Another year...

Today marks the first day of another year at Aberdeen Women's Centre! Yesterday, I completed my first year working as a doctor in the outpatient paediatric clinic. There was a lot of transition at the start, including a move to a new home, resuming clinical work and starting my online Masters in Public Health and at times I wondered if I would make it to the end of the contract. Thankfully, I did and I’ve decided to stay put for another year.  

Although there are parts of my work that are frustrating and challenging, like any job I suppose, the work I do in Aberdeen is also very rewarding. I have the unique opportunity to help children get better and advise and encourage the caregivers to provide healthier environments for their children, whether it’s through nutritional advice, encouraging them to bring their children for immunisations or teaching them how to prevent illness. It’s a privilege to work alongside a Sierra Leonean team and provide healthcare that makes a difference in the lives of children and families in Freetown.

Now that the rains have started, the clinic is even busier than usual and in the past three days alone we’ve treated over 400 patients. We are seeing more diarrheal disease, respiratory disease, as well as cases of severe malaria, in children of all ages. At times it’s scary to see just how sick these children can get but on the flip side, it is amazing to see how so many of them recover. I’m hoping for ongoing wisdom and energy for our team as we strive to help as many children as we can despite the craziness and long days. Here’s to another year at AWC.  

Exam Day: The results...

Friends and family already know this of course, but for those of you following this blog and the excessive posts about the exam, I thought I should write something about the results. Unfortunately, after two weeks I found out that I did not pass the exam. I was disappointed of course, but not entirely surprised. It is a tough exam. There were about 280 candidates of which 85 passed. So, a 30% pass rate and I was not among the 30%. I am sure I simply didn't answer enough questions because the negative marking threw me off.

So, for the past 4 weeks I have not studied. I think I picked up my embryology book once, before the results were even out, just to do some reading. Now I have to decide whether or not I will re-sit in April. Part of me says I might as well. I've already studied a lot, gone through it once, so should give it one more go. The other part of me wonders why I want to put myself through all of this again and the many hurdles to come! The thought of failing again is not pleasant. However, I also don't to give up. So, very likely I will start studying again very soon and give it one more go. I'll keep you posted.

In the meantime it's work as usual. Well, kind of as usual. I am off to Ghana this week for a conference that the West African College of Physicians is putting on in partnership with the Royal College of Paediatrics and Child Health. The focus is on postgraduate training, which is one of Welbodi's main interests. I will be attending with two colleagues and am hoping for a fun week and lots of useful networking and a visit to Korle Bu hospital and two of our residents there!

Exam Day: Has come and gone...

The exam is over. What a relief. The 24 hours prior to the exam were the hardest. I was just ready for it to be over. And now it is!

I stopped studying at 7:30 pm the night before the exam and tried to focus on other things. I was the first one at the exam center on Friday morning, with a 7:40 am arrival since my colleagues dropped me off on their way to the hospital. The first person to show up after me came at 8:15! The official start time was 8:00 am. At 8:30 we were allowed to enter the exam room but there was still one person missing – he was stuck in traffic. I think we should have just started – seeing as it was clearly mentioned that we need to be on time. The final hour of waiting was agonizing. At least the invigilators decided to start handing out the answer sheets and exam instructions, which was quite entertaining. You see, there was a suitcase on one of the tables which was opened somewhat dramatically. The invigilator made sure to show us the big sealed DHL style envelopes containing the exam papers per specialty. Then there was a moment of hesitation when one of the invigilators said that a photo should be taken to prove that all of the envelopes were sealed, however, it was quickly decided that this wasn’t necessary. Next there was some discussion around ‘the clock’. There was a clock in the room but it did not have any markings. Then, to my surprise, one of the invigilators pulled another clock (with markings) out of the suitcase! After switching batteries from one clock to another, the exam papers were handed out and at the same time the final candidate arrived.

At 9:00 am the exam started. The first 15 questions were easy. I was surprised. I recognized topics and could answer all of the sub-questions. Then it became more difficult, with questions concerning topics I hadn’t even read up on. Normally, I’d take an educated guess and answer every question, however, this exam has NEGATIVE marking and so guessing is not a smart move. Basically your score is the number right minus the number wrong. One needs to find a balance in answering the right number of questions to get a passing mark. To make a long story short, I am now more concerned that I might not have answered enough questions to get a high enough mark because I was being overly cautious. I guess I will know in a week! The unfair thing is that for pediatrics 1 point is subtracted for every wrong answer, whereas for the other specialties only 1/5th is subtracted.  At 10:00 am there was another moment of panic when one of the invigilators said that pediatrics only had another 30 minutes. I was only on question 40 out of 100 (with 5 sub questions each). We were quick to speak up and say that the exam paper clearly states that we have 2 1/2 hours! Phew. So, at 11:30 we handed in our exam papers and left the room. We had to wait in the waiting room for another 30 minutes while the other specialties (who had 3 hours) finished their exam.

It was tough, but it’s over. Pass or fail, it’s done and I have time to do what I want! At least for a little while.  Of course, I would love to have passed in one go – I’ve never failed a medical exam and would like not to have to do all this studying again. However, if I do need to re-sit, it’s not the end of the world. I’d have 6 months (till April) and know exactly what topics I need to focus on (I think). Plus, the hospital won’t be accredited till March 2013 (that’s our goal!) and so I can’t start residency until that time anyway. If I pass, I probably still won't start clinicals till 2013. Right now, there's an x-ray department to set up!

Exam Day: T-12 hours...

