Australian Medical Elective - Cairns

Indescribably and memorably, the best 7 weeks of my Life!

Advice/stories of my medical placement in Cairns [LONG blog entry] in June-July 2012.
My 2 weeks in Brisbane, Sunshine Coast/Noosa, Gold Coast and Sydney is another story.


Initial Aims - Why Cairns?

Cairns is a small city on the east coast of Far North of Queensland, Australia, with a population of approximately 150,000.  The city has such an outdoorsy and sporty vibe, and is the most popular city for tourists wanting to experience the Great Barrier Reef, a tropical climate, and adrenaline activities.   North Australia is warmer than the South in the Winter.  Cairns experiences temperatures of 20-26 C, no humidity, little rain, blue skies and sun in June-August.  It was a safe and welcoming city for an active, lone female traveller, who could easily meet the likes of other elective/hospital students and backpackers.  Cairns also has Aboriginal inhabitants and nearby villages/communities, and I wanted to witness the differences in healthcare services and issues.

I'm admittedly the adrenaline-junkie, active, outdoorsy type, who loves the thrill of socialising and meeting new people.  I wanted to sky dive, scuba dive, bungee jump, water raft, surf,... and be a local.  This was the perfect place for all my agendas.  My weekends were full-up, and I did go to placement.  
  
Along the Esplanade (a long stretch on the coast) is literally physically active.  Free sessions of Pilates, Yoga, Zumba, (coached) volleyball on sand pits, BodyFit/Bootcamp, Boxing Fun, bouldering, Aqua Aerobics, VPR, skateboard area,... the swimming pool/lagoon !  The Zumba was amazing - held in a park and easily about 150-200 people doing it altogether: men, women, children, tourists... such a brilliant atmosphere, no one is laughing at you, but laughing altogether!  Numerous people jogging and cycling.  Really can't fault the 'active' scene.

Perfect weather: apparently I brought the sunshine when I arrived.  The previous 2 weeks had been rainy.  But my weeks there were blue skies, sun shine, warm... perfect British Summer weather.  Not humid at all.  This is their winter and it was bliss! 




Why this placement?

My aims included gaining hands-on experience in a whole range of medical conditions in hospital and community Non-Aboriginal and Aboriginal settings.  General Medicine seemed an appropriate specialty choice, providing me much freedom and range of clinical cases and experiences. 


I applied via James Cook University to work at Cairns Base Hospital.  The hospital is Tropical North Queensland’s major referral centre and its major provider of specialist hospital and community (outreach to remote and rural areas) services, with a capacity of 491 beds.  I applied in July 2011, and my placement commenced in June 2012.  You need to arrange almost a year in advance with medical electives in Australia.  

Admin fee was £64.58

Placement fee (4-8 weeks) £301.57

When I arrived, the registrar I spoke to was in General Medicine/Endocrinology.  Despite not having an interest in Endocrinology as such, I just got a good vibe off him... so agreed with General Medicine with Endocrinology, and then met the team... and I was on a win.  [I didn't see that registrar again though! He went on holiday... for a long time.]  But my team: another registrar and 2 house officers - I loved them.  They were super nice, chilled, easy-going, smiley ... and 'cruisey', a word I picked up.  I had an aim of not being a 'medical student' nor a  'come-and-go-person' on my elective, but I don't think I quite broke that barrier (always going to be there) but am glad we managed to take photos, go eat out together and still be in contact with them.

We had coffee and cake almost every day - midway through ward rounds.  Needless to say, I made them cake too - the Mango Napoleon.  There are other medical students from JCU there too.  I met a few of them and went for meals/nightout.  They were lovely people too.  There were 2 Newcastle medical students joining my second week in.  They coincidentally lived in the same apartment/complex as me too, and they were muchos fun...and lovely too.  (Met too many 'lovelies'.) I met some great and really sound physiotherapy students from Brisbane/Gold Coast (through the accommodation) who were doing a placement at the hospital too. 


