A PUBLICATION OF THE T&T MEDICAL STUDENTS’ ASSOCIATION (2015-2016)
The Clinical Years
Beyond Office Hours
A visit with William Osler
Student Life
& much more!!
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THE PULSE TABLE OF CONTENTS T&T Medical Students’ Association THE PULSE TEAM Taureef Mohammed (Editor) Irfaan Ali (Graphic Artist) Nicole Maharaj Cimone Ramcharan Patrick Edward Chin-Kong Sneha Rao Mateus Fernandes Sherry Ann Soongoon Keeron Tull CONTACT US Email: ttmsapulse@gmail.com Tel: 735-1001/769-1865 Facebook: Trinidad & Tobago Medical Students’ Association Cover photo of William Osler reproduced by permission of the Osler Library of the History of Medicine, McGill University
A message from the Dean Greetings from the TTMSA president Advice from the TTMA president A dose of reality Music and Medicine Building a strong foundation Adventures Down Under A visit with Sir William Osler Beyond Office Hours A psychiatrist extraordinaire A plea for voluntary blood donors Ward rounds: medicine, psychiatry, surgery White coat—a pictorial review of year 4 Evolution Valedictory Speech 2015 Do you know your history?
JGI Hall Football Team— 2016 Big 4 Champions
4 5 6 7 8 10 11 12 14 16 18 20 23 25 26 28
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A MESSAGE FROM
THE DEAN
PROFESSOR TERENCE SEEMUNGAL
Let me begin by commending the editor and his staff for putting together an exciting and enlightening collection of articles that range over 150 years in time and several thousand miles in space.
The editorial team interviewed one of our new members of staff but also had a visit with an old physician who would have been about 160 years old today. William Osler is one of my heroes and I am so pleased to be able to share a brief moment with him! Osler is credited with advancing the modern system of teaching through service for the clinicians that set the basis of the residency system in the USA. This issue of The Pulse also has wide geographical limits as it includes visits of countries as far apart as Canada and Australia. Medical school learning really encompasses a wide array of information and this issue reflects this. I recall learning some salient facts about African History while I was at the Mona Campus on a day when our laboratory session was cancelled and thus I am pleased to see articles that encompass the humanities as well as 'tastefully' related personal experiences of students. The epitome of it all comes at the end when the valedictorian, Dr. Erron Ramdass, encompassed it all with his delivery of a message using a unique combi-
nation of formal speech, music and dance. I wish the editorial board every success for the future of this journal.
“This issue of The Pulse also has wide geographical limits as it includes visits of countries as far apart as Canada and Australia. Medical school learning really encompasses a wide array of information and this issue reflects this.�
Call 735-1001/769-1865 E-mail: ttmsapulse@gmail.com
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GREETINGS FROM
THE PRESIDENT On behalf of the executive of the Trinidad & Tobago Medical Students’ Association (TTMSA), I would like to welcome the newest addition, the Class of 2020, to the Faculty of Medical Sciences, of the University of the West Indies or as I refer to it, the MedSci Family. You all have proven to be the crème de la crème in that mountain-high pile of applications. The TTMSA is a representative body of the medical students in T&T. We are actively involved in medical education and service initiatives in communities across the country, as well as in the coordination of extracurricular activities for medical students. Most of you have come into medical school with the preconceived notion that it is all about studying and exams. Indeed, this should be your first priority as a student, but it should not be your only one. Involvement in extracurricular activities has been proven to have an extra benefit to not only you as a person but as a medical professional as well. There are so many avenues now at the faculty to participate in enriching activities. The myriad of clubs and associations now open to students are a testimony to this fact. The TTMSA itself has a variety of subcommittees in which students can join and participate in projects and events that benefit the student population, community and the individual. Medical school is no walk in the park. These five years may be some of the most enduring times of your life. From that first spotter in MDSC 1001 right up to that
I’ve seen for myself the huge difference a compassionate and caring doctor makes in the management and outcomes of patients. No matter how far up the hierarchy you go, always remain humble and compassionate; the people who stand to benefit the most are your patients. I would like to wish you all God’s choicest blessings and a very successful year ahead. May your hands be the instruments of service and comfort to those that need it the most.
MITRA MAHARAJ
Mitra Maharaj, TTMSA President (2015- 2016)
Class of 2017 last station in your final MBBS OSCE, sweating it out in front of a consultant you’ve never seen before, medical school will test every last molecule of your very existence. Being a doctor means living a life of service and sacrifice and sometimes it may stretch you to the limits of your endurance. Never be discouraged; remember the reason you have joined this profession; keep your chin up and keep moving forward. A very young, but wise doctor once said, “Medicine is an art, as well as a science practiced by medical professionals who bring to the bedside not only technology and training but also humanity, caring and compassion.” Being in my final fourth year clinical clerkship,
“Being in my final fourth year clinical clerkship, I’ve seen for myself the huge difference a compassionate and caring doctor makes in the management and outcomes of patients.”
TTMSA EXECUTIVE 2015-2016 Mitra Maharaj (President); Isabella Griffith (Vice president); Jonathan Edwards (Secretary); Alyssa Singh (Assistant Secretary); Keston Rattan (Treasurer); Thais Razark (PRO) and Years 1-5 class representatives
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Advice to students from the TTMA president:
Of what we know for sure When Taureef (who has to be the most patient editor in history) asked me to write for The Pulse, I wondered what I would write to my former student self. What is it that I know now, for sure, that would have been useful back then? Mind you, there are a lot of people who give great advice to you as students – I have seen the interviews from your excellent past editions of The Pulse with the esteemed Dr Prem Ratan; the “Jitterbug” himself, the incomparable Prof Paul Teelucksingh, and the inspiring addresses by Prof Samuel Ramsewak, your former Dean. There is an abundance of wisdom there already – far be it for me to wax philosophical to you on the heels of these great colleagues. So instead allow me to give practical advice for your years as students. The academia of the first three years are hard, but an essential foundation for the real life pathology you'll meet on the wards in the fourth and fifth years. Learn, learn, and then learn some more! The foundation will hold you in good stead on those late nights, clerking that patient with nine “presenting complaints,” no family to fill in the details of the sketchy problem list or medicine list to give you clues. So as you hold your head wondering where to start, just remember the basics: always take a good history and the rest will unfold from there. Make use of your time in Skills Lab as well so that your practical procedures are
not a hit or miss attempt, but an execution of a well-practiced clinical skill. When you do hit the wards, here's the deal: 1.The patients' are your greatest resource: The books have nothing on the wealth of knowledge at your feet in hospital, served to you on a platter, embodied by each person in A&E, or on the wards. Take their histories, hear their stories and let them teach you about illness and life. 2.The nurses are your friends: They bail you out of more sticky situations than you knew existed (especially if they like you). Be polite, remember they are your colleagues and give them the respect they deserve. 3.Try not to screw up too much: This is a learning curve, you're not meant to know everything yet. Practice does indeed make perfect; so ask for help (instead of winging it and hoping for the best) if you're in over your head. And remember, your education as a doctor is lifelong—Continuing Professional Development (CPD) and Continuing Medical Education (CME) events are going to be a necessary part of your future so embrace the curve! 4.Take care of yourself: Eat healthily and try to rest properly – if you're grumpy you'll not be kind to the patient who looks to you for help. (And feed and water your intern regularly.
