Chilling with the lions

Took the afternoon off today and decided to go to The Lion Park. This is in Johannesburg and has been named of the top 10 lion parks to visit! Their white lions have been featured in lots of movies, especially the one called "White Lion". It is about 30 minutes away from where I am staying and went with Li and Niki. Here are some pics to give you a small glimpse of what we saw!!! Hope you enjoy :)

* I took all these pics with my iPhone - they aren't from google :P

This makes me think of Internal Medicine 

Ostrich feather!!

Li got out of the car to try and get another Ostrich feather!

We were so close to them - like right beside them with our car. The only time I opened my window in Joburg was in this place....probably not the safest LOL

A little scared, seeing as how they tried to bite some other guy. 

New pet?

This ones coat was red from the meat it was just eating - good thing because it's not hungry for me now! 

Nani nani booboo :P

He was just shoving my whole hand in his mouth!! 

Steve, Steve, Steve.....uhmmm....Alan, Alan, Alan! 

Leaving the park

Driving on the opposite side!! Piece of cake now ;)

Tomorrow is a holiday and big weekend up ahead in Johannesburg- that means LOTS OF TRAUMA expected!! I will be working nights for the next 2-3 days in a row! Also, next weekend is easter weekend and the end of the month. The hospital is a little scared for how busy they are going to be. They have asked most of the medical staff to be available in case they all need to be called in!! 

Thanks for following ;)

Evie - you think we our new condo accepts baby cubs? I'm down! Check this clip out and you will understand why - http://www.youtube.com/watch?v=btuxO-C2IzE  Thanks to Niki for showing that to me!! 

Good night everyone!! 

Phil 

xox

A day in Joburg...

Hey guys!! 

I decided that I would post some pics today and give you guys a glimpse into Joburg and my experience at the Johannesburg General Hospital....

Tuesday morning Morbidity and Mortality Rounds

Major Incident Trends at Johannesburg General from 2005-2010
The scale goes up to 900 people....take a look at their numbers!

Hospital hallway

The suture room

This is where they keep the headboards for immobilization

The clean, before the stretcher area

The Lodox machine - takes full body xrays of most trauma patients that come in right away before they get off the paramedics stretched, unless they are unstable. 

One of the many different ambulances they have here!

Inside one of the ambulances....very basic stuff here. But this is a first response vehicle.
Most are paramedics that can start IVs, administer morphine, etc...

Me and the crew

Chilling outside the trauma bay

Small world - this is Kevin Sawchuck. I bumped into him in the trauma bay and we started talking. He tells me he's from Canada. I ask where? He's like you prob don't know it, but from BC. I am like, well maybe I do, I am getting married in Penticton, BC. He says no shit, I live in Powell River. I was like uhmm...why does this sound familiar. Oh! Wait...do you know Jessica Bowes? He's like yea! I was like, she's my fiancee good friend and she's in my wedding! He is a student at the medical school here and is in his last year. SMALL WORLD!!! 

Sofie eating my Toblerone after leaving it on the table outside while I ate my lunch.
It melted in a matter of 10 minutes! She enjoyed it. It looked like poo. 

Chilling by the pool right after our shift

Billtong! This is sooo good, kind of like beef jerky but better!!
South African yummy :)

This is for you Vicki! My car parked at the university parking.
I managed to get free parking here for the whole month!! 

My car parked at my place :)
Thank you Vicki and Avis!!

A night out for dinner with the international students at Moyo Restaurant.
Germany, England, Austria, Australia, Sweden, Denmark and Greece!
We have all become great friends!!

Entertainment at Moyo Restaurant

Face painting at Moyo!! 

Costa! The greek surgeon from Crete, Irakleo.
This is where Evie's mom is from! We are getting together soon for some greek festivities in Joburg.
I found a greek restaurant called Mythos - we will give it a try!!

My reaction to the weather in Montreal while FaceTiming with Evie!
She was happy it was a snow day and got to stay home and relax, while my Toblerone melted :(

 Hope you guys enjoyed them and hope you are all enjoying the snow!! 

Good night from Joburg

Phil (+ Evie for life xox)

Already one week!

Hello!!