With my team, we attended to and followed up patients in the Emergency Department, 6 floor levels of wards, Intensive Care Unit, Coronary Care Unit and Women’s Health.  I also attended Endocrinology and General Medicine clinics in the hospital and Community Health Centre (381 Sheridan Street), and Outreach clinics in Innisfail (2 hr drive, in consultants' car) and Yarrabah (1.5 hr drive).  I missed out majorly apparently on a Wuuchoppren outreach.  The consultant said the day before that he'll pick me up from a Community Health Centre, which was 35 minutes walk from my accommodation... and he forgot me. When I went to find him, he said, "Oh so sorry.  I forgot.  Oh, you missed out.  It was the best Indigenous Gnereal Clinic I have ever done. The best. Saw everything.  Oh sorry... you really missed out."   Hm.  I spent that day at the Health Centre in a paediatrics diabetes clinic.


Regarding the Outreach clinics though, Yarrabah was the only Outreach consisting of entirely Aboriginal patients.  I was told to expect the Indigenous communities and health services to be ‘Third World’ within ‘First World’ Australia.  This was definitely not witnessed from my (limited) experiences.  The centres were well-equipped/financed and clean.  Patients wore clean clothes and were respectful (although in Cairns Base Hospital, I cam across a few not so agreeable patients).  I was told Wuchoppren and Aurukun are ‘more Indigenous’.  An overnight Outreach trip to Aurukun, very north of Queensland, would have been a great opportunity, however as it required flying and overnight accommodation, I could not be accommodated on the private plane, neither could I afford to self-fund if I had the option.

Other teaching opportunities:  

• Tuesday morning General Medicine teaching to Interns (UK equivalent to F1s).
  Tuesday lunchtime teaching to Interns: presented by interns. FREE LUNCH!
• Thursday lunchtime: Endocrinology team teaching. No free lunch.
  Thursday lunchtime teaching to Interns. FREE LUNCH!
• Friday Professional Grand Round. FREE LUNCH!

Summary of the medical placement, I saw everything pretty much.  Indeed General Medicine.  Awesome team. Lots of free time/flexibility.  Lovely hospital - on the Esplanade.


My Two-Cents about Cairns

Flight: LONG!  I had to get the train to London airport (3.5 hours). Wait around.  London to Singapore to Sydney to Cairns.   Departure from London was Saturday 9pm UK time, and arrived in Cairns Monday 12pm AUS time : 26 hours according to the itinerary of flight and transfers time.  It wasn't that bad though.

Social: You'll make new friends every day.  Lots of backpackers, students, young people touristing or with working visas... can't go wrong.  Everyone was just really friendly and outgoing.  Not one moment did I feel lonely, it was actually the other end of the spectrum!  Through volleyball, bouldering, skydiving, scuba diving, bungee jumping, etc., despite going by myself, I made new friends there who I hung out with later.  It was also nice to know that I had a luxurious (one of the cheapest in Cairns) apartment to return to and just chill and kick-back. 

Alcohol/Clubbing/Pubs/Bars: I only went clubbing ONCE in Cairns (Gilligan's) and that was on my very final night in Cairns with some other medical students, where we stayed out until 3.30am, then I got a 5am flight to Brisbane!  I went for social drinks.  Pier Bar, Rattle & Hum, and The Courthouse were nice. Checked out Woolshed and O Paddy's, but went home with my housemates at 10.30 or midnight.  Main backpacker's areas are Gilligan's and Woolshed - lots of freebies, competitions (I won a free diving trip in a raffle), discounts, vouchers, cheap drinks.  There was an air guitar competition for a diving trip worth £500.  Shame I was wearing a denim mini-skirt, otherwise I would have been all over it.  

I got into my wine during the whole Australia trip.  Just chilling in good company.  Mind, I bought a £2.50-3 bottle of red wine... and it was genuinely really good, and was from the off-license 'One Stop' (Grafton St).  So now I quite like my Australian wine.

Australians don't drink Foster's.  They don't have it (rare).  'XX' is probably their equivalent.

Food: MUST try kangaroo meat!! As a steak-lover/general meat-lover... YUM !  Crocodile and emu too.  Bay Leaf restaurant (next to the hospital) was gorgeous (Balinese) : well-priced lunch set, which my registrar kindly paid for the whole team!  Grill'd Burger restaurant... win.  Burger King = 'Hungry Jacks'.  There's Subway, McDonalds, KFC, and Nando's.