She/he is your fellow minion and one day will be your senior—so spoil them a little.) 5.Never stop asking WHY? It is easy to run a battery of investigations and assuredly tell the patient what they don't have (“Good news, it wasn't a heart attack!”), but that's never enough. Why were they having that chest pain in the first place? And if your tests didn't give you the answer, you haven't finished your job. Keep going. The answer is probably at your fingertips. So good luck – you have a bright future ahead of you! We at the T&T Medical Association are proud to support you all as future colleagues and are here for you as mentors. Allow me to close by sharing a quote from Dr Margaret Hamburg at Stanford School of Medicine's 2012 graduation ceremony: “Patients do not put their trust in machines or devices. They put their trust in you … remember that the more skilled you become, the more specialised you become, and the more dependent on technology you become, the easier it becomes to lose your humanity, forget your compassion, and ignore your instincts....Never, ever lose your moral compass." Dr Stacey Chamely, T&TMA President 2016
The Official Journal of Trinidad & Tobago Medical Association
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LETTER TO THE EDITOR
A Dose of Reality After an exceptionally busy call on the obstetrics ward, I had slipped into a whole new realm of exhaustion. I had sharp, well-localised epigastric pains, which I attributed to hunger but, as many a medical student has done before, suspected it to be another insidious disease. I narrowed the differential by the process of elimination and hunger remained. Admittedly, fourteen consecutive hours in the hospital climate was no feat, but as a fourth year medical student it seemed extraordinary. I felt validated, like an essential part of the team, a real doctor so to speak. I had assisted with numerous procedures and had been interacting with patients all day. This sentiment filled me with purpose and pride. But as the cliché goes, what goes up must come down. It was around 9pm, and the house officers were at the doctors’ station. The students and I sat a short distance away from them—we all looked comically unkempt. There was an emergency caesarian section scheduled and several other women had been induced. It looked to be a busy night. The sounds of fetal heartbeats on cardiotocograph machines and one particularly vocal mother having contractions filled the ward. I was staring blankly into space, when I noticed a bright light shining in the distance. Standing a few feet from the doctors’ station, a middle-aged woman stood with her cell phone recording both the doctors and the group of students. She loudly proclaimed that she and her underage pregnant daughter had been waiting for so long while all the doctors relaxed. The doctors and students attempted to engage her in a professional manner, but her responses and body language were belligerent, insulting and very confrontational. In an attempt to quell the situation, a doctor showed the irate woman the signs
around the ward saying video recording and violence toward staff were not allowed. Only the promise that her daughter would be seen imminently pacified her. She went back to the sitting area, still loudly complaining about doctors and her perceived mistreatment. Patients before had verbally abused me but I felt a peculiar sense of dread
“I realised that despite the overwhelming negativity, the combative attitudes and the moments of selfdoubt, we are part of a noble profession, and should allow ourselves to be no less than excellent.” this instance. This woman had a recording of all of us. Thinking about the fate of the video, I became paranoid. Was she going to upload it to a social networking site? Was I to be featured on a popular local crime show or the evening news? I went from a state of dread to infuriation in a matter of seconds , as I realised that any platform she chose to spread the video on would be met with widespread approval. There is an apparent adversarial relationship between the public and the healthcare sector, largely spurred on by sensational reporting in the media. Too often would I read the denigrating comments on articles featuring healthcare professionals—comments based not on reason or fact, as the details surrounding a patient are usually confidential. The doctors on my team had been working tirelessly all day and I envied
their stamina. And actually, the woman and her daughter were not waiting for a long time. She was not critical and there were other patients who required immediate attention. Yet, I could envision the multitude who would label us as neglectful and indolent without a second thought. It begs the question, are we to forsake our physical needs the moment we enter medical school? Despite my industry, would it ever be enough? Would there always be someone to berate me the moment I slowed down, the moment I was human? Fatigue breeds error, as evidenced by numerous studies. And, as we all know, medicine requires a particular attention to detail. This means that each patient must be devoted adequate time. We treat the most likely cause of the patient’s complaints, but there is always a differential. To borrow from Sir William Osler, “Medicine is a science of uncertainty and an art of probability.” I went home that night feeling defeated, but I woke up the next morning with several realisations. I realised that there will be more incidents like this, but I must still work diligently. I realised that this was only the start of my medical career and I should not allow this incident to diminish my passion. I realised that despite public perception, I would still treat every patient professionally, and I would prove naysayers wrong. Lastly, I realised that despite the overwhelming negativity, the combative attitudes and the moments of self-doubt, we are part of a noble profession, and should allow ourselves to be no less than excellent. Narina Thompson Class of 2017
Do you have an opinion on anything related to medical school? We would like to know. Write a letter to the editor and send it via e-mail to: ttmsapulse@gmail.com
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Talent, in all its forms, is ubiquitous at the Faculty of Medical Sciences. We have all at some point or the other gathered in Amphitheatre A to be entertained, whether it was at the Christmas concert, the Divali play or Meds Mt Hope Idol. Have you ever thought about what inspired these incredible performers? We had the privilege of interviewing two of the most noted at this time, guitarist Adriel Rahaman of the Class of 2018, and violinist Rachel Spann of the Class of 2019. As we sat in rituals, because every great discussion needs coffee, it was obvious from the get go that they were both unique. Their stories prove that with passion and practice musical talent can blossom into its full potential. Adriel and Rachel started music at 11 and 14 respectively, both for different reasons. Adriel showed initial interest by asking his dad about learning to play the guitar. Rachel, on the other hand, required a spark. She asked for violin lessons after being introduced to the flute at secondary school. Rachel had the privilege of training
under the late Ester Batson, Kenneth Listhrop and Sameer Alladin of the St Augustine Chamber Orchestra. Coincidentally, Sameer Alladin is Adriel’s cousin— we’ll leave that there for the geneticists to determine if musical talent is a genetic trait. Although Rachel’s passion was guided by gifted professionals, Adriel’s gift was almost natural. His dad gave him his first basic lessons and subsequently, Adriel picked up the rest on his own using the ever faithful YouTube.
“Music expresses that which cannot be said and on which it is impossible to be silent.” These two musicians had quite unique tastes. Adriel’s anthem was ‘Mr. Jones’ by Counting Crows: “We all want to be big stars / But we don't know why, and we don't know how / But when everybody loves me / I’m going to be just about as happy as I can be.” One of his most memo-
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rable experiences was at Fiesta Plaza in 2013 when he and his band, Haven Close, had the privilege of performing songs from Kings of Leon and Taylor Swift in front of the crowd. “Having family and friends there in the audience was an amazing feeling,” he remembered. Rachel in contrast appreciated classical music and playing alone or in the company of a 100-person orchestra. In 2014 Rachel and the orchestra played her absolute favourite instrumental, Beethoven’s 5th Symphony by Antonio Vivaldi and Johanne Sebastian Bach, at Queen’s Hall. Beaming with adoration, she said “It is a glorious piece of music where the instruments are having a conversation with each other.” We spoke at much length as to what inspired them to continue playing music. They both agreed music was a universal language. Adriel quoted Victor Hugo: “Music expresses that which cannot be said and on which it is impossible to be silent.” Rachel explained: “There is a special joy that comes from playing a special piece for someone.” Upon having
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the opportunity to teach a group of students, Rachel said, she really saw the positive impact music could have on someone’s life. Playing a musical instrument made them more confident as young individuals and also formed strong bonds of friendship. Adriel met his best friend through his band and he admitted that with his brother in the band their relationship is now stronger than ever. Academic pursuits require a lot of time and energy. Yet these two were able to become accomplished musicians while
succeeding at the familiar milestones: CAPE, spotters and phase. They both shared the opinion that playing a musical instrument can be very therapeutic during stressful times and it was done simply for their enjoyment and relaxation. As for their future plans, Adriel expressed his interest in the use of therapeutic unorthodox musical techniques.“I want to go as far as I can go,” he said nonchalantly. Rachel doesn’t have any solid plans but wants to restart music classes to develop her technique and hopefully recommence teaching too.
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Looking at Rachel and Adriel we see two young, intelligent, and talented medical students. Playing music taught them how to adapt to stressful situations, time management, and it continues to help them become proficient students. It’s no secret that music conditions the mind, it engages the brain and muscles, and aids in concentration. So, while in medical school, don’t be afraid to pick up that instrument you have always dreamed of playing—who knows, passing exams may become much easier!
