Preparation!

Six days until I fly off to Namibia and I'm terribly disorganised and am only just trying to figure out what I need to bring with me! Namibia is both freezing cold and relatively warm at this time of year - rather unhelpfully. I could talk about how I still feel so out of touch with clinical medicine, how it's taking a LONG time to return to the level of knowledge and skills I had prior to my essay-laden year out of medicine, and how I would love to be going to Namibia with my brain stuffed full of everything I'd need, how it would challenge me more, how I'd feel more confident, less out of my depth. But I'd rather focus on other things. Let's talk about beauty. Or sand. I'm going to be living in a desert for a month! First times for everything. Apparently it has internet access, good, as I'm applying for jobs in early October and the best thing about applications is you get to rank them in return. So I'm going to take my time nit picking exactly what I want. How am I already back talking about work, I thought I was talking about the desert? Ok, work. I loved the idea of being in a clinic in the desert, a clinic which serves the original bushmen of Namibia, the San Community, a marginalised and fairly deprived population. I chose this clinic because it incorporates the work I've done in international health - I'll be able to apply all those juicy nuggets of knowledge about determinants of health, the 6 components of the health system, etc etc. The risk of not using knowledge is that you lose it (don't I know it!). But also, it's a huge clinical challenge for a medical student. Patients may walk in with anything commonly found in the UK, or a tropical disease which, although common, is rare for me. So here, the mind maps you need to create in your head when you take a history need to grow larger, you need to be aware of a greater list of differentials, or at least an alternative list, probably, to the ones you'd have for a patient in a GP surgery in Devon. You probably need to grow comfortable with thinking 'oh ... I have no idea what's going on here', and here you have an excellent opportunity to rely on your management plan (optimism to the end!), which will include finding out what is wrong, or just asking the doctor...Patient examination will need adjusting to meet the social customs of the country..I'm guessing. And communication. Diagnosis is all about communication. Patients give you the information to give the diagnosis. A wise doctor, Lord Ian McColl in fact, once told me this before I went to med school 'listen to your patient. they are giving you the diagnosis' - I thought it was rubbish to be honest, how can they when they haven't gone to medical school?! Is what I thought when I was 18. No, no, the wise doctor was right! I've eventually learnt this, 5 years later. You need to ask the right questions, but you need to ask them in a way which is understood, and you need to listen to what they say. Listening consists of two things. Firstly, hearing the sounds that someone makes. Secondly, hearing the meaning in their words. Take the phrase 'the light is bright'. This could mean both photophobia, where external light hurts your eyes, OR it could mean a patient's retina is producing spots of bright light, caused by a number of conditions (or even normal). Trust me, when you're tired, hungry and thirsty you may not care to delve much into the meaning of this phrase, which could take a number of questions and MUCH patience. But you do, always. So you see, it's tricky enough when two UK nationals talk to each other, how is it going to be taking a history from a Namibian? Phrases have different meaning even if said the same way. I learnt this from carrying out focus groups in Uganda. So I expect I will be having to pick up the lingo quite quicky to help with history taking. To be honest, now I'm talking about medic stuff, I'm getting nerdily excited. It's always good to rely on nerdiness to push you along to face challenges. It might be hard, it might be scary, it might be tricky..but fulfilling, it will always be fulfilling.