Coles and Woolworths are equally priced supermarkets.  (I did sadly go to both shops and note down and compare the prices.)  They are like Tescos.  They have 'Tesco Value' stuff.  Food in Australia IS NOT that more expensive than UK.  Bread is though... and some dairy stuff.  They have ever changing offers and discounts.  Also there's Rusty's market - super cheap!  I only ate out 3-4 times, so I hardly spent much on food (budgeting).

BBQs are big in Australia. Lots of free BBQ cookers along the Esplanade.  It is a man's job. 

Tim Tams.  I ate 10 packets of 9 biscuits in 5 days (They were on offer!! Like £1 a package).  Addictive.  Think I bought a total of about 30 packets...and consumed about 20 of them in 5 weeks.  Managed to bring 5 back to England.  Think of penguins - but beyond penguins.  The Tim Tam Slam - nibble the ends of the biscuit and then suck up a hot drink (hot milk/tea/coffee) like a straw and it melts heavenly in your mouth.  An experience one should have. [Double Choc Caramel displayed.]  There are 9 different flavours of which all have entered my tum.

Think it's an over-exaggerated perception that Australia is more expensive.  Certainly in Queensland it is not the case.  Sydney (major/capital cities) are definitely going to be more expensive, as London is.  You just have to do the research and know where to shop.  UK has it's expensive supermarkets like Waitrose and M&S afterall.

Transport is really good and not expensive at all either - bus and train pricing (taking distance into terms) is similar to England.  You can hire a car and drive around quite easily too (drives on same side of the road and accepts UK driving license), but you can easily get around Cairns on foot or bike.  I walked everywhere.  Hiring bikes is really cheap.  Most tour activities picked you up from your accommodation.


Mobile: I got a pre-paid SIM card from Woolworths.  5GB 3G connection (so important!) and 1000 mins and 1000 texts for 7 weeks for ~£30.  I didn't even manage to use half the quota, even with some international calls.  There was a package for half that too.

RUGBY is BIG!  Especially State of Origin.  NSW vs Queensland is one of the biggest games in Australia.  Watched my first rugby game from start to end at The Courthouse on the big screen, and I LOVED it!!  Purple/Maroons = QLD.  Blue = NSW.  Atmosphere was amazing.  Think of World Cup Football... or Premiership Finals.

Planking:  I did not witness anyone (else) doing it.  Think it's a bit out of fashion.

Being a girl appeared to have its advantages.  Putting it simply, sweet-talk/flirting to get favours, discounts, freebies, attention etc.  Quite incapable of doing that and only capable of friendly banter, there were countless opportunities and I certainly saw lots of it.  It is a youthful touristy city and turnover rates of people/tourists/backpackers are quite high. Just sharing.  It was simply an eye-opener ... real world perhaps.  You're definitely more approachable as an individual or lone female traveler.

In Australia, everyone likes openness, friendliness and light-hearted banter.  It's the culture.   On all of my touristy escapades, I would mingle with other tourists and the staff, joke about, share stories/opinions, help, etc. It really made the experiences more fun and memorable.  A thing I noticed - there's a difference between 'nice' and 'friendly', I prefer the latter.  

Another thing I noticed in Australia is that they just seemed more generous and not stingy at all.  No offense, but Britain is a bit stingy... especially amongst the student population.  The strangers/new friends/housemates (also students) just readily offered a hand: free rides, food, accommodation, going out of their way,... a nurse I just met for 2 minutes gave me a big load of fresh frozen mango the next morning after I was just casually asking the staff during lunchtime where I could find mangoes after scouring everywhere and failing [Since it wasn't the season, there were no mangoes available at all.  Mango Puree was a rarity... managed to find a tin in an Indian shop in Brisbane and Sydney later along my journeys.]  Generosity without expecting something back is not a common personality attribute nowadays, and I have always wanted to stumble upon more of those, so the generosity was something I aimed to bring back and share with England...

that and the cruisey-spirit, approachable-friendliness, ...and the few packets of Tim Tams that survived.

That said, I think being in a new place is like 'Freshers' again : you become more bright-eyed, eager and pro-active to make new friends.  Once you've settled in a place and have your set of friends, you 'settle' and unconsciously adopt an unapproachable body language.  Having always been certain of the city of where I wanted my first job as a doctor to be, I came back re-considering.   I also came back from electives having formed a special interest and actually wanting to intercalate... but as that was too late, I can only say now 'I wish I intercalated'.