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Studying medicine is a lot like building a puzzle. You need to put together all the pieces to see the full picture. The knowledge you acquire during preclinical years are some of the most important pieces of that puzzle and it is important to not take it for granted. Preclinical students, you are now on the stepping stone toward becoming health professionals—whether it be a doctor, dentist, veterinarian, pharmacist, optometrist, or nurse. A lot of us are eager to do very well in our exams and proceed to the next stage of our medical career and that is excellent, while some of us (let’s be honest) are not sure if this is what we really want to do. It is okay if you fall into the latter category because many of us are still finding ourselves. You will figure it out eventually, sooner than you think. Medicine demands dedication and is notorious for consuming a person’s life. I am not going to disagree with this but it may not be as bad as it sounds. A profession in the medical field is more than just a job. It requires so much commitment that it becomes a lifestyle—and that is beautiful. It is very important to focus on your holistic development during your time as a student. One of the best things about the Faculty of Medical Sciences is the opportunities available to participate in extracurricular activities: TTMSA, MSSC, Leadership Council, Rotaract, MEDS, MHIS, IVCF etc. These are also great avenues to make new friends and new connections. Every subject in your Preclinical courses is equally important—anatomy, physiology, biochemistry, public health
“Remember, the ultimate goal is to use the knowledge you acquired during these years to treat people and to do this, it is essential that you truly understand what you are taught in the foundation years.” and even PECH. They all are necessary for you to be a good health professional, so do not neglect any of them, especially PECH. I’m sure you have seen examples of poor doctor-patient communication on television or you might have had your own experience. Furthermore, PECH stimulates intellectual conversation, an art which is being lost in today’s technological age. While exams are necessary and you need to pass all of them to advance to the next stage, do not allow the stress to overwhelm you. In my opinion, exams are not the best measure of one’s
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intelligence and it is easy to feel inadequate or incompetent in medical school. Just remember that we did not get here by accident and we are all very intelligent. Some friendly competition is healthy but do not base your worth by comparing yourself to someone. Remember, you are not in this alone. Just look around the amphitheatre during class. There are literally hundreds of people going through the same thing as you. Try to find people or even that one person who you can study with, laugh with and vent to at the end of a long day. Also, do not be afraid to take up any qualms with your lecturers (especially Dr. Odekunle). Many of them are approachable and are willing to address student issues. In terms of study tips, the best advice I can offer is simply this: try your best to stay on top of your work. Do not underestimate the workload. Do not let the work pile up, only to cram it off right before the exam. You might pass the exam, but subsequently go on to forget most of what you learnt. Remember, the ultimate goal is to use the knowledge you acquired during these years to treat people and to do this, it is essential that you truly understand what you are taught in the foundation years. Trust me, it will come back to haunt you not only in third year, but the rest of your medical career. It is extremely easy to get distracted. Remember why you are here: to change the face of medicine! (hey, we can be optimistic, right?). Stay focused, work hard, play hard and be not afraid of greatness. We are all definitely very capable.
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By Nadeem Kothdiwala My colleague Sachin and I did our elective in gastroenterology at the Royal Adelaide Hospital (RAH), Adelaide, Australia. So the first question on everybody’s mind: ‘How come Australia? It was actually our friend, Teja, who had suggested it, as he had an uncle living there. Unfortunately, he could not make it, but the seeds were already sown. Australia it would be! We wrote our Obstetrics and Gynaecology clerkship exam on the Thursday and by Friday afternoon, we had started our 36-hour journey to the ‘Land Down Under’. It took us almost a week to get over the jet lag and adjust to the time difference (14 hours ahead of Trinidad time). We had no problems adjusting to the new system. On the average day we had to reach the hospital, which was just a ten-minute bike ride away, for 8am. At this time, the registrar started ward rounds with the team. When the consultants arrived we had to revisit all the patients. This was a bit frustrating at times, especially when patients were spread among five floors. Grand rounds was on Tuesdays and Thursdays, and they normally provided a hefty meal, so we made sure to capitalise. Clinic was on Mondays and Wednesdays in the afternoon. There
were three clinics: cystic fibrosis, inflammatory bowel disease, and general. Unfortunately, we did not see many cystic fibrosis cases, due to the limited number of doctors and other medical students being present. We generally finished around 3pm. In terms of infrastructure, there was a huge gap between what we saw in Australia and what we were accustomed to at home. The entire system at the RAH was computerised so you could access lab results for a patient within seconds, even those done privately. Another cool thing was a pneumatic tube transporter which delivered blood tubes directly to the lab. (Oh, how we medical students would love that!) Despite these differences, it was enlightening to see how similar their medical students were to us. Like us, they found grand rounds boring and tried to duck out at any given opportunity. They followed around their team aimlessly on ward rounds, smallsing in the back. And they always questioned why they decided to do medicine in the first place. The highlight of our elective, however, was the experience beyond the hospital doors. Adelaide, where we were based, was a pretty quiet place, so we
made it our business to visit a different city every weekend. We saw quite a few aborigines, the indigenous inhabitants of Australia. Their features were so different from any other race or people, so distinct—I had to stop myself from staring. Luckily, we were just in time for the 2015 Cricket World Cup finals. We took a 16-hour drive across the Great Ocean Road to get to the venue. It was a beautiful drive, except for the fact that we knocked over a kangaroo along the way, leading to the most tension-filled three hours of my life! Sachin is a certified diver and it’s any diver’s dreams to explore the waters of the Great Barrier Reef, so he did and loved the experience. Swimming with great white sharks and huge turtles isn’t an everyday experience. My advice to those about to do their elective is to truly enjoy the experience. Whether you go the high draft route of surgery or medicine, or something more relaxed like radiology, enjoy it. If it’s taking drives to Chaguaramas, or liming or just visiting somewhere else, spend the time doing things you enjoy, because it might be the longest time that you have off in a while.
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Photo reproduced by permission of the Osler Library of the History of Medicine, McGill University
If you are in the medical field and do not know Sir William Osler, then you aren’t exactly in the field: you’re probably on the sidelines, spectating. He is quoted everywhere: in textbooks, lectures, conferences, on the wards. But knowing just Osler isn't enough—as I realised last year when I visited the Osler Library of the History of Medicine at McGill University, Montreal, Osler’s alma mater. Indeed visiting the library was like visiting the man himself: I was in the company of his ashes, surrounded by his books—his most prized possession—his portraits, paintings, furniture, various paraphernalia, all housed in an oaken architectural wonder that took me to his early twentieth century home at 13 Norham Gardens, Oxford. Opened in 1929, the Osler Library is a collection of rare books, artefacts, paintings, and contemporary work on the history of medicine. The most substantial contribution to the library came from its eponymous benefactor: Osler’s collection, numbering close to 8,000 titles, covered the works of the Greeks, Arabs, Europeans, et al.—language and geography were irrelevant. During a tour of the library, assistant head librarian and archivist Anna Dysert, whose hospitality gave me a sense of the “Open Arms” policy which the Oslers were known for, explained why history meant so much to Osler: “As a healer, physician, and thinker,
he really believed in the importance of mentors: having people who knew something who can impart something significant to you. Not only our relationships with actual mentors but also considering these great thinkers of the past as mentors who you can commune with and engage with through their writings. “He recognised the importance of history, but beyond that he believed in a sort of spiritual way in the importance of
“He believed in a sort of spiritual way in the importance of learning from the people who came before you.” learning from the people who came before you.” Osler’s contributions to clinical medicine as a physician, pathologist, and professor were revolutionary. He was one of the four founding doctors of Johns Hopkins School of Medicine, commonly known as the “Big Four.” At Johns Hopkins he established the concept of medical residency training, which he considered to be his most significant contribution to medicine. In 1905 he was appointed Regius Professor of Medicine at Oxford, a position he held until his death in 1919. But a visit to the Osler Library reveals the other side of the “father of mod-
ern medicine”: his humanistic side. His most cherished book the Religio Medici (1862), the Religion of the Doctor, by Sir Thomas Browne, is given pride of place in The Osler Niche, an alcove comprising a bronze sculpture of Osler; his ashes and those of Lady Osler and Dr WW Francis, the first Osler Librarian; and his favourite books. “Religio Medici is something of a spiritual biography. He (Thomas Browne) was a doctor so he talks about the development of his beliefs about religion and his spirituality and also his medical practice. It ties in a lot of themes that Osler was interested in, not only science and the medical profession but also more humanistic areas.” Purchased when he was a student at Trinity College, Toronto, the Religio was the second book Osler owned—his first book, the Globe Shakespeare, was stolen. He always kept a copy near him on his night table and would pack it in his bag when he was away for the night; at his funeral service at Christ Church Cathedral, Oxford, the book lay on his coffin; today it rests close to his ashes in a secured bookcase to the left of his sculpture. The Professor and his hobby “No man is really safe or happy without a hobby,” Osler said [1]. From his early days as a young college student, Osler was fascinated by books of all kinds: geological, biological,
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religious, medical. A true bibliophile, he was drawn to books and libraries wherever he went. As his medical career grew, so did his interest in books on the history of medicine. “He identified significant works by medical thinkers, went out and bought them and formed this giant personal library of important moments in the history of medicine,” Dysert said. His hobby of book collecting consumed a significant part of his income, and today the value of his collection is well beyond the pockets of any one individual. His connections were far and wide: from a contact in Iraq, he purchased an Assyrian cuneiform tablet dated to around 700 BC, making it the oldest item in the library. Once part of an extensive medical treatise, the tablet describes eye remedies—the active ingredients included oil, scorpion blood, serpent blood, and hedge mustard—and concludes with the reassuring words, “he will live.” [2] At Oxford, already the most famous English-speaking physician at the time owing to his contributions to clinical medicine, Osler explored the medical humanities more deeply. “When he went to Oxford in 1905 it was a bit of respite for him because at Johns Hopkins he was very busy with clinical responsibilities and teaching. So
Anna Dysert, assistant head librarian, displaying a medieval manuscript on travellers’ medicine
as Regius Professor he was able to do a lot of his book collecting. “There are also records of him giving lectures to classic students. He would go into literature classes and classic classes and teach on ancient medicine, the medicine legacy, the Greeks, the Romans. It was a period when he really got to indulge his interests in medical history, medical humanities, and books.”
