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Arctic Char

Full Member
15+ Year Member
Joined
Sep 23, 2005
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hey all, been a while. i figured that since i have received some thoughtful emails (scurred, TMZ), i'd post on the open board. i've been in Africa (western kenya) for the last 6 weeks, and since the internet is slow as all hell, i have limited my internet time to essential matters.

as for any inquiries about my CS conundrum, the answer is: according to the NBME, i won't receive my score before April 1st. which means i am completely screwed and ineligible for the match. what hurts, adding insult to injury, is getting emails from programs that say they are ranking me anyway, despite my informing them that i AM INELIGIBLE!! man this sucks. crossing my fingers that 1) some good programs don't fill, 2) they'd be willing to wait for my CS score.

As for commenting on my time here in Kenya so far - the messages i have sent home thusfar, have been rather lackluster; and, to be quite honest, our first few weeks here were just that. Eldoret isn't much on the eyes, its a 3rd world environment, and if you've seen one you've seen most of them. Our days consisted of rounding on inpatient wards, both pediatric and internal medicine. The wards are probably a lot like you would imagine - dark, yellow light, hot, humid, with flies all over. We would show up, and be surrounded by 25-35 Kenyan medical students (an absolutely ridiculous amount of people. and when they present at the bedside, they whisper. so in effect, maybe 2 or 3 people can hear the presentation, meanwhile 30+ others are giving each other wet-willies in the background). Being white folk as we are (Mazungu's), all eyes were on us. The Kenyan students present the patients' histories to us at the bedside, as we had to as 3rd year students (the kenyan students take excellent histories. but thats about it). We would then discuss the physical findings, and then we'd devise the treatment plan. This is when we'd learn that no one had even performed a physical exam. The Kenyan students and Residents and Medical Officers are very knowledgeable, and are good students . . . but they don't use their knowledge, at all. We'd round on the wards where patients would be 2, sometimes 3 per bed (not uncommon in big hospitals in developing countries). but, my god, sometimes the combinations were just disasterous. My mouth dropped when I saw an AIDS patient sharing a bed with somone with Tuberculous meningitis!

To this, I scratched the back of my head, raised my eyebrows, looked around and said "yeah . . . um...guys...someone tell me why this isn't a good idea?"

Occassionally, we were lucky to have a "consultant" physician join rounds with us to assist us in our management plans. these "consultants" are the equivalent of attendings in America, but here, as soon as they reach this status of training they enter private practice. They can't afford to waste their time in the hospital. They would only join rounds at the university hospital out of the goodness of their heart - once a week, maybe? We've also benefitted from some American docs from Indiana and Utah. They helped us tremendously, and I learned a lot from their guidance. Nonetheless, with such limited resources and diagnostic services, empiric treatment is the rule . . . i.e. everything is malaria until proven otherwise, chest pain does not mean heart attack, but, rather, Tuberculosis, and, ask all you want: no one knows where the goddamn X-rays are!

anyway, so the wards experience wasn't so fun. i did join the pathologist here several times performing dozens of FNA's. it was fun, and wow did i see a lot of shocking tumors! wilm's, neuroblastoma, tons of nasopharyngeal masses (who knows why), thyroid, skin biopsies, and some "other". i learned a lot, and am glad to have some experience with the procedure. other than all that, we've been enjoying the obligatory weekend wildlife excursions across the country though. we've seen some great African wildlife so far, fit for The Discovery Channel.

but all that was until this week, when everything changed.

We were joined last friday by a professor from Ben Gurion name Dr Yoram Singer, a specialist in palliative care. In addition to being an extraordinary person in demeanor and experience, he's an amazing teacher, and an inspirational doctor. Since he has been here, we have devoted our energies to working with the evaporating hospice service here. We may have imposed ourselves on their 5-person operation, but everyone seems the happier for it. They haven't had a physician consult for their hospice service in years, and so the long list of patients scattered around the region that need a doctor, and must be seen at home, have been going without. We've spent this week in our van, armed with a suitcase full of meds and treatments, driving out each morning across the countryside, seeing the hospice patients in their homes, their huts, and their tents. The vehicle is limited in capacity, so each day one of us follows behind on a motorcycle. its bitchin'

Note: i've done work in developing countries before, so its not the novelty of all this that excites me. it that somehow the experience, and this particular professor, somehow integrate perfectly with my level of knowledge and clinical skill. as a result, its just been getting better and better, and more and more fun.