Cultural diversity I had heard of some 'dislike' towards SE Asians and Aboriginals in Australia.  The former because there's been a tremendous influx of them and their businesses.  The main complaint being that some don't learn English and have manners, which are considered 'bad manners' in the 'Western world', but the norm in some parts of Asia.  I hardly saw SE Asians in Cairns: 3 doctors in the hospital, a handful of SE Asian tourists strolling about... I hadn't made a 'friend' in Cairns who was SE Asian actually.  Brisbane: Reasonable amount.  Gold Coast - I didn't see many.  Sydney was where I understood. There were many areas where it was entirely SE Asian.  The population overall in Queensland seemed predominately Caucasian, whereas NSW (esp Sydney) was more multicultural.

Muscles on girls : A bit of a tongue-in-cheek sub-header.  But muscles and (quote) 'an outdoorsy glow' on girls are positive attributes in Australia (the generally discouraged attributes in SE Asia culture).  I felt right at home =)  

Accommodation: I've attached the table I made of all the accommodation in Cairns 2012.  I recommend staying at a long-stay accommodation like Cairns Sharehouse or Red Key which are both close to the hospital.  NOT Gilligan's and those party Hostels - they're more expensive, loud (you want sleep for placement) and were further from the hospital.   I will go back to Cairns Sharehouse any day, any time.  Like-minded students and workers from Australia and abroad stay there.  I stayed at the Martyn Complex: clean, double bed, ceiling fan, personal outside garden space, (small) swimming pool, BBQ, 2 bathrooms, kitchen lounge, own little TV/DVD player in bedroom, 6 people to an apartment.  My housemates were unbelievably sound: from Newcastle UK, Gold Coast and Brisbane.  I ended up staying at theirs and hanging out with them when I went down the coast (Brisbane & Gold Coast).  Fate is an amazing coincidence.

 
Slang: 
Thongs = Flip Flops.
Bogan = Chav.
Pommies = English
Ozzies = Australians
Kiwis = New Zealand-ers 
[I'll remember more later]

Started to say 'Good Day!' and 'Mate'.


Organizing Touristy stuff
Do it there and then when you are in Cairns and have settled.  There are always lots of offers and hostels often do 10% off tour bookings.  If you're a 'local' you get 20% off (general tourism).  I waved my swipe medical card, and got offered a discounted trip.  Didn't work another time.  Hit and try.

I did most of mine through a tourist agency as you can haggle.  I've never haggled before... yet managed to (woop!).  You can create your own packages and it always ended up being the cheapest option.  Literally I went to every tourist agency and compared prices (a lot of time invested) and Happy Travels on Abbott Street were great.  I was told about 'Wicked Travels' but didn't get as good of a vibe and attention/help as I did from Happy Travels (the main guy who helped me was from Cardiff).  I think by the end of my Cairns trip, they maybe got fed up of me as I would always have found a better offer on the internet or something which they had to then try to beat ;)  I don't like being cheated.  Every dollar brings me a step closer to cake/good food.

Things I did:

• Bungee Jump : Did 2 jumps; satisfied by Jump 2 - Running off the roof.  I befriended a English guy there (now a Leeds Fresher) who gave me a 'Free 2nd jump' voucher. 
• Sky Dive : Cairns (Innisfail): There's the choice of landing in the Park or on the Beach.  Both offer stunning views.  Must do the 14 000 ft.  Worth every penny. (Another location is Mission Beach which is further away though and a bit more expensive)
• Atherton/Tableland Waterfalls:  Swimming in waterfalls, including Peter Andre's Mysterious Girl Milla Milla Falls.  Rock jumping/sliding.  Super cold yet refreshing and fun.  There are 3 companies doing tours $105, $88 and $48/55.  They always advertise the 2 more expensive one's (Uncle Brian's & Barefoot Tours) which are also highly rated, but the cheapest one seemed to be similar and not had a bad review!  I had 3 people wanting to go with, so we decided to hire a car for the day and go around by ourselves. 
• Scuba Dive trip : see below.
• Kuranda : zoo, skyrail/cable car, Aboriginal culture/dance show, rainforests, feeding kangaroos.  Found a cheaper deal on the internet than the ones in the brouchures.
• Palm Cove Beach: Just hopped on a bus (Cairns doesn't have a beachy sandy coastline by the way), 20 minutes, on a reputable beach.
• Tully River White Water Rafting

Other things you can do that I was about to do but didn't have time:

• Port Douglas: 4 mile beach, scuba dive, snorkel, 
• Quad biking in Daintree Rainforest (I chose to go on an Outreach trip instead...)