“A library represents the mind of its collector, his fancies and foibles, his strength and weakness, his prejudices and preferences…The friendships of his life, the phases of his growth, the vagaries of his mind, all are represented.” —Sir William Osler Describing his book collecting, Osler said: “I am adding treasures to my collecting on two lines—books that are of historical importance in the evolution of medicine, and books that have interest through the character or work of their authors.” [3] Later, in the introduction of the Bibliotheca Osleriana, he wrote: “To know and to make known to students the lives and works of these men was a labour of love.” [3] The Bibliotheca Osleriana Nearing the end of their lives, most people write a will, but Osler, being the bibliophile that he was, had an additional task: to catalogue all his books and direct their final destination. Some went to Johns Hopkins, some to the University of Pennsylvania, others to the British National Museum. But the most significant portion, listed in the Bibliotheca Osleriana: A catalogue of books illustrating the history of medicine and science collected, arranged, annotated by Sir William Osler, Bt. and bequeathed to McGill University, went to his alma mater in Montreal. Expanded to hold close to 100,000 works on the history of medicine, the library today is just what Osler hoped for:
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“A library which would have (a) a definite educational value, (b) a literary, and (c) an historical interest.” [3] Describing the people who use the library, Dysert said: “It’s surprising to see the different fields they come from. It’s much more than just medical students or history students. There are literature students, art historians—quite a variety. “As much as you want medicine to be scientific it can never be a hard science because it has too much of a human aspect that is just undeniable.” With its green carpets, oaken walls, wooden furniture, glass-cased bookshelves, and fine architectural details— like the crown moulding shaped into Osler’s initials—the Osler Library does not only provide insight into the great medical minds of the past, but it also presents, in the most spectacular way, an opportunity to discover the life of the “father of modern medicine.” After all, Osler did say: “A library represents the mind of its collector, his fancies and foibles, his strength and weakness, his prejudices and preferences…The friendships of his life, the phases of his growth, the vagaries of his mind, all are represented.” [3] References on page 17.
Taureef in the Osler Niche
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with Dr. Sherry Sandy A mother, wife, and an internist with a special interest in neurology, Dr. Sherry Sandy is a sterling example of what it means to be a doctor. Dr. Sandy joined the university’s staff last year, replacing Prof. Seemungal, now the faculty’s dean, as the university’s medicine consultant at the Port-of-Spain General Hospital. Moulded by those who she now works with, Dr Sandy is passionate about teaching and eager to raise the standard of neurology in T&T.
By Nicole Maharaj & Sneha Rao Where and why did you study medicine? I studied medicine right here at Mt. Hope at the University of West Indies. I always wanted to be a doctor. My brothers tried to dissuade me, but I decided from early on that this is what I wanted to do. I wanted to help people. I thought that medicine was a combination of two very noble professions: teaching and being a doctor. I graduated with my MBBS in 2003, then in 2007 I started the Doctor of Medicine (DM) program here as well. Following that, I did a two year fellowship in general neurology and then one year in epilepsy at the University of Calgary, which is well-recognised for neurology. What was your proudest moment in medical school? I was lucky to have had a really good group during my clinical years. We made sure everyone got through exams and no one got left behind. So I think my proudest moment was graduation when all of us graduated together. And it was the first year our campus had won the gold medal for Internal Medicine. We also won gold for Obstetrics and Gynaecology and overall. So we won three out of the four gold medals awarded.
Is there anything about medicine that you don’t like? I always didn’t like that the medical faculty was away from the rest of the campus. We didn’t get to explore the different extracurricular activities on main campus and barely had exposure to university life. Everyone I knew were doctors, and we didn’t interact with other faculties.
“I hope that by teaching this generation of students, that future generations and my children will have good teachers.” The closest thing we got to experiencing university life was when we had to do foundation courses on main campus. And even as staff now we are still excluded because we are away from the rest of the university. And it’s really just a matter of logistics, nothing else. Why did you choose neurology? There was a need for people with neurology training in T&T. At the time when I left there was only one neurologist, Dr. Esack, and a few internists with a special interest in neurology.
Originally when I started the DM, neurology was my worst area, but then I began to invest so much time into it that I began to love it. In the second year of the program, there was this doctor from Jamaica who did a few sessions with us, Dr.Ali, and he really showed us how much we could do for patients with neurological conditions. I did my elective with him in Jamaica and was exposed to more neurology, and became fascinated with the neurological exams. He also introduced me to people in Calgary who were world-renowned in epilepsy. Their interest in it and seeing firsthand what they did for patients with epilepsy inspired me. Neurology is an exciting field to be in right now, because things that we thought we couldn’t treat, we’re actually finding drugs for them. What does teaching mean to you? I’ll quote the Dean here in saying, “We teach through service.” When I do ward rounds, I have 40 eyes on me. Everyone is watching what you’re doing and listening to what you’re saying and taking it very literally so it forces you to raise your standards. As a student I was inspired by a lot of people here, but also disenchanted and frustrated when I wasn’t taught. I believe in the law of karma: you do as you want others to do unto you. I hope that by teaching this generation of students, that
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future generations and my children will have good teachers. What are your current research interests? My interest is in seizures. I want to change the therapeutics that we use locally for seizures. We do a lot of research in knowledge, attitude and beliefs but I want to consider therapeutic research or meta-analyses. I think it is something that is needed. An advantage of going to Canada is that I formed links and they are willing to be part of those analyses. In Trinidad we have an advantage compared to the North Americans, because our neurologist are also internist. The North Americans don’t see a lot of the advantages of merging the two. What do you like and/or dislike about the current batch of students? The professionalism is very high. You all uphold respect and dress professionally. I’ve never had to tell anyone about their attire on ward rounds which was initially an issue. When I ask you all to do something, you all try to do it. What I dislike is that reading seems to be less, for example reading the Macleod’s; I think time management is the problem. You all are going to be busy for the rest of your life but you have to make time to read around what your patients present with. Also the camaraderie in the groups, I’m not sure how it is because the groups are so disjointed. I found that there were some weak members in a group, and I expected that other members would help them out, but that wasn’t the case. What do you expect of clinical students? At the end of fourth year, I expect a safe intern, someone who can examine a patient and deal with the emergencies. If you don’t take the time in year four to examine patients and make that your routine, then you will never be a good doctor. Year five is about trying to shine, going beyond being a safe intern and aiming for honours or distinction. By this time, you’ve seen and read and learnt so much in fourth year, you’ve examined patients and you know what to expect, so you don’t have to spend time doing those
things; it’s really about reading and training yourself for lifelong reading. I also expect that to pass exams you read the required texts: especially the Macleod’s in year four and a little broader in year five.