This work has taken us to refugee camps the size of 10-20 football fields, completely saturated with A-frame after A-frame tarp-tents that say "USAID: From the People of The United States of America." It makes me proud to see that, and makes me think every time i see it. But anyway, these camps are completely devoid of any services, there are no media crews, journalists, medical doctors, nurses, or security (anymore). just tents, sticks, a goat here or there, and a lot of dirty, sick people who need help. Most of the refugee camps are composed of the Kikuyu people, who were being slaughtered by the thousands last year. It was absolutely amazing for me to see how many people I am capable of helping - no kidding helping - in such a short period time, armed with just a basic medical kit and attention. its simply unbelievable. I have never, ever experienced anything like this - and i've been around the block a few times. To me, i feel i am doing very little, and nothing really special - basic cleaning and dressing wounds (with some good tricks i know for bad anaerobic infections), prescribing palliative doses/regimes of steroids for those with unresectable tumors, giving opioids, antibiotics, teaching about when to take drug-X and when not to, and especially super-fine-tuning my skills at physical diagnosis. I'm just taking care of people and their medical problems, and helping them feel comfortable. medicine. its never been more fun (path still rocks though!)

Between these patients and those we've seen in their home, we have really begun to feel good about our work here, and our patients and their families have expressed immense gratitude - again, they have never seen doctors visit them before. this is what medicine truly is all about: making people feel better. Dr Singer has given us fantastic tutelage, and has gradually graded our role in decision-making. This eventually lead to an adventure last week that involved a financially empty cancer patient from a rural area, a hospital that didn't want him . . . and me. The patient is better already. The "Mazungu" Doctor usually wins ;-)

suffice to say our time here has truly become worthwhile, finally. We'll be taking ourselves out next week, for two weeks, to a remote area called Webuye. We'll be working the local hospital and the health clinic, and are optimistic that we'll gain from the experience, and also be able to help, and feel good that we're not just medical/humatarian tourists like the rest of the other white people here.

so, tomorrow we are taking off with the motorcycles to go see the Kerio valley for little R&R. it should be a good time. i'll tell all about the rest of our adventures later on down the road . . . i have plenty of stories already.

so, i'll keep you all posted on my whereabouts and activities. I'm crossing my fingers that everyone is happy with the match results in a couple weeks - and i am extremely flattered by the support (moral and otherwise) i've received on here. My situation sucks, and i'm hoping something good can come of it, but i'm not going to pout. So, thanks to all, and best of luck on March 19!

that is all for now. i'll check back in when my internet connection speeds up a wee bit . . .

cheers

-AC

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Last edited:
Arctic Char said:
as for any inquiries about my CS conundrum, the answer is: according to the NBME, i won't receive my score before April 1st. which means i am completely screwed and ineligible for the match. what hurts, adding insult to injury, is getting emails from programs that say they are ranking me anyway, despite my informing them that i AM INELIGIBLE!! man this sucks. crossing my fingers that 1) some good programs don't fill, 2) they'd be willing to wait for my CS score.

Sucks man, but keep your head up. Every year solid programs don't fill for various reasons. If you're flexible you can potentially land a very good position.
 
Sounds like a great experience. I just recently got to work in a free clinic on an away rotation and loved it. It's hard to describe, but it's medicine done in a cool way. Both you and the patients know everyone is doing the best you can and most patient contacts entail some type of improvisation whether it's to get a lab value, some treatment, or a follow up issue. There aren't all the expectations and algorithms that go into strict clinical medicine. It's pretty refreshing actually. I'm not saying one practices medicine in a poor way, but it allows you to really THINK about what you're doing instead of following a chart on the wall.
 