Diving

You need a Medical if it's your first time and you're wanting a qualification/PADI : cheapest around was $55.  Really simple, fast - trip to a GP centre. 

There are the following companies if you want a PADI, from most expensive/reputable: Prodive, Diver's Den, Deep Down Under, Cairns Diving Centre.  I visited all these shops to check out their vibe. 

I went with ProDive in the end because they discounted AUS $100 off their 5 day (2 classroom, 3 liveaboard) trips (usually about AUS $850/£540 ... inclusive of all meals, drinks, accommodation, teachings, transport, equipment, tax/insurance/levy) ...and were just £20 GBP more expensive than the next option.  Everyone kept on highly rating and raving about them too.  I split mine PADI course between 2 weekends as I wanted to still go to placement. 
 

I wouldn't RAVE about ProDive to be honest - unfortunately 1-2 staff were really 'sell-sell-sell', 'really-don't care-about-your-safety-but-just-for-your-money.' =/ The diving itself was fantastic.  I had a great diving buddy too.  My instructor on the second weekend/diving weekend was nice (and much better).  Food was plentiful and yummy.  You meet people from all over the world.  9 dives including a night dive with just a torch.  Diving is surprisingly tiring!  Saw turtles, sting rays, sharks (friendly ones), Finding Nemo, etc.

I later did a Day Reef Trip with Cairns Diving Centre (the cheapest), and couldn't fault it either.  Just maybe has a higher ratio of people:instructors, so if you're the panicky or slow-learner type, you might want to favour the companies that will give you more attention.

The weekend I did my PADI dives, the water surface were SUPER rocky and choppy, and the weather was rainy and windy cold, whereas the weekend before that it was calm and my friend got sunburned.  You do have to be a confident swimmer.  The Day Trip on shallower reefs was calm. 

My advice is just to go around these places (there's loads of companies if you already have your PADI), talk to them, see what vibe you get and what offers they have.  There are Day trips (no PADI qualification or Medical needed), 4 day, and 5 day trips offering diving and snorkeling.  Snorkeling IS harder.  The journey there was SUPER rocky (literally 90 degrees rock), so do take your sea-sickness tablets and SIT OUTSIDE!  (I was fine...just about.)   You may get ear pain from constant/repetitive equalizing of your ears.  Some people are born to be able to easily equalise.  I think I had the sensation of water in my ears for a good week afterwards.... alongside sea-legs!


There are so many islands near Cairns that you can go to for snorkelling trips: Fitzroy, Green, etc.  Quite cheap.  Just go into a tourist shop for brochures/pictures.

The Great Barrier Reef is simply stunning. 


Breakdown of costs - The Basics

• Placement fees: £365
• Flights £850 for 3 trips [[London-(Singapore-Sydney)-Cairns]] [[Sydney-Hong Kong]] [[Hong Kong- London]]
  Cairns-Brisbane £90-100
  Gold Coast to Sydney ~£45-50
  [Use http://www.webjet.com.au/flights as it reliably compares both JetStar, Qantas, Virgin.]
• Accommodation ~£550
• Visa: "at your own discretion."  Free E-visitor - OR  - Visitor Visa Subclass 676 (need CXR/medical done privately in UK ~£300)

Social/institutional/culture difference

The universal Australian health care system, hospital, life as a doctor and social culture are very similar to the UK.  The Australian health care system ‘Medicare’ includes both private and government institutions. 

Australia was ‘discovered’ or invaded by Captain Cook and the Europeans in 1788, and the differences of culture, economics, social manners, and religion resulted in “culture clash, culture conflict and culture shock”, leading to the oppression of the Aboriginal people.  In 2008, the government made a formal apology to the Aboriginal people for the wrongs, but the on-going process of reconciliation has not been easy.  The predominant Indigenous health problems presented during this elective included alcoholism and type 2 diabetes. 