“The things that stay with you aren’t the things lecturers told you, but are those things patients tell you and what you read around.” Do you have any advice for the current students? Be on the wards when you are expected to be there. It’s very important that you help your house officers and interns because they recently graduated and would know more than anyone else how to pass the exam. After the ward work, go back and take an interest in the patients. I expect that when you get to know the patients you develop this burning desire to want to know what’s wrong with them and how you can help. The things that stay with you aren’t the things lecturers told you, but are those things patients tell you and what you read around. You need to find your own way to destress, stay healthy and manage your time. I recommend that you find your most efficient time, which for me is 5 am or when it’s quiet and get the work done then. I try to exercise for half hour every day and that helps to keep me up. How do you manage your family and such a busy work schedule? Generally I just do what I have to do. It’s hard to tell you how I manage it. Some things take priority at different points in time. My husband is very supportive so he would take care of the kids when I have clinic, and vice-versa. For two years when I went abroad, I put my family on the back burner so I think they deserve to be at the front for a while. So I make an effort to pick them up from school and do their homework with them, and then they go to bed by
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7pm so then I have my time. Who are your role models? I have a few. Definitely my brothers because they always inspired me to work hard, and my parents. In terms of medicine, Dr Maria Bartholemew, Prof Seemungal, Prof Teelucksingh, those are the people who really moulded me and also Dr.Andy Bhagwandass, who was a lecturer here for a very brief period. Where do you see yourself in the next 10 years? I want to establish a full neurological service with a seizure monitoring unit at one of the local hospitals. Patients who have not just seizures but episodes that look like seizures can come in and be observed for 24-48 hours. And hopefully we will have a neurosurgeon to operate on patients who can be cured with surgery. There are other aspects of neurology we don’t have here. For example we don’t have an MRI machine in Port-ofSpain and we don’t do nerve conduction studies. We really need to improve the standard of neurology to match those of other specialties. I hope that we can eventually have an advocacy group for epileptics. In general I think epilepsy is underserved in this country. Nobody advocates for these patients. I also hope to continue publishing and contributing to the neurology program and internal medicine program for the medical students. I hope that the faculty here continues to do extremely well.
Throwback! Dr Sandy and her medical school classmates at the Eric Williams Medical Sciences Complex.
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A Psychiatrist Extraordinaire TAUREEF MOHAMMED Progressively worsening dyspnoea associated with an incurable lung disease would usually be enough to keep an ordinary man down, but not Prof Harrinath Maharajh. With his oxygen tank and an indomitable spirit, Prof Maharajh carried on with his duties as senior lecturer in the Department of Psychiatry at UWI, St Augustine, literally until his last days. His dedication, passion, selfless service, and uncanny nature set him apart from the rest and paved the way for the courageous few who chose to pursue a career in psychiatry. In an interview with The Pulse, Dr Tayo Akingbala, registrar psychiatrist at Mt Hope and a past student of Prof Maharajh, said: “When it came to teaching us he was extremely dedicated. He went over and above his calling to make sure that he imparted what he knew to us. Classes that were meant to be from one to four ran until six and if we got hungry he bought us pizza.” Dr Tayo recalled, “When he got really, really ill he used to come to class with his oxygen tank. In fact he was admitted to the hospital from the psychiatry unit because he just could not get up. That dedication I haven’t seen paralleled anywhere by anyone.” This dedication stemmed from his attitude toward work in general, as Prof Gerard Hutchinson, who started his career as Prof Maharajh’s houseman, now head of psychiatry at UWI, St Augustine, explained: “He was very passionate about work and service and felt that people really needed to invest time in work and not view it as an incidental thing while the focus was elsewhere. “He felt that if you commit to an endeavour then you should really try to optimise your performance in it otherwise you shouldn’t commit. He thought very poorly of people who didn’t invest that energy in their work.” If his principled stance about work was not enough, his limitless passion
definitely was. “His commitment to the discipline reflected a deep love for it. He really found his resting place academically and intellectually in psychiatry and that was a beautiful thing to see,” Hutchinson said. A former teacher at Naparima College, Prof Maharajh was a natural albeit unconventional teacher. His classes were not for the faint-hearted or weak-minded. “It seemed as if he was always out to press your buttons, to see how far he can push you before you broke. This was his modus operandi not only to students but generally to people including his patients. That was a bit striking. I didn’t see any other psychiatrist do that,” Dr Tayo said. Hutchinson added: “He was committed to the students, loved teaching and
“He was very passionate about work and service and felt that people really needed to invest time in work and not view it as an incidental thing while the focus was elsewhere.”
Prof Hari Maharajh
contributed a lot to the unit. And his passing created a bit of a vacuum which I think we still haven’t been able to fill.” The legacy of a Caribbean psychiatrist Four years after his passing, his name still resonates through T&T’s psychiatric wards; his posters greet visitors at the psychiatry unit at Mt Hope; his writings guide psychiatrists throughout the world, particularly in the Caribbean; his patients continue to speak of the profound impact he had on their lives. Of his many contributions, Hutchinson said, his research and writings were the most significant. “He was a prolific writer and he wrote extensively and that is always a good legacy. His writings particularly in sociocultural areas in psychiatry and how culture influenced behaviour were outstanding.” Why are Trinis compulsively late? Could it be part of a disorder? Should wining and jamming be considered normal cultural behaviour or a paraphilia? How does our history of slavery and indentureship affect our mental wellbeing? The author of over 100 published papers and two books, Neurology for Students and Social and Cultural Psychiatry Experience from the Caribbean Region, Prof Maharajh dedicated his life to exploring these kinds of questions and documenting his findings, advancing the idea of what he called “Caribbeing Psychiatry.” Convinced psychiatry in the Caribbean was unique and should be treated as such, he was circumspect in applying imported tools in the diagnosis and management of mental illness in the Caribbean. “His work sought to challenge the paradigms that we’ve been presented with by both the American and British psychiatric communities. He felt that we needed to come up with a Caribbean psychiatry, a Caribbean phenomenology, a Caribbean nosology that would reflect who we are as against using the DSM or
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ICD-10 or whatever.” Prof Maharajh wrote:“Classification systems such as the DSM-IV and ICD-10 are often picture-fitting and menu-driven and fail to capture the essence of presentations of Caribbean peoples.” [1] Prof Maharajh joined the university staff in 2001 and spent the last decade of his life training the next generation of psychiatrists and improving the psychiatry programme at the university. “He ensured there was a documented syllabus for the Doctor of Medicine in Psychiatry. In the past the syllabus was very vague with the understanding that you just had to know everything. He felt that students should be guided more specifically, so he made it more detailed and also made extensive notes in a way that hitherto was not really done.” As a regional examiner, Hutchinson added, he changed the format of the postgraduate exams to be more consistent with the Royal College exams in London. His deep interest in academia and involvement in projects on a national and regional scale did not make him oblivious of the needs of his community in Chaguanas. For years he voluntarily conducted weekly sessions for adolescents in his community where he explored their problems and helped them to cope. “This was something he did on his own as an act of service and many people who went through it have spoken about how it helped them. He was very well thought of in his community because of that. “He was very sensitive to the needs of his community and was committed to developing those communities through improved mental health.”
In February 2012, Prof Maharajh succumbed to his battle with pulmonary fibrosis, marking the end of an extraordinary life. But through his family, his writings, his colleagues, his students, and his patients, the legacy of the inimitable professor lives on.