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hey all, been a while. i figured that since i have received some thoughtful emails (scurred, TMZ), i'd post on the open board. i've been in Africa (western kenya) for the last 6 weeks, and since the internet is slow as all hell, i have limited my internet time to essential matters.

as for any inquiries about my CS conundrum, the answer is: according to the NBME, i won't receive my score before April 1st. which means i am completely screwed and ineligible for the match. what hurts, adding insult to injury, is getting emails from programs that say they are ranking me anyway, despite my informing them that i AM INELIGIBLE!! man this sucks. crossing my fingers that 1) some good programs don't fill, 2) they'd be willing to wait for my CS score.

As for commenting on my time here in Kenya so far - the messages i have sent home thusfar, have been rather lackluster; and, to be quite honest, our first few weeks here were just that. Eldoret isn't much on the eyes, its a 3rd world environment, and if you've seen one you've seen most of them. Our days consisted of rounding on inpatient wards, both pediatric and internal medicine. The wards are probably a lot like you would imagine - dark, yellow light, hot, humid, with flies all over. We would show up, and be surrounded by 25-35 Kenyan medical students (an absolutely ridiculous amount of people. and when they present at the bedside, they whisper. so in effect, maybe 2 or 3 people can hear the presentation, meanwhile 30+ others are giving each other wet-willies in the background). Being white folk as we are (Mazungu's), all eyes were on us. The Kenyan students present the patients' histories to us at the bedside, as we had to as 3rd year students (the kenyan students take excellent histories. but thats about it). We would then discuss the physical findings, and then we'd devise the treatment plan. This is when we'd learn that no one had even performed a physical exam. The Kenyan students and Residents and Medical Officers are very knowledgeable, and are good students . . . but they don't use their knowledge, at all. We'd round on the wards where patients would be 2, sometimes 3 per bed (not uncommon in big hospitals in developing countries). but, my god, sometimes the combinations were just disasterous. My mouth dropped when I saw an AIDS patient sharing a bed with somone with Tuberculous meningitis!

To this, I scratched the back of my head, raised my eyebrows, looked around and said "yeah . . . um...guys...someone tell me why this isn't a good idea?"

Occassionally, we were lucky to have a "consultant" physician join rounds with us to assist us in our management plans. these "consultants" are the equivalent of attendings in America, but here, as soon as they reach this status of training they enter private practice. They can't afford to waste their time in the hospital. They would only join rounds at the university hospital out of the goodness of their heart - once a week, maybe? We've also benefitted from some American docs from Indiana and Utah. They helped us tremendously, and I learned a lot from their guidance. Nonetheless, with such limited resources and diagnostic services, empiric treatment is the rule . . . i.e. everything is malaria until proven otherwise, chest pain does not mean heart attack, but, rather, Tuberculosis, and, ask all you want: no one knows where the goddamn X-rays are!

anyway, so the wards experience wasn't so fun. i did join the pathologist here several times performing dozens of FNA's. it was fun, and wow did i see a lot of shocking tumors! wilm's, neuroblastoma, tons of nasopharyngeal masses (who knows why), thyroid, skin biopsies, and some "other". i learned a lot, and am glad to have some experience with the procedure. other than all that, we've been enjoying the obligatory weekend wildlife excursions across the country though. we've seen some great African wildlife so far, fit for The Discovery Channel.

but all that was until this week, when everything changed.

We were joined last friday by a professor from Ben Gurion name Dr Yoram Singer, a specialist in palliative care. In addition to being an extraordinary person in demeanor and experience, he's an amazing teacher, and an inspirational doctor. Since he has been here, we have devoted our energies to working with the evaporating hospice service here. We may have imposed ourselves on their 5-person operation, but everyone seems the happier for it. They haven't had a physician consult for their hospice service in years, and so the long list of patients scattered around the region that need a doctor, and must be seen at home, have been going without. We've spent this week in our van, armed with a suitcase full of meds and treatments, driving out each morning across the countryside, seeing the hospice patients in their homes, their huts, and their tents. The vehicle is limited in capacity, so each day one of us follows behind on a motorcycle. its bitchin'

Note: i've done work in developing countries before, so its not the novelty of all this that excites me. it that somehow the experience, and this particular professor, somehow integrate perfectly with my level of knowledge and clinical skill. as a result, its just been getting better and better, and more and more fun.