I can't believe how it's already been one week and 2 days since I have left Montreal. They say time flies when you are having fun - that's exactly what's going on here in Joburg!! It has been quite the week, I did not expect things to be this busy. I mean, I have heard from Oliver and Brendan when they came out here and recapped their experiences. Being able to experience this first hand is a whole different thing! I will try to explain things the best I can, but there are some things I just can't describe, for the sake of keeping this for a general audience.

Where do I start?

As I had described to you all, on Monday, this was more of an orientation day. Get acquainted with the medical school, the hospital, paperwork, meat the team, etc...

Tuesday was our first real morning. We started at 7am, where we attended the morning surgery division wide M&M rounds (morbidity and mortality). All specialties of surgery are expected to present their cases over the week, every week (not like back home where it's every month). As the registrar (resident) presenting these cases - you must know your patients history COLD. The profs and consultants use this time to grill you hard and ask impossible questions (even though you never saw this patient). Although stressful time on the stand, this is rather educational for those in the audience, ie. medical students. After this, we attended hand over rounds, where the consultants go over all the cases that occurred the day before and discuss them with the registrars. This as well can be a very intimidating process. The consultants sit at a table facing the registrars, the medical officers sit behind the registrars and then the seats all around the walls of the room are for the others. I did not know this and was lucky I didn't sit in any of these seats because they would have asked you to move, as if you should have known this already! After hand over, we then attended ward rounds with the consultants and rest of the team. We mostly round on the patients in the Major Injury Unit (trauma ICU), while the registrars manage the ward patients. These rounds are an opportunity for the consultants to ask you questions and you realize how you have forgotten a lot of the anatomy you once learned in first year! "Can you describe to me the course of the vertebral arteries from start to finish?" Uhmmm...no I can't was my first answer, laughing. And then he asked me to try - by then, I was saying things that didn't make sense, out of fear/embarrassment! It is amazing how well trained the registrars are here. They are VERY strong in anatomy, they know it COLD. However, after hearing the answer, a light bulb light up and I said "Oh yeaaaa" LOL. So I have now been looking back at anatomy, to refresh my memory because it has been so long (only 3 years).

Morning ward rounds

As you can see, they round a lot here. However, this is great teaching opportunities because they are very keen to teach you what they know, despite sometimes making you feel dumb. It's all part of the game! Once rounds are over, we grabbed some lunch at the medical school cafeteria. They have great selection of food, however the caf is always packed with students! It's really a great place - so many students everywhere and it's a fun environment. After lunch, we headed to 163, known as the casualty care area, where all the traumas come in. On our first day in 163, we were a little lost! Lots of people working and lots of patients coming in and we were standing in the middle of the room, trying to figure out what we can do to help! We met one of the Medical Officers (MO), Freddy, he wants to be a vascular surgeon, but needs to work as an MO until a spot becomes available. He helped us out and got us to start seeing some patients with him. This was a rather quiet afternoon, a couple of PVAs (pedestrian vehicle accident) these are very common here! Some hand and feet injuries - to which he asks me "Can you tell me about all the tendons in the hand and arm?" Geez! What's with all these anatomy questions on the first day...in my head, I was like I want to be a surgeon...but quickly thought that this is important to know and maybe I should brush up on this as well. Again, they mean well and want to push you to learn while your there. We left that night around 6pm and when I got home, I quickly turned to my anatomy book online and studied a bit. Felt much better after that!

On the next day, we repeat the same routine. Only this time, we started at 9am, when the handover meeting occurs, then ward rounds, then lunch and then 163 for trauma. This day, we met Sofie!!! She's an awesome international student from Sweden. She was our life saviour. She basically showed us everything we needed to know, how it works, what to do, where to go - she has been around for 7 weeks of a total of 9 weeks. This was very much appreciated!! She even brought us to 163 and showed us where everything is, where to suture, what they use, how to draw blood gases and run them yourself, what to do during resuscitations. We were now properly orientated by Sofie :) So the next few days were fun, seeing lots of patients coming in with all kinds of traumas. I will save the details for when I talk to you about my friday and saturday call!