Wow. It's almost time. My bag is packed: HB pencils, eraser and exam number. 12 hours from now I will be at Connaught Hospital waiting for the final instructions before I write my exam. I have stopped studying for now. It is time to eat some dinner, take a break and get a good nights sleep. 

I have no idea how this will go. I feel well prepared, however, I also know they can test anything under the sun and there is the dreaded NEGATIVE marking and the odd ambiguous question here and there. This is one of those exams that I feel like I could study another 6 months for and probably would still not know nearly enough! Oh the world of medicine is so big. I keep having to remind myself that I am doing this with the hopes that it'll ultimately, eventually, in the long-run, improve paediatric health in Sierra Leone. 

This sure has been an interesting journey so far and it is only the beginning. I'm still not sure what I am getting myself into. I'll battle the first hurdle tomorrow and then take it from there. Thanks for prayers, encouragement and support! Fingers crossed.

Exam Day: T-3...

"There comes a time when for every addition of knowledge you forget something that you knew before. It is of the highest importance, therefore, not to have useless facts elbowing out the useful ones." - Sir Arthur Conan Doyle

Three days to go. Eat. Study. Relax. Study. Take a deep breath. Study. Eat. Study. Chocolate. Study. Sleep. And try not to dream about studying. I can do this. Almost there. I picked up my exam number today, so in theory, I am ready to sit the exam. Of course, I feel like I don't know nearly enough but I'll give it a go. I'm still trying to cram in facts that I think will highly likely appear on this exam (who knows really!) and wrap my head around a few difficult concepts that are sure to be tested. Better get back to studying.

Exam Day: T-7...

Seven days to go.
As much as I do like studying, I have to say I can't wait for this exam to be over. I have no idea how I'll do, the only thing I know is that I'll give it my best shot. Let's just be honest, there's a lot of information to know, the exam consists of a lot of questions in very little time and the negative marking may just be a killer. I always think of the many people I met during the course in Nigeria who are attempting the exam for the second or third time. Ugh. In a few weeks we'll know. If I pass, well, then I am definitely celebrating big time and if I don't then I'll celebrate the fact that the exam is over, take a few weeks off and then start studying again for April. Either way, I'm celebrating!

I'm heading back to Freetown today. I'll spend the weekend studying, using my handmade flash cards (see photo): memorizing and hopefully retaining the information. These flash cards have become somewhat of a treasure - they never leave my bag - I'll be using them in the plane today and I better not leave them in the pocket of the seat in front of me. That would be a disaster. On Monday I'll go to the hospital for work and meet with my colleagues to discuss various things and help with some planning. Tuesday hasn't been planned yet but I'll stay West-side on Wednesday and Thursday to cram and hopefully not freak out. Friday morning by this time I will have arrived at the conference hall at Connaught Hospital, ready to take the exam!By God's grace I will get through the next 7 days in one piece. 

Exam Day: T-20...

My sister asked me yesterday if I was starting to feel nervous about my exam. I said "no, not too nervous yet but I do want to get through all of my Nigeria material before leaving Holland if I can". I was on chapter 17 of 30. (I've been reading a lot of text books since Nigeria, but decided 6 days ago to start revising power points & notes as a final revision. Until yesterday, progress was good. I think I needed a bit of a study break, which I took in the afternoon.)

Today, I feel differently. Why? I decided to look through some past exam questions. Bad move. I thought I'd look through a couple of questions and encourage myself that I know a lot of the answers.

Well, the first question was about the composition of breast milk versus cow's milk. I thought I'd nail it because I know breast milk has: less protein but of better quality, slightly more fat (but more is unsaturated), lower osmolality, more carbohydrates (mainly lactose), less vitamin D (need to supplement), better iron availability and lots of other good stuff like immunoglobulins.

Unfortunately WACP thinks I should know this in more detail and expects me to answer true or false to whether or not breast milk contains 4.2 g/100 ml of fat, has an osmolality of 400, has 60.0 kcal of energy etc. Ugh. Of course, I can't remember the exact figures at that point and am unsure of whether things are true or false! A quick glance at my flash card reveals the answers true, false (300), false (66.6). Why can't they stick to testing whether or not I understand concepts. Why focus so much on numbers??? Surely that's not any more helpful in medical practice, besides you can look it up if you need to.

For now, I will ignore the exam questions and continue to revise my Nigeria notes. Once I'm done I'll tackle past questions again, and hopefully I'll see that not all of the questions are so bad and I can answer a good percentage of them correctly. Time will tell.

Exam Day: T-26...

After reading various books (paediatrics, physiology, embryology - not in full, but big chunks of them at least) I decided I should probably work through my Nigerian revision book, which is a collection of all of the presentations given during the revision week I went to in July with my notes included and nicely bound together. There are thirty chapters in all and I need to go through every one of those chapters thoroughly. It also includes some questions that were thrown out as example exam questions (very important!), notes to self about topics to read up on, questions asked by the professors that prompt further research, etc. Lots of good study material in other words. I worked my way through chapter one today: "Pharmacology". Tomorrow I hope to tackle "Transplantation Immunology", "Immune Mechanisms, Immune Deficiency and Hypersensitivity" and "Haematogenesis". Fingers crossed I'll succeed. More importantly, I hope that I will retain the information. I'm not sure if it's age or something else, but I am finding it more and more difficult to retain information. Sometimes I feel like my head is empty and won't allow anything else to enter and other times I think my brain is like a sieve. A lot goes in and a lot comes out again. It's time to keep things in my head! I'd really like to belong to the 1 in 5 that pass this exam...