Those from Torres Strait Island are called ‘Torres Strait Islanders’ people, and those not from there are called ‘Indigenous’ people.  ‘Aboriginal’ can be used to term either communities.  Some TSIs may be sensitive, if (wrongly) termed ‘Indigenous’. 

Summary/Reflection/Last two-cents

Going to the other side of the world alone does demand self-efficiency, organisation, maturity, courage and mental, emotional and physical stamina.  I still remember my first day - 'lost' and overwhelmed.  I constantly put myself out there, being outgoing (it did get tiring) and bantering with doctors, students and strangers.  I formed some amazing friendships (thankful for Facebook in these circumstances), had the most unforgettably indescribable experiences (especially down the coast), and made the most out of every given opportunity, time and situation - I didn't waste any.  The people made the place and I could not be any more appreciative.  I gratefully and greatly thank my parents for all their hard work  to be able to fund me.  Sadly, money can/does open opportunities.

Most students treat medical electives 'as a holiday'. A minority treat it 'seriously as a placement'.  I took it more as an opportunity to challenge myself to fit in as a local, get the real deal of what it'd be like to live/work there.  Not that I definitely have Australia on the cards in the future 

(although I never say never)

but it is just how I treat traveling in general. There is the quote:

"The traveler sees what he sees, the tourist sees what he has come to see." - Gilbert K Chesterton.

I had a lot of eye-openers... and I do believe that traveling (especially alone) really matures you culturally and as a person.

I still miss Cairns.

Roy Lichtenstein Pop Art Fancy Dress

Roy Lichtenstein Pop Art Fancy Dress

October 2011 Fancy Dress

Hand-painted, self-designed clothes with fabric and acrylic paint.

5 weeks costume preparation.

3 hours of makeup and hair.

Plain white nylon blazer £5 and cotton dress £10 , & wigs £8x2 : Ebay.

Fabric paint £5 and black acrylic paint 99p : The Works and Wilkinson's respectively.

Created with a biro, cotton buds and old eye makeup brushes. Not a professional.  Standard student.

Makeup: Porcelain foundation, red lipstick/facepaint for dots, black eyeliner/facepaint.

Video of the process:

Food, Share, Love

What is Life without food that's been poured with love, effort and time?

Here's a specially selected creations of ours (recipe sources shared).  There's a beauty in cooking/baking and spending hours/days to make something for friends and family who mean something to us and are simply lovely, genuine people.  Kindness is repaid by kindness and good food makes everyone happy, so it makes sense to share yummy creations! 
 

Inner Heart C'Ache

 

  Mango Napoleon Cake (Mille Feuille) 
 

My Birthday Cake by my best friend - Lychee, Rose and Raspberry Chiffon Cake

 

Gordon Ramsey's Beef Wellington

Chinese Roast Pork (Char Siu) Buns

  

Springboard Diving

Photo Source [Check out more of their amazing diving photographs!]

You see it at the Olympics : gymnasts jump launch, swirl and twist so elegantly; pointed toes; ballet hands; perfectly arched back; powerful yet graceful; and land with little splash.  Anyone can jump off a pool side, but it's all about trying to achieve the quality and perfect technique of beautifully pointed and powerful shapes/dives if you're having lessons!

Lessons occur on Fridays at a renowned venue for springboard diving, and with hockey season over, I had 6 Fridays free.  I learnt... a lot, and man, it's hard!  You water-slap-bruise a lot! 

You need to maintain a tense core body during the jump.  You need to be able to powerfully jump high enough off a non-springy and springy platform to gain enough height.  It is important that you don't arch your spine too far back or forward otherwise you don't get the right streamline or you get a painful water-slap on the back of your calves or bottom.  Even just the slightest change in curvature of the spine or angle that you approach the water can make a difference in terms of the amount of splash or how much you're going to water-slap-bruise yourself.  Pike dives and tuck dives are simple yet impressive, important basics.  Kids - their brains and body are like sponges, in other words, they pick up things so quickly.  Due to their low mass:muscle ratio, they would just 'fly' effortlessly.