On Wednesday night, we decided to go out for supper with Li, Niki and Olivia. Our electives administrator had suggested we go to Gramadoela's, supposedly a fantastic south african restaurant, very famous and we would love it! Trusting her advice, we all decided to go. However, we ran into a little bit of trouble. We left the house around 7:30pm, which was dark outside and followed our GPS. Only thing is, our GPS was a little confused and brought us around circling what looked like a very dodgy, unsafe area! Niki was following me with her car. At one point we ended up in this area with no lights and two guys in the middle of the road. Li asked me to open my window to ask them for directions - I thought she was crazy, but yet I opened my window just a tad and asked them. These guys had no idea, but wanted us to park our car in a spot they had reserved in the dark for us. They are parking guys - basically, people who find parking spots for u and promise to keep your car secure and you pay them. We quickly drove off and called the restaurant asking for directions. They claimed they didn't have an address, because they were in the theatre market square, which we couldn't find! Then at one point, we ended up on another street with no lights, few hundred people or so all sitting along the side of the streets (was like a scene from a horror movie). We quickly drove towards the light part of the city and again found ourselves in a dead end. Backed out, weren't stopping at red lights, and finally found the place! It was right beside the theatre market, very well hidden! We parked in an area with a real parking security, who watched our car for 2 rands (almost 20 cents) and off we went to eat! Honeslty, I know I am probably scaring some of you with this experience, but the restaurant was well worth it! The food was amazing - it was a buffet style of south african dishes! Here is the website for those interested! http://www.gramadoelas.co.za/ We ate and arrived safely back home :)

Sofie, Niki and I decided that we were to be on call on Friday and Saturday night. Basically we were going to work in 163 from 6pm to 7am. Friday and Saturdays were known to be the busy nights. Obviously, this is the weekend, people drink, have fun, get violent, etc...This makes sense, I mean we are busy back in Montreal on Friday and Saturday. However, not the same busy at all! The trends that have been described to me are the following: there is a baseline of violence all the time around here, it increases much higher when there are soccer games, mid-week and end of month (pay day) and holidays. The week before when there was a soccer game and South Africa lost - they had 9 stab wounds as of a result. So this Friday, we were ready (it was mid week).

Our office :)

One side of the 8 bed trauma bay

Niki and Joan (Swedish Orthopedic Surgeon) - on call

Night sisters!

I kept a record of all the cases we resuscitated and this was just in 12 hours: 7 stabs, 3 severe PVAs, 2 gun shot wounds (one of which was in the head with brain matter exposed and another was a guy who got shot at a bar after getting into a fight, his friends brought him by taxi - when we carried him out of the back of the car, he had already passed away. Shot went through left side of chest and out the right side), 4 assaults (most of which were community assaults - if you are being robbed in South Africa, you can scream "Injur" or something like that and people around you will know you are being hurt. The members of community will then take it upon themselves to run after the suspect and stop him to be arrested, however they sometimes take matters into their own hands and assault them first, very badly.) The casualties didn't stop all night. There was never a dull moment - we were busy all night long!! We get a lot of hands on experience here. We start all the IV's (getting in 14G needles is tricky - they are huge), do all the bloods, blood gases, etc... You learn fast and I am very impressed with how good the trauma surgeons are here. They manage with the resources available to them, but they still have most of the resources we do back home. Next morning when I was done, I went home and slept all day! I woke up at 2pm. Li was going to the mall, so I went with her to Sandton City mall. We went for a walk near Mandela Square, had lunch at an italian restaurant, then went shopping. The mall is absolutely gorgeous - its huge!! Did not expect this! After that, it was 5pm and I had to get ready for another night on call.

Mandela Square

Saturday night was even crazier and busier than Friday night. To sum up the night quickly - non stop from start to finish. 6 stab patients, 4 serious PVAs and random stable traumas. We had one transfer by helicopter of a patient run over by a truck. The helicopter landing is right outside the trauma unit, in the parking lot.

Helicopter landing with unstable patient

Around 2am, we received a patient who was stabbed in the chest, in the heart to be more specific. Patient was unstable, dropped his blood pressure and then quickly lost all vitals. We did an emergency thoracotomy. Basically, open up his chest and get to his heart which is being surrounded with blood and basically can't beat anymore because of the pressure chocking it from the blood. The trauma surgeon found the hole and put a stich in it, stopping the bleeding. While we were doing that, another patient came in, stabbed in the chest, in the heart. We quickly got him ready and another thoracotomy was done! I couldn't believe my eyes - in 15 minutes we had done 2 emergency thoracotomies!! This was insane, but when speaking to the other South African doctors, this was normal, business as usual. Luckily for the two patients, they survived and doing well now on the ward. WOW After a long night, Niki, Sofie and I decided to go for breakfast. Got home at 10am and then I slept until 6pm :)

Breakfast at Walnut Grove! Steak, eggs and billtong!!