“Classification systems such as the DSM-IV and ICD-10 are often picturefitting and menu-driven and fail to capture the essence of presentations of Caribbean peoples.” Prof Maharajh Memories of Prof Maharajh Dr Diana Narinesingh (Class of 2006): “I admired his dedication to teaching. Even while he was very ill, he graded papers and prepared classes. He was equally dedicated to his patients. He worked tirelessly, ensuring their best care. He was a mentor to the house officers at the time and guided us not only in psychiatry but our personal lives. He cared deeply for his family and appeared to be a loving father. “He was stern, humorous, kind but confrontational in the classroom. Classes were entertaining for some but difficult for others. “I have learnt so much from Prof Maharajh: interviewing and management styles, confrontational interviewing techniques (which I rarely use but it’s useful!), kindness to patients and seeing the
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humour in all situations.” Dr Andel Roberts (Class of 2006): “He had the ability to speak the truth without fear of what people may say. He was also very helpful to students and backed them even when the students didn’t know that he was backing them. “Prof Maharajh challenged convention and challenged us to think outside the box. “As his illness progressed, his desire and passion for teaching never faded and I found that to be very admirable. He would come to Chaguanas clinic with his oxygen tank and it would take him some time to get settled in due to his shortness of breath, but he did it anyway.” References 1. Maharajh H. 2010. Social and Cultural Psychiatry Experiences from the Caribbean Region. Nova Science Publishers. For more information on Prof Hari Maharajh’s life, visit: https://profharimaharaj.wordpress.com References (A visit with Sir William Osler) 1. Gray, C. The Osler Library: A collection that represents the mind of its collector. CMA Journal 1978. 2. Wallis, F, Miller, P. 75 Books from the Osler Library. Osler Library of the History of Medicine, McGill University, 2004. 3. Osler, W. Bibliotheca Osleriana: A catalogue of books illustrating the history of medicine and science collected, arranged, annotated by Sir William Osler, Bt. and bequeathed to McGill University. Kingston: McGill-Queen's University Press, 1987.
Tel: 735-1001/ 707-9432 E-mail: ttmsapulse@gmail.com
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Uwi blood
By Fatima Ali Blood transfusion saves lives and improve health, but many patients requiring transfusions do not have timely access to safe blood. In T&T, about 20,000 units of blood are collected annually. The World Health Organisation recommends that 65,000 units should be collected each year to meet the country’s transfusion requirements. Founded in October 2011, the UWI Blood Donor Foundation is a voluntary organisation established within the Department of Para-clinical Sciences (DPS), Faculty of Medical Sciences (FMS), UWI. Its vision is to use the medium of education to promote safe and reliable blood donation and appropriate use. What is Voluntary Blood Donation? Voluntary Blood Donation occurs when an individual donates blood without getting anything in return, a truly selfless act. Blood will then go to anyone in need. This is often confused with Remuneration Blood Donation (RBD). RBD is the current system in T&T in which you get a reserved credit for the blood you donate in the form of a chit or a donor card. This is therefore not voluntary, but a credited form of donation. There are many disadvantages of RBD such as reduced blood bank supplies, as blood is only being donated in emergencies i.e. reactively and not proactively. This emergency pressure to donate can also lead to donors falsifying information to important donation questions which can lead to infected blood being deposited in the banks. WHO recommends that to ensure adequate and reliable supply of
safe blood, regular, voluntary, unpaid blood donors are needed. These donors are the safest group as the prevalence of blood borne infections are lowest. Of 72 middle to low income countries, more than 50% of their blood sup-
“In T&T, about 20,000 units of blood are collected annually. The World Health Organisation recommends that 65,000 units should be collected each year to meet the country’s transfusion requirements.”
ply come from family/replacement of paid donors. But does this have to be our reality? Is it possible to establish regular voluntary blood donation from healthy
members of the community in T&T, and indeed the Caribbean? We believe it is. The UWIBDF, by conducting research and education in the community, aims to identify and provide the information needed as well as investigate preferences for making the donation process attractive to the community. Other organisations that have partner partnered with us include: Share Goodness, SEWA T&T, TTMSA, MSSC, MHIS, IVCF, Hindu's Students counsel, CASMET. We welcome and encourage all the groups under the Faculty of Medical Sciences to become involved and help spread awareness. Being in the medical profession we see the great demand in the wards on a daily basis and the difficulties our patients and their families undergo to obtain blood. Let's be proactive and play our part.
Dr Kenneth Charles, senior lecturer in Haematology; Sir George Alleyne, Chancellor of UWI, and Prof Samuel Ramsewak, former Dean of the Faculty of Medical Sciences at the launch of UWIBDF
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The UWIBDF holds Voluntary Blood Drives every three months with the intention of eventually increasing the nation’s blood supply and availability in all circumstances. On the Voluntary Blood Donation day, hourly time slots of donation, for example 9-10am, 10-11am etc are available. Individuals can prebook these slots to limit their waiting time. To become a part of the UWIBDF or for advanced bookings, contact: E-mail: uwiblood@gmail.com, Tel: 290-0600.
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WARD ROUNDS
Internal medicine at the Port-ofSpain General Hospital (POSGH) was one of the few rotations in which a patient referred to me as a “young doctor.” I actually felt I had deserved the title. However, I was eager to correct this as one of the better aspects of being a medical student is the opportunity to learn on the wards without the responsibility of the physician. I was assigned to Prof Seemungal’s unit. It was an intense unit, but the unit and Prof Seemungal himself were very pro-student. I was treated as part of the team, rather than a nuisance. When Prof Seemungal was present, especially on post-call days, we had to stay sharp, listening to and observing the physicianpatient and physician-physician interactions. The month at POSGH was structured to give the student a first-hand experience of what was required from an intern. However, I did find myself consumed by ward work and at times wondered if I was wasting time. My purpose began to transition from being a student with the aim of learning, to a junior intern whose job was to complete the ward work. Still, I was expected to do both and that posed to be difficult. I decided to dedicate the month to learning on the wards, and in the end, I learned more of the practical aspects of medicine: setting up IV accesses, putting in nasogastric tubes, catheterisation, venepuncture, running ABG samples etc. I realised mastering these skills were vital to become a competent intern and decided to take full advantage of the opportunity.
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Port-of-Spain General Hospital
Later into the clerkship I really began to appreciate the skill of learning medicine on the ward. It was about being proactive, actively looking for patients with findings and interesting histories; opportunistic, being present wherever knowledge was being shared; and bothersome, constantly disturbing and questioning both doctors and patients. It was all about seeking my own interest to learn medicine. The month was physically draining and, I must admit, I was eager for it to end. The students, like the interns, had to be present every day, including weekends. Strangely, when I moved on I did somewhat miss the experience and the involvement. Time was a valuable resource and I had to learn how to manage my time. In the end, I was better at it. I must mention two pocket-sized books that were vital to my learning on the wards: the Oxford Handbook of
Clinical Medicine and the 250 cases in Clinical medicine. The former contains everything that is relevant to clinical medicine in a gorgeously concise manner, while the latter is almost ideally suited to preparing for the medicine OSCE. I also picked up a few jewels from being on the unit and interacting with Prof Seemungal: always show interest, be thorough and precise, ask for help when you do not know, and most importantly, do not bluff especially when the patient is concerned! All in all, internal medicine at POSGH was a worthwhile experience and I am glad I chose to spend a month of my fourth-year medicine clerkship there.
“It was about being pro-
active, actively looking for patients with findings and interesting histories; oppor-
tunistic, being present wherever knowledge was being shared; and bother-
some, constantly disturbing and questioning both doctors and patients.”
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WARD ROUNDS
After a gruelling rotation in internal medicine, we in Group A felt we deserved a break. We had gotten used to waking up before sunrise, ward rounds with over fifty patients, and endless ward work. Throughout those weeks, we daydreamed of the upcoming psychiatry rotation, with its short days and flexible schedule. That was the attitude I had when I started psychiatry. It was my vacation. I had no real interest in it. I was prepared to come to class for the sake of attendance, and leave as soon as possible. On the first day we assembled in the classroom for orientation at 9am. There was no sign of anyone. We were just about to leave class when an old greying man crept through the door. The room fell silent. Hunched over, he scanned the room with his bloodshot eyes and said, "World coming to an end. I looking for one hundred and fifty woman to make back children with." I had suddenly become intrigued. I started the rotation at Mt. Hope where we had sessions with Dr. Tayo. We clerked patients on the ward, and presented the cases to him. The sessions were always interesting, and the cases were bizarre. There was a young boy with schizophrenia who would sit on his bed and look out the window every day for a raven with three eyes. He spoke about seeing women with heads of pigs and hearing voices. I vividly remember that interview. There was this total absence of emotion that sent chills down my spine. He was not suicidal, but he did not care if he lived or died.