Knowing dancing or gymnastics basics would help you speed along.  On my first lesson, within those 40 minutes, I progressed (well, I had the guts) to each level up : 1m, 3m, 5m... then the almighty 10m.  It looks high from ground-up, but oh my, from up there... it's soooo HIGH!  I just did a simple feet-first dive.  Perching on the edge, my toes went tense, heart racing, and I was psyching myself : 'Keep your body tense.  Remember, angle.  Arm straight and taut.  Look straight ahead.'  Then I jumped.  Tense.  But then I relaxed my core body at the VERY end (it felt like I was falling for a while), and BAM, landed in the water with a big water-slap on my bottom as my legs gave way.  I had to mermaid myself to the water surface - tensing my buttocks - because they were simply numb yet 'prickly'...and I just mermaided to the side and tried to act all cool as if my bum wasn't numb.  It was numb for like 4 minutes.  There was no evidential bruise the next day, but it was sore.

I attempted again.  This time much better.  With that 10m over the way, the next few lessons were more focused on technique, and moving from non-springy to springy boards. 

Sometimes I wish I could have continued, but I can't do everything and Friday nights are always busy.  But I definitely will never look at a diving board in the same way again.

I'd completely recommend that "To Jump off a 10m diving board" to be on your list of things to do in Life!!

Hong Kong (HKU) Medical Elective

• Hong Kong used to be British, then was handed back over to China in 1997, so it’s quite ‘Westernised’.   
• The Chinese language is compromised of the following dialects, in the order of most spoken: Mandarin, Cantonese, and Hakka.  ‘Mainland China’ = Mandarin.  HK’s main dialect is Cantonese, however most people are educated to speak a bit of Mandarin and English.
• Geographically, HK has 3 territories. From the most North: “The New Territories”, “Kowloon”, and “Hong Kong Islands”. 
• There are only 2 medical schools in HK: Chinese University of Hong Kong CUHK (Kowloon) and Hong Kong University HKU (Islands).  Taught in English.  5 year course.  Similar to UK.
• Colleagues speak together in a mix of English and Cantonese.  Chinese is mostly spoken with the patients.  Sometimes, there’ll be English-speaking patients or expats. 

Application process:
I approached CUHK as an ‘SSC student’, but CUHK doesn’t accept 'SSC students', only 'elective' applications.  So I advise future students to just approach CUHK as an 'elective' application.  HKU accepted the fact that I described it as an SSC.  They have something equivalent in their MBBS course called SSM (Module instead of Component). 

I had to apply 6 months in advance (now it’s changed to 12 months apparently).  The earlier you apply the better.  It is competitive as I heard of rejections, but I think some time periods might be less competitive than others.  After giving me an offer, HKU gave me a document about the blackout periods in departments in HKU due to exams.  My first choice was actually Paediatrics but there was a blackout period then.  A few other specialties had blackout periods in March-April.

HKU Medical School

Standard medical school application procedures.  No placement or admin fee.  They do have hospital accommodation but had no vacancies for my period, but I stayed at my grandparents in Kowloon and did a daily 50 minutes commute by public transport.  HKU got back to me in about 2 months time (December) – offered Cardiology, Queen Mary Hospital (biggest hospital in HK).  Bought flight tickets (~£480).  HKU required me to send in 3 insurance policies within 2 weeks before I could be officially accepted: Indemnity (MPS/MDU); Life, Death, Disability, Critical Illness (Insure-Me-Online); and Medical (a HK insurance company $192=£18 for a year).  This was during revision/exams, and knowing little about the different/cheapest insurances, it took me a while to try and find cheap ones that was sufficient cover, so do a quick search in advance!

Placement Life There

I kept a diary and video diary of what I did and patient cases, which I’m glad of – as literally reading/watching back over the stuff, I wouldn’t have been able to recall it!

You wear a white lab coat on the wards.  They wear the same white coats to the canteen.  The white coats differentiates you as a doctor/medical student.  Bare-below-the-elbows do NOT apply.  You wear a mask in any clinical area, ward round and taking a history/examination.  (You often see in the streets of HK people wearing masks anyway!  Very common.  Ever since SARS.) 