I know that all of this sounds horrible and that it seems like there's nothing but violence out here. But I do have to remember that I am working in a busy Trauma centre and see nothing but trauma. They have patients being transferred over from all over the surrounding areas. I am getting great first hand experience - as one of my friends said - gotta find the silver linning. All of this has gotten me thinking and reflecting and trying to understand why this is so abundant out here. While I was at the mall, I bought a book on the history and direction of South Africa, which I started reading. I will reflect on this and get back to you on my thoughts :)

For now, this is truly an experience of a lifetime! I am enjoying every minute of it. I am surrounded by good people, making lots of friends from all over the world, meeting great doctors, and will be visiting great places in South Africa!!

Please do not worry. I am being safe, staying out of trouble and aware of the reality out here. I find that this experience will be teaching me a sense of security when not in a place that I am familiar with. I am learning lots out here and I hope that this will make me be a better doctor one day.

My fav house buddy Elvis!

Thanks for reading :)
Phil

P.S. Evie reminded me today that we are getting married in exactly 5 months!! AHHHHHHHHH but I can't wait :) Love you babes! Missing you like crazy!!

Settling in

Hallo! (Hello in Afrikaans :P)

Just to put most of you more at ease, I have managed to acquaint myself much better to the driving on the "wrong-right" side - as I explain it to the South Africans here. Once you get used to driving on the left side, now I just need to avoid the random time I try to shift with my right hand and hit the window!!

We last left off at me getting settled in to "Swanage". That is the place where I am staying and again to put most of you at ease - we have high walls around the house, electric gate entrance, alarm sensors in yard, bars on doors, gates inside the house separating the upstairs from the downstairs. So, it can't get anymore safe. Actually, nice rottweilers would be great! LOL In other words, I am pretty safe here at night when I sleep :)

Elvis and I - the little boy that lives at the house with me :)

On my first day, I had to drive Li (friend from Denmark) to the hospital she works at because her car had broken down the day before. Lot's of traffic in Joburg at 7:30am, kind of reminded me of highway 15, only thing is that the "combies" (small buses that pack more people than they can) think that every lane is a bus lane and will try and zig zag their way through anything - most of the fender benders you see are caused by these guys!! So you just try and keep a nice distance. Oh and when they are honking right behind you, don't take it personal because this is not directed at you, but the person across the street they are trying to catch their attention! Once I dropped off Li, I made my way to the University of Witts Medical School. This is a buzzing university, there are so many medical students, nursing students, health science students around. It's a great mix of people from all over the world.

I finally met Dawn Francis, the lady I was dealing with by email for the last 9 months while setting up my elective. She is awesome! Really nice lady who loves taking care of her international students! In her office were 3 other students who were going to be around for the next month or so. Olivia from England, Nicki from Australia and Pavel from Russia/Australia/Austria. We got our scrubs, trauma books, orientation, ID passes (even hospital has gates to enter) and we were all set!

Nicki from Australia.
We swipe our cards here to gain access to the hospital. 

Taken after my shift. 

Nicki was going to be with me at Joburg General, Olivia at Bara and Pavel doing ER at Bara. Nicki and I went to go say hi to the trauma team and figure out our schedule. We kind of arrived during morning handover, which can be pretty intimidating. The consultants (staff) sit across from the registrars (residents) and the medical officers (interns) sit along the wall behind them and everyone else finds a seat somewhere. We entered the room and they just kept talking as if they didn't care who we were. At this point, they talk about all the traumas that came in the night before. We were not dressed for the occasion - i was in my jeans, flips flops and back pack. Oh well! Once that was over, the head of the unit, Dr. Steve Moeng, asked us to round with the team and we will talk to him later. And so we did, but we couldn't find him after. We slowly sneaked away and decided to leave and come back tomorrow morning all dressed up and ready to go!