“The intricacies of the mind are a baffling phenomenon, and all the stories...made me completely fascinated with psychiatry.� By the time I started my placement at San Fernando General Hospital, I had developed an appreciation for psychiatry. We were stationed in Ward 1 and had to attend clinics in Princes Town or Siparia. The range of cases we saw was incredible! There was a young man who threw a sink at his father because he thought his father was having an online affair with his girlfriend, Hema Ramkissoon. My favourite case was of a middleaged man who insisted that a computer from out of space was targeting him. The computer used to paint him white, green, and blue, but when the computer painted
him red, he was in danger. Nothing the doctors did could convince him otherwise, and I even thought, who were we to tell him he was wrong? San Fernando was a wonderful experience, and since most of my colleagues were from South Trinidad, we had a great deal of fun having house dinners and exploring. One day after we were finished at the hospital, my friend Anusha and I went to the Original Bar-B -Que Hut. Suddenly, a deranged man stumbled in, rambling about Jesus Christ, sinners, and Queen Elizabeth, and announced that the world was going to end. While everyone in the restaurant was alarmed, Anusha and I calmly asked the man, "Sir, you do feel like your thoughts are racing?" He said yes. We continued questioning him, and just like that, we performed a Mental Status Exam in the Bar-B-Que Hut! I regret that we did not get much time at St. Ann's Hospital, the only mental hospital in T&T and the place to learn psychiatry. There we met a patient who was convinced he was a lion. His story was very interesting, and I never challenged his delusion. In the end, he told me I was a lion too. The intricacies of the mind are a baffling phenomenon, and all the stories of spaceships, computers, imaginary lovers and animals made me completely fascinated with psychiatry. I do not know if I will ever study it again, but I am grateful to have had the opportunity, for it opened up my eyes. After all, each of us can use a little imagination.
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WARD ROUNDS Reflections on surgery By Sayad Balgobin
Prior to entering the surgery rotation, I anticipated a tough two months, maybe even the toughest. I had just completed Family Medicine and I figured I was in for a rude awakening; it turned out I wasn't even close. I chose to write about surgery because it was by far the toughest, most hectic, and most interesting rotation. (I haven't yet done internal medicine at the time of writing this.) I was assigned to San Fernando General Hospital (SFGH) and Sangre Grande Hospital (SGH). The hospitals differed in several ways. SFGH had multiple units each with a consultant, a registrar, house officers, interns, and medical students. SGH had one unit with three consultants at the head of a fairly large team. We were required to take call once per week in SFGH, compared to every other day in SGH. The transition from the classroom to the ward was not an easy one, but it was welcomed. Everyone had to be present and punctual every day for ward rounds: 6am in SFGH and 8am in SGH. In SFGH, it was necessary to reach half hour before rounds in order to S.O.A.P patients. My experience in SFGH under Prof Dan was the best I have had so far in all of medical school. In clinic and on the wards we were assigned patients to clerk and examine and had to present them. We also had to assist in screening which involved clerking patients who came in for elective surgeries. Furthermore, we were required to organise all the lab results for the patients, scrub in for their surgeries (even if it was just to hold a retractor), and S.O.A.P them every morning until their discharge. But it wasn't all sunshine and rainbows, as these included diabetic feet.
“The best part of surgery for me was the actual interaction I had with some of the elderly patients. Not only did these patients provide clinical pearls through their various presentations, but they also provided pearls of wisdom through their experience.” The days and nights at SGH were mainly spent clerking, examining patients, and reading. Clinic mornings were very informative, especially when one of the consultants opted to teach us everything we had missed in classes at Mt Hope. The consultants were concerned of their students’ safety in making the drive up and down the Valencia stretch and preferred we kept the driving at a mini-
mum, so they decided to teach us to save us the drive. We also became proficient at catheterising patients, as SGH had a catheter clinic every Wednesday. Having just completed third year, I figured I might be able to handle whatever questions were thrown my way; I had never been more wrong before. No matter how much I read, or how many times I read it, I always went blank whenever a doctor asked me a question. This and the ever increasing list of things to look up and learn before rounds the next day added to the perpetual exhaustion that was typical of surgery. However, the workload actually felt manageable, compared to the first three years of medical school. The best part of surgery for me was the actual interaction I had with some of the elderly patients. Not only did these patients provide clinical pearls through their various presentations, but they also provided pearls of wisdom through their experience. “Don’t be afraid to ask questions. The worst answer you will get is no,” an elderly man advised. “Whatever you do, always do it the best of your ability and you will become the best,” another wise one said. My advice to students entering surgery is to review anatomy, especially the anatomy of the abdomen which you should know better than the back of your hand. Make sure you fully understand the common conditions, because common things are common. Also, wear shoes that are comfortable—you’ll be required to walk long distances and stand for long periods. And last but not least, never be short on gloves and gauze while on the ward!
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#medschool
#mbbs
#tips
#year4
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The Story of the Art Society of Mt Hope
Art society
By Sneha Rao “Medicine is an art and just as medicine evolves so does art and so will our group,” said the founder of the Art Society of Mt Hope, Dr Srikanth Rao. In 2010/2011 The Art Society stepped foot into the Mt Hope environs as a group of people merely attempting to coax artists into displaying their art pieces. “It was inspired by the fact that many students had artistic talents that even trained artists do not have so it was a crying shame to say that we were unable to showcase their talent.” With a pure intention, minimal manpower and a handful of resources, the first executive planned the Art Gala which became a pinnacle event that was able to muster 20 art pieces on day one and 140 pieces on day seven. After this astonishing success, the society embarked upon redecorating the students’ common room. The mural, designed and painted by the supremely talented Dr Richard Dookie, was unveiled in 2013 after much conversation with the artist, the president and the faculty’s Dean. By this time, the standard was set and the Art Society was held at a pedestal by the student body. After years of dedication, a new executive came on board in 2014-2015 to the keep the ball rolling. Khavindra Singh was appointed president and envisioned an Art Society on a larger scale, unique projects, and innovative ideas with self-sustaining profits. His tenure marked the launch of the ‘Bed Time Stories Initiative’ (BTSI) and ‘The Human Art Project’ (HAP). The initial intention behind hosting a party, HAP, was to fund the BTSI. “The BTSI has allowed us to be able to communicate with children and this develops interpersonal skills and
fosters a sense of compassion,” Khavindra said. This project has a perfect blend of both medical and non-medical students thus providing an opportunity for various faculties in UWI to socialise. The society faced its greatest challenge during Khavindra’s tenure when they were requested to design a mural for the 25th anniversary of the Faculty of Medical Sciences. In all optimism, the team decided to assemble a mural demonstrating the ‘daily Mt Hope life’ within 70 hours.
“Never feel shy about anything you work on, even a slither of talent must be showcased. Creativity never runs dry, it only runs deeper.” Sofiya Barrow Sofiya Barrow, the society’s current president, admitted to having a heavy responsibility on her shoulders. “Keeping up the standard and producing events in a cost-effective way without compromising the quality of any event will remain our major responsibility, or rather, our aim,” she said. Sofiya added her idea was to hold strongly on to the primary purpose of promoting art, and not just being associated with an event. She encouraged others to join in, saying, “Never feel shy about anything you work on, even a slither of talent must be showcased. Creativity never runs dry, it only runs deeper.” Having a vast experience in university activities, Sofiya emphasised that participating in extracurricular activities
must not be a hassle but rather a hobby. It is an escape from the stressful occasion of examinations and assignments. In retrospect, The Art Society has expanded tremendously as evidenced by the number of patrons in each initiative. The Art Gala went from being a Rooftop event to a national event with some 450 guests and 350 art pieces. The BTSI transformed from a weekly hobby with 3 people to a group with a membership of 105 students and 60 active members. The HAP’s popularity has been immense and is now an annual event. The Art Society continues to broaden its horizons with many novel projects in the pipeline including: developing an art course free of charge, jam sessions for musicians, decorating the foyer, organising a live music show by medical students and even joining hands with other UWI campuses to expand the gala. The dreams are big and as the founder said, “Once there is money, manpower and time, everything is possible.”