This work has taken us to refugee camps the size of 10-20 football fields, completely saturated with A-frame after A-frame tarp-tents that say "USAID: From the People of The United States of America." It makes me proud to see that, and makes me think every time i see it. But anyway, these camps are completely devoid of any services, there are no media crews, journalists, medical doctors, nurses, or security (anymore). just tents, sticks, a goat here or there, and a lot of dirty, sick people who need help. Most of the refugee camps are composed of the Kikuyu people, who were being slaughtered by the thousands last year. It was absolutely amazing for me to see how many people I am capable of helping - no kidding helping - in such a short period time, armed with just a basic medical kit and attention. its simply unbelievable. I have never, ever experienced anything like this - and i've been around the block a few times. To me, i feel i am doing very little, and nothing really special - basic cleaning and dressing wounds (with some good tricks i know for bad anaerobic infections), prescribing palliative doses/regimes of steroids for those with unresectable tumors, giving opioids, antibiotics, teaching about when to take drug-X and when not to, and especially super-fine-tuning my skills at physical diagnosis. I'm just taking care of people and their medical problems, and helping them feel comfortable. medicine. its never been more fun (path still rocks though!)

Between these patients and those we've seen in their home, we have really begun to feel good about our work here, and our patients and their families have expressed immense gratitude - again, they have never seen doctors visit them before. this is what medicine truly is all about: making people feel better. Dr Singer has given us fantastic tutelage, and has gradually graded our role in decision-making. This eventually lead to an adventure last week that involved a financially empty cancer patient from a rural area, a hospital that didn't want him . . . and me. The patient is better already. The "Mazungu" Doctor usually wins ;-)

suffice to say our time here has truly become worthwhile, finally. We'll be taking ourselves out next week, for two weeks, to a remote area called Webuye. We'll be working the local hospital and the health clinic, and are optimistic that we'll gain from the experience, and also be able to help, and feel good that we're not just medical/humatarian tourists like the rest of the other white people here.

so, tomorrow we are taking off with the motorcycles to go see the Kerio valley for little R&R. it should be a good time. i'll tell all about the rest of our adventures later on down the road . . . i have plenty of stories already.

so, i'll keep you all posted on my whereabouts and activities. I'm crossing my fingers that everyone is happy with the match results in a couple weeks - and i am extremely flattered by the support (moral and otherwise) i've received on here. My situation sucks, and i'm hoping something good can come of it, but i'm not going to pout. So, thanks to all, and best of luck on March 19!

that is all for now. i'll check back in when my internet connection speeds up a wee bit . . .

cheers

-AC


Hey, I've been reading your posts every now and then, but I'm not sure if you have done this: asking the programs that interviewed you for a PRE-MATCH (As I think you are NOT a US Grad, correct?)

Last year, I had the same problem with NOT being eligible for the match b/c I took CS too late. I'm sorry to hear that you have to go through that. I know it's so stressful for you now!

Another thing that you can do is call different programs NOW until August to find programs that have spots NOT listed anywhere, IF the scramble doesn't work out for your. If you are NOT picky about locations, you can get a path spot in many unexpected places.

Good luck!
 
Hey, I've been reading your posts every now and then, but I'm not sure if you have done this: asking the programs that interviewed you for a PRE-MATCH (As I think you are NOT a US Grad, correct?)

Last year, I had the same problem with NOT being eligible for the match b/c I took CS too late. I'm sorry to hear that you have to go through that. I know it's so stressful for you now!

Another thing that you can do is call different programs NOW until August to find programs that have spots NOT listed anywhere, IF the scramble doesn't work out for your. If you are NOT picky about locations, you can get a path spot in many unexpected places.

Good luck!

thanks for the words and the consolation.

yes, i have raised the issue with many PD's that i interviewed with. it just seems that no one is willing to offer a contract to me without CS in hand, at least not at the current time. i don't even know what to expect with the scramble - i don't know if they will take me even through the scramble without CS. did you scramble last year without CS? if so, how did the scramble go for you? any tips? PM if you like . . . thanks again

knowing you are at least a resident is encouraging
 
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