From the bus stop

You arrive on your first day …and the hospital is overwhelmingly MASSIVE and TALL.  Once you gulp that down, you report at 9am at the Professorial Building (admin) and the lady you’ve been emailing gives you the 4^th year (in UK terms, however they are considered 'Final Year' as it's of '1.5' years duration) medical students’ timetable who are doing their Specialty Clerkship, so you can go join any clinical teaching or lectures with them.  You watch an Infection Control teaching video, do some paperwork, then go meet your supervisor.  At 11am that day there happened to be a small group-based medical student Case Discussion which I went to and met 7 other medical students, who I afterwards had lunch with at the overwhelming hospital café, which was a Café de Coral (大家樂 Daai Ga Lok) - a fast food restaurant…Chinese style!  

Then in the afternoon I went to an AIM clinic with the medical students, which is like a primary care (GP)-like clinic within the hospital.  Literally, in a medium-sized consultation room (like a mini-classroom), us 7/8 medical students would sit there in chairs with those mini-tables, we’re briefed on the patients case, the patient comes in, we watch the consultation (sometimes one of us took the history), and then let the doctor examine the patient (or again, one of us examined and presented the findings), then after the patient leaves, the doctor does another briefing.  Total of 3-4 patients in one session… all in front of 7/8 medical students… as opposed to 1-2 medical students in UK!  I attended several teaching OPD clinics of the same teaching format, so I came across a lot of different specialties, and it was really good teaching I have to say!  I also attended some lectures (Haem, Neuro, even Evidence Based Medicine, Pharmacology, Resp) to complement the teaching clinics, refresh my memory, and to prevent me from getting ‘bored’ of just doing Cardiology.  You can pretty much join any medical students from whatever year!  I met some 3^rd years and attended lectures/clinical teachings with them too.  Even went to a 2^nd year’s microbiology labs session.  I was just curious how it all compared to UK’s medical school syllabus…and the answer was just pretty much the alike!!  And the medical students that I met were simply genuinely very nice and hardworking people.

A few Cantonese vocab I picked up along the way:

"Chung ying": Double vision
"Deem mm deem ar~?": Is it sharp? (testing sensation)
"Mei sac": Close tightly (your eyes).
"Dou lic": Resist (power of peripheral limbs)
"Siu bo" : small steps (describing Parkinson’s gait)
"Gei yuk": muscles

I pretty much started speaking/self-teaching Cantonese when I was 17 and can converse basic day-to-day stuff. So I always had a Cantonese phrasebook with me, as well as my Oxford Handbook.  And I found a really useful leaflet off Google with English pronunciations of how to take a history and instruct on clinical examinations in Mandarin and Cantonese (click for the pdf). But cutting to the chase, as long as you know English it’s fine!   Consultants and doctors and medical students spoke to me in English, despite trying to speak Cantonese as much as possible anyway.

The hospital library lets you access Facebook.

Cardiology

The Cardiology department is highly reputable in HK.  Even 'important people' would be treated in this public hospital.  I saw reporters and cameras outside the ward doors and downstairs at the building entrance like 3-4 times that I had to use the back entrance.  The team was very hard-working.  The consultants/professors (and my supervisor) were all very nice, and valued good-quality care and would quietly pull aside juniors for ‘a word’ if necessary.

So, 26-bed ward.  I pretty much came across everything expected of Cardiology.  On the wards: WPW, Brugada Syndrome (age 17), femoral dissecting flaps, heart blocks, PE, cardiomyopathy, pulmonary hypertension, congenital defects, MIs (obviously), Sinus Sick Syndrome, etc.  In the Catheterisation Labs: Percutaneous Coronary Interventions, pacemaker replacements, ablation of accessory pathways, etc.  Saw lots of ECGs.  Went to arrhythmia and pacemaker clinics.  As my ‘assessment’, I did a case report and literature review on the safety of dual antiplatelet therapy and management of patients with thrombocytopenia and acute coronary syndrome requiring percutaneous coronary intervention… 4000 words and 70 references (probably won't sound exciting to you).  My supervisor also asked me to do a presentation on top.  I asked him to clarify whether he wanted it ‘formal’ or ‘informal’.  He said the latter, so I thought it would be just a handful of people… but it turned out to be like 25-30 people, so thank goodness I prepared a formal Powerpoint and all that jazz!

Since I hadn’t had my Cardiology rotation yet, nevermind much teaching, I initially felt a bit in the deep end, having to read up so much and get my head around ECGs.  But it was interesting, especially Interventional