We have a generously allocated office with intermittent Wi-Fi, this is quiet a luxury out here. There is even aircon (although I am loathed to turn it on when I am alone, imagining horrendous energy consumption in a city with daily blackouts). So, I spend the longest period of my life on Microsoft office; writing presentations, designing pre course assessment, spreadsheets of candidates and trying to plug the large amounts of holes in my knowledge.

I am here to teach point of care ultrasound. This is the use of ultrasound by the treating doctor at the bedside with an acutely unwell patient. It is become more and more popular in emergency departments and intensive care units in the UK. Now the devices are becoming cheaper and more portable there is much interest in using this technology and skills in lower resource settings. In settings here when CT scans are very expensive and difficult to come by, or in more rural settings, even basic X-Ray may be impossible to come by, these devices may provide a wealth of information.

It is this point the imposter syndrome kicks in. I am by no means an ultrasound expert. I know what I am doing, but in a ward full of HIV, TB and acutely unwell patients presenting with bemusing pathology I am somewhat out of my depth here. So, I try to learn, I read articles, watch videos, and send video clips to helpful colleagues back in England. Hopefully, by the time the doctors here get up to speed with the more complex applications I can have a rough stab at helping them identify things.

What I am somewhat an expert in is emergency medicine. After having run several A/E departments overnight with only very rarely called upon distal consultant support and with a freshly minted “fellowship of the royal society of emergency medicine” after my name I feel confident to say this. However, here, it does not exist. They refer to their new arrivals area as an “outpatient department” and the junior doctors who staff it in daytime hours are “family medicine” doctors, a speciality that is much more generalist than the GPs we are used to in the UK setting.

With lucky timing, they are opening a brand new “Outpatient department” with a resuscitation area (in theory), a procedure room (we shall see) and medical/surgical short stay wards. It currently looks impressively organised (without patients yet) with much more monitors than in the old one which is basically just one big room. We shall see if I can locate any more equipment and see what I can contribute to this shiny new department. One must measure expectations. I, as a sole outsider, here for only 6 months, must not attempt to convert a whole hospital of doctors and nurses to an entirely new specialty. A project doomed to failure. If I can get a few doctors performing useful ultrasound scans on patients after I have left this will be 6 months well spent.