A piece on display at last year’s Art Gala
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The following is the transcript of the valedictory address delivered by Dr. Erron Ramdass on Saturday 24 October, 2015 at the graduation ceremony of the Faculty of Medical Sciences, University of the West Indies, St Augustine. Introduction As we curved around that roundabout on our very first day, there it was, straight ahead, the Faculty of Medical Sciences, a place that would soon metamorphose the very outlook of our lives. I was told, this Faculty was one of complexity and sophistication, and driving past the car park, I was already confused. I wondered to myself, ‘Why does staff need to have five whole lanes to park?’ We all were confused. And that confused facial expression seemed to have remained on our faces for the next five years. But as we trotted to Amphi A in our newest clothes and heads held high, we knew that what lay before us were pieces of our new lives, waiting to be assembled into the persons we have become today. Congratulations My secondary school’s motto stated, ‘A Posse ad Esse’, - ‘From possibilities to actuality’. Indeed, a few years ago, the possibility of our dreams began as we tiptoed outside TCB3 classroom, nervously searching for our names on an acceptance list. Today however, we stand tall, staring at our names engraved on a degree awarded by the University of the West Indies. From possibility to actuality! Who knows where our names will be next? Congratulations Class of 2015! We made it!
Reflection I am told a Valedictory speech is expected to represent the life of every student. I wondered, “How can this speech portray those students who ate books for breakfast, lunch and dinner while still exemplifying those envied students who slept or partied all night and walked into the exam room next day with a huge smile on their face and still aced the exam? How can my words adequately describe those sleepless nights of a Pharm student, cramming off a Drug Interaction Handbook, while still representing the anxiety of our Psych students as they counselled their very first suicidal patient. How can my tone of voice relay the enthusiasm of a Vet student as they delivered a new born? And still describe those golden hearts of care and compassion of our nurses here. How can my imagination comprehend the feeling of accomplishment of a Dent student after doing their first filling; whilst capturing the miracle of sight delivered from the hands of our optometrists here. What about the satisfaction of a Med student after delivering our first baby in O&G or feeling important scrubbed up in theatre holding a retractor?” Words are inadequate to portray the totality of our differing emotions, experiences and hardships but what unites us today is that after all, we stand together today as titans in our own field, having conquered the complexities of that place, Mt. Hope.
UWI life The UWI experience was indeed a learning experience in and out the classroom. It began as a Rubik’s cube with all our pieces haphazardly arranged, but life gained order as we moved from one level to a next. We discovered ourselves; we discovered our passions; we discovered a home away from home and some luckily
Dr Erron Ramdass
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discovered love and life partners, while some found none at all. All those fond moments that define our success today not only captured by the many selfies on our phones but engraved in the limbic systems of our brains. Many of you will remember my song back in year one for Mt. Hope Idol, ‘Who say Med Sci’ Let me sing a few lines for you! **SONG** Gratitude Today we not only celebrate our own success but also the success of a great institution, the UWI, for yet again producing another class of intelligent, competent and good-looking individuals. May we ever be minded of our roles as UWI ambassadors and take pride in our Caribbean identity. Today we not only celebrate our own success but the success of our mothers and fathers, our family and friends, whose sacrifices and support were invaluable to our lives. To all our loved ones who may have passed on and could not be present today to share our joys, we say, ‘We love you and thank you’. We salute our past and present governments for giving us the opportunity to study free of charge at the best University in the world. We pay special tribute today, to a man who went beyond the call
of duty to ensure our best interests as students, our former Dean of Faculty, Professor Samuel Ramsewak; a man of wisdom, humility and a model doctor. We graciously welcome to our faculty in a new capacity our incoming Dean, the well-renowned and well-loved, Trinidad’s very own ‘Dr. House’, Professor Terence Seemungal. We praise God most of all for without Him, we would not exist and we know that all good things come from Him.
“The UWI experience was indeed a learning experience in and out the classroom. It began as a Rubik’s cube with all our pieces haphazardly arranged, but life gained order as we moved from one level to a next.” Encouragement But after all this success, Albert Einstein said, ‘Try not to be a man of success, try to be a man of value’. Col-
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leagues we live in a society today where more emphasis is placed on certification rather than compassion. To some here today, our degree paper means a ticket to a better life, financial stability, comforts and luxuries. But I ask today to consider the alternative. Consider it as a ticket to change the world. As Bono said, ‘The world is more malleable than you think, it is there waiting for you to hammer it into shape’. We can be world changers today. But competence is nothing without character, hand is nothing without heart and skill is nothing without spirit and integrity. Let us therefore arise as a new breed of intellectuals, a peculiar generation of professionals, who is willing to put society before self, country before comfort, world before wealth and God above all! Closing Ralph Waldo Emerson once said, ‘Do not go where the path may lead, instead go where there is no path and leave a trail’. As we open a new chapter in our lives; as we enter a whole new world of possibilities; as we walk into our own destinies, let us leave our own mark in this world. Let us be catalysts of positive change. Let us be better. Let us be stronger. Let us be united. Let us change the world. Congratulations Class of 2015!
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ACTIVITY
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ACTIVITY
The Port of Spain General Hospital, formerly the Colonial Hospital, was opened.
The Caribbean Medical Journal was founded.
The Faculty of Medical Sciences, UWI, St. Augustine celebrated its 25th Anniversary. Prof. Vijay Naraynsingh performed the first laparoscopic cholecystectomy in Trinidad and Tobago.
Walter Clement Noel, a Grenadian dentist and the first recorded case of Sickle Cell Disease in the world, died in Grenada.
The Faculty of Medical Sciences of UWI, St. Augustine, was established at the Eric Williams Medical Sciences Complex, Mt. Hope. The medical school was the vision of T&T’s first prime minister Dr. Eric Williams and was conceptualised by a committee chaired by Prof. David Picou.
UWI, formerly University College of West Indies, opened in Mona, Jamaica, welcoming its first undergraduate medical students.
Trinidadian bacteriologist Dr. Joseph Lennox Pawan isolated the rabies virus from several species of bats, setting the stage for the development of a vaccine.
Prof. Courtenay Bartholemew discovered the first known case of HIV/AIDS in the Commonwealth Caribbean, and the first case of adult T-cell Leukaemia in the southern Caribbean.
Dr. Theodosius Poon King’s pioneering study on diabetes in T&T, which revealed a high incidence of the disease in the population and found ethnicity, heredity, obesity and multiparity as risk factors, was published in The Lancet.
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TTMSA FUN DAY 2016
Answers and references 1. A (1858) History of the Port-of-Spain General Hospital (Formerly “The Colonial Hospital”) during the Nineteenth Century by Lisa Gonzales. 2. I (1991)The history of laparoscopic general surgery in the Caribbean by D.Dan et al. WIMJ (2012) 3. B (1916) Steensma et al. (2010). Walter Clement Noel—First Patient Described With Sickle Cell Disease. Mayo Clinic Proceedings,85(10), e74–e75. 4. H (1989) Prof Picou—a global revolutionary. The Pulse 2013. 5. E (1948) The University of the West Indies, Mona, Jamaica. http://www.mona.uwi.edu/content/history 6. D (1938) History of medicine in the Caribbean region: a medical association perspective (1938-2008) by Hari Maharajh (2010) 7. J (2014) 8. C (1932) Caribbean icons in science, technology, and innovation, Niherst. 9. G (1983) Caribbean icons in science, technology, and innovation, Niherst. 10. F (1968) Caribbean icons in science, technology, and innovation, Niherst.