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!

Back to work, the highs...

Can I just start by saying that despite the many challenges at the hospital, I love my job? Maybe it’s easy to say that since I just returned after being away for 6 weeks! I was basically in the office the entire day but it was good. Even with the very slow Internet I still managed to get a lot done. What I liked most about today is realizing again how diverse my work is and knowing/believing that between now and 6 months we will see a lot of positive change at the hospital. I’m convinced of that! Just to give you a glimpse of my job as it stands now, I’ll throw out some of the activities that I’m involved with. Bear in mind that some of this is leading up to activities that will take place early 2013.

Delivering Emergency Training to nurses

Co-organizing our first Paediatric Symposium

Improving laboratory systems and practice

Setting up a new x-ray department

Chasing auditors for the completion of an audit

Arranging a trip to Guinea with patients

Communicating with our residents in the sub-region

Database queries and hospital data compilation

Representing Welbodi at a conference in Accra

Immigration and medical registration logistics for colleagues

Planning the official hospital accreditation visit

Paying bills for the Welbodi flats

In summary, there is a lot to be excited about. This hospital has a lot of potential and I am determined to help bring some positive changes over the next 6 months. Yes, I know, I am back on the Salone roller coaster and the lows are inevitable but when those lows come I hope to remember that there are many highs as well. I am convinced that we will move things forward. Watch this space!

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...

Exam Day: T-28...

In a previous post I explained that I am studying for a paediatric residency entrance exam. Well, the studying continues for another 27 days. 28 days from now I will be sitting at a desk at Connaught Hospital, writing an exam.

I never thought the Krebs cycle would come back to haunt me but sure enough, I found myself in the depths of biochemistry yesterday reading about metabolism of carbohydrates, lipids and proteins. I have to say, it is somewhat more interesting to look at it with much more clinical experience but the fact remains, biochemistry is not really my thing.

It's unbelievable how much material I have to cover. Physiology (renal, cardio, pulmonary, digestive), biochemistry, embryology, pharmacology, statistics, etc. There's just not enough time, but I'll do what I can. I'm a bit alarmed at times but once I sit down and study, I find I quite enjoy it. I can only do my best and hope for the best. Unfortunately the exam contains of loads of questions in little time, plus there is negative marking. It's going to be a bit of a gamble to know how many questions to fill in!

This all makes me wonder if this idea is just too crazy. Is this what I should be doing right now? It's funny how throughout life we/I tend to question what the future will hold and how we can shape that according to God's plans. Spending a bit of time out of Sierra Leone gives me the chance to reflect. I find myself wondering if the hospital will ever change? If we (me, Welbodi, aid in general) are making a difference? How we can motivate people? If there's any point in carrying on if people's attitudes don't change? If I should continue to invest time and energy? Will spending hands-on time on the wards day in and day out change things? As you can see there are many questions and right now, few answers. It's a good thing I have a few more weeks in Holland to reflect in between the studying!

Nine days in Nigeria...

Nigeria. What can I say? I went, I survived and I came back. I did not get a t-shirt or any other souvenirs for that matter but I do have a stamp in my passport and more importantly by West African standards, I have a certificate of participation to hang on my wall! That's all that really matters, right?

Honestly, it was a pretty good trip (I can say that now that I'm back). It could have been a lot worse. I was not pleased that it took us about 1 1/2 to get our luggage on arrival and much less pleased by the 3 so-called police officers that harassed us in the parking lot at midnight. It wasn't the nicest welcome. Let's just say that as soon as I arrived in Lagos, I was ready to move on to Ibadan.

Of course, in Ibadan we were again faced with the somewhat less safe conditions in Nigera. Dr. Jalloh was supposed to stay with friends but their house had been broken into the previous night. He decided he would stay in the hostel on the hospital compound as well. So, 4 of us stayed in the hostel- small but decent. The only annoying thing was that the electric stove took about 1 hour to boil water. Oh, and the toilet didn't flush properly and the tap was broken but other than that it was fine.

The revision course was good. I was pleasantly surprised by the high quality of teaching - what a relief!? I would have backed out of this whole idea had the teaching been rubbish. Thankfully it was good- interactive, up-to-date, relevant, etc. Of course, there were a few lecturers who were extremely boring, but that can happen anywhere. We had lectures from 8am-7pm which meant long days, after which we stumbled back to the hostel for some more studying and sleep.

Really, the course was worth going to but I have honestly never missed Sierra Leone as much in my life. It sounds strange now but I was counting down the (nine long) days to come back. I was so thankful for phone calls and text messages with Suzanne, Allison, my mom, Gibrill and Osman. And the random calls from people in Sierra Leone that didn't realize I was out of the country. It's quite convenient that Airtel works in Nigeria!

Thanks to those who prayed for my trip! I appreciate it. Especially Allison and Suzanne who prayed after I texted them from a crazy highway on our way back to Lagos. I'd not been so afraid on the road for a while. Talk about manic driving. As you can imagine, I was happy to arrive in Lagos again, thankful we could stay at Prof's son's house (thanks Prof!) and happy to be flying home the next day. It's a bit of a shame we didn't see much of Nigeria... maybe next time. We did see Prof's hospital which was quite fun and I was impressed by the level of the commitment the staff showed. All in all, it was quite the experience...

Exam Day: T-49...

Many of you may already know this but I have done something crazy. I registered to take the West African College of Physician (WACP) Primary Exam in Pediatrics this October. This is a very difficult exam which one needs to pass to enter the residency program through the West African College.

Why am I doing this? That’s a very good question and one I ask myself often. Believe me, having to study for this exam is quite stressful and I wonder why I am putting myself through this when I could be hanging out with my friends! Since I’ve just done general medicine but love pediatrics (and have been doing pediatrics for the past 7 years) I’ve been contemplating actually specializing in pediatrics. However, it just didn’t seem like doing so in Europe or the USA made much sense. First of all, I’m not too keen to practice in those places, plus it’s not quite as relevant for the situation here. So, since I heard that the WACP is recognized as an equivalent to the Royal College of Pediatrics in the UK, I thought this might be the way to go. Another reason why I’ve chosen this option is because I still want to contribute to improving child health in Sierra Leone, and with that, the postgraduate training program for doctors here. What better way to support the program than to go through it myself and show people this can be done. That’s the idealistic reason behind this of course.

So, it’s another 7 weeks till the exam. This is the first hurdle and a very difficult one. The exam has a 20% pass rate and it’s not because people don’t study. It really is a tough exam. I recently went to Nigeria to attend the update course – a very intense week with about 10 hours of lectures a day and I’m hoping that increased my chances. All I can do is try. I’ll try in October, and if I don’t pass, I’ll give it a go again in April. If I still don’t pass, we’ll just say God has other plans! It’s not like there aren’t any options out there…it’s a matter of figuring out what’s His best plan for me.

I already know that once I master this hurdle there will be many more to come. First of all, our residency program is not established yet, but we are trying. We hope to get the Children’s Hospital accredited early next year through the West African College. This involves making sure we get the digital x-ray system up and running (thanks for donations so far) and improving the laboratory and medical records as well as many other things. We have our work cut out for us! It also means I would start rotating around the hospital and doing on-calls – both frighten me a bit. And it means many more things will come my way that I’ll have to deal with as they come up. It also means staying here for the next few years, which some days excites me and other days really doesn’t. I think the hardest thing for me has been seeing so many friends leave over the past few months…I get tired of doing this ‘on my own’. Even that is something God knows and sees and I truly am thankful for the people He’s brought along my path!

Anyway, for now, I’ll try to study when I can and trust that God will open and close doors along the way.