Just to clear things up. It is so difficult to get a general surgery residency spot here! This is known as a registrar spot in general surgery. For the most part, medical school is 5-6 years, then you do 2 years internship, 1 year community, then work as a medical officer until you can get a spot as a registrar and then that will be 5 years + specialization.

I was quite surprised to see how huge the hospital was. People everywhere, every specialty available, but very basic set ups. Trauma has their ward, major injury unit (trauma icu) and casualty care area (trauma bay) and theatre (what we call ORs). The major injury unit is a 8-10 bed ICU, that's full with critically ill patients. Ventilators, one to one nursing (expect for at night, when you can have maybe 2-3 nurses for all 10 patients in an ICU) and any procedure can be available at bedside (ex. percutaneous tracheostomy). The casualty care area, known as 163 (local number in hospital) is a 6 bed trauma bay that for the most part squeezes 10-12 on weekends. This is where the ambulance, helicopters, cabs, cars drop off critical trauma patients to us to assess. This is where I will be spending most of my time!! Just to give some people an idea, the saturday before I came, they performed 9 exploratory laparotomies in one night! That is intense! They had 7 stab wound patients and 3 gun shot wounds. This usually occurs on the nights of a soccer game. Also, I will be here for 2 big crazy weekends - soccer again, easter weekend and human rights day. This are going to get interesting! They made sure that those not working will be available to come in, which they most probably will!! I will be working overnight on those days!!

It's really amazing out here! Such a great experience and even all the people I am meeting! So far, I am good friends with people from Australia, Denmark, Sweden, England and Austria! We have been getting together for dinner our first 2 nights. We all get along really well and all have different perspectives of medicine, life, etc... It's going to be a great month with them and more students are expected to join us! We are trying to organize some safaris together and other fun trips!!

It's getting pretty late now and I also have to finish an assignment that McGill Medicine Public Health course gave us to do with a deadline one week after our course was done. Obviously we are all going to procrastinate!

Talk to you guys soon!
Phil

P.S. Shout to my mom, dad, steven, lawrence, ice and angel! Miss you guys :) xox
P.P.S Evie - you get your own shout out. Sagapo para poli! So proud of you on your perfect teachers evaluation!! Your kids are so lucky to have such a smart, talented teacher to show them the way! And I am even luckier to have you forever!! xoxo

gnight

Johannesburg, South Africa

Hello!! 

Last time I started my blog, it was over a year ago when I first ventured off to Africa, where I stayed in a small village in Ghana. Since then, I have had a tremendous interest in international experiences and thought I would finish off my last elective spot at McGill by going to Johannesburg for a Trauma Surgery rotation. This location seemed appropriate as Johannesburg is one of the busiest trauma cities known. There are two major hospitals here that coordinate the Trauma patients - the busiest in the world (I'm assuming based on stories and volumes!) is the Baragwanath Hospital. Bara is intense and there has been good McGill representation there in the last year (Justine, Oliver, Brendan and Sajjid). Now my turn, I will be spending a month at the Charlotte Maxeke Johannesburg General Hospital. This is based right beside the Wits University Medical School, one of the largest medical schools in South Africa!

I had booked this elective almost 9 months before the date because this is one of the hardest places to get a spot at. People from all over the world are trying to get an elective in Trauma because of the reputation they have. With that said, lots has changed since 9 months ago! Engaged to my beautiful Evie, accepted in General Surgery at McGill, new condo coming up, graduating in a 2 months and planning a wedding! I feel like this is a lot going on at the same time, but have been used to this crazy lifestyle. However, this made it so difficult for me to leave this time around. I was scared of leaving all this behind to go to South Africa and do Trauma in a busy violent city! Weeks leading up to my departure date, Evie would cry and beg for me not to leave. I was almost convinced to stay home, but I really wanted to get a chance to experience this. The day I left Evie at the airport, I was so miserable. I had this weird feeling in my stomach and I truly missed her. Never felt like this before and was thinking how 5 weeks was going to feel like forever. Evie and I are strong, we have been apart from each other before, only difference this time is that we have promised to spend the rest of our lives together, so any time away from each other makes it difficult, but healthy! 

My trip to South Africa started on late Friday night with a flight to London, England in order to catch another flight 12 hours later to go to Johannesburg. I figured I would venture out into the city and be a tourist, seeing as I had 12 hours! Within minutes of posting on facebook that I arrived to London, 3 of my friends living there messaged me and told me where to go, what to see, how to get there, etc... In 12 hours I : starting at 10am took the Heathrow express to Paddington station, then took the tube to Oxford circuis road, then I walked around downtown, Liecester square, Trafalgar square, Buckingham palace (in time for changing of the guard), Big Ben, London Bridge, Borough Market, St-Paul's Cathedral, some free museums, ate at Pret a Manger, met up with Rita (friend from long time ago, she's working there now as an Architect) had a drink on a rooftop lounge overlooking the city (while in my sweats and zip up and backpack) and then we took a London cab (so cool!!) and met up with my brother's friend/my high school friend's brother Roberto at a pub where there was a live rugby match playing, had some more beers!! I figured at around 6:30pm, that it was timet to get back to Heathrow Airport for my 9:05pm flight! On our way to the tube, we crossed paths with the Canadian House Pub, so we had to get another beer here! (silly me) I was sitting on the tube to the airport at 7:05pm - feel asleep because I had too many drinks and exhausted! It actually took 1 hour and bit to get to the airport. At this point its 8:15 and my flight already started boarding and I was at Terminal 1 from the tube. Luckily I didn't have to change Terminals and ran for 15 minutes to get to security and my gate! As soon as I showed up at the gate, she said just walk on the plane right now please. PHEW i made it on time!!! Then I slept for the whole flight, yes - the whole 11 hours!! Then voila, I was in Johannesburg! 

I am not going to lie, I was scared at first. You hear so many crazy stories about Joburg that it definitely keeps you on your toes! Also, this time I was all alone. This made it difficult because there is no one to share your fear with! Got to customs and waiting 1 hour circling around the line waiting to show my passport. No questions asked and I am in! My suitcase also made it too :) I was so happy! As soon as you crossed into the real world, the airport was buzzing. So many people with signs up, asking you for lifts, help you with your bags. I was on a mission: find a sim card for my phone and find avis for my car rental. Yes, I will be driving in Johannesburg. 

Once I got settled into my car, I couldn't get the GPS to work because I was underground. OH WAIT - so in Joburg, driver side is on the right and you have to also drive on the wrong side of the road. So exiting the parking lot, I figured I would be able to stop somewhere and fix the GPS with the address of the place I was staying at. Nope, it brings you exactly on the highway. So imagine this - driving on right side of the car, opposite side of the road, shifting with your left hand (standard car) and trying to fiddle with the GPS. DANGEROUS lol but you couldn't pull over and I didn't know where to go. Eventually I fixed it up and focused on my driving. Get off at an exit and turn right - DAMN IT - I just turned into the oncoming lane of traffic and car heading straight at me. I swerved to the shoulder and he slammed his breaks. People walking were screaming at me. My heart was racing, I was uncomfortable in the car, I was scared, shaking and wanted to be home cuddling in bed with Evie on a Sunday morning :( It got much better! I got used to, but you never actually get 100%, probably not until I leave from here in 5 weeks. 

Swanage - this is what the house is called where I will be staying for the time I am here. I am staying where Brendan, my friend stayed when he was in Joburg for Trauma. The house is owned by Dr. Alan Peter, a pulmonologist, a priest and a game ranger!! Such a cool man, unfortunately, he is away until March 10th on a safari! However, he has promised to take us to Kruger National park one weekend, camping with the animals! When I arrived, I was greeted by an Australian medical student who was leaving that day after spending 8 weeks here on elective. This house can house up to 7 medical students and also has a family from Uganda who are here for their PhD. (Clementine, Fidel and their cute little son Elvis! ) Eventually, a student from Denmark, Li, who is here for 6 weeks for a peds elective arrived and showed me around, gave me tips and we will be spending most of our time here at the house together.

It's getting pretty late now here and I think I will end my story here. I will continue to talk about the rest of my journey soon. I have started working at Joburg General - all I can say is that it's pretty eye opening to see how busy it can get here on the Trauma service. 

Good night and until next time....

Phil 

P.S. Miss Evie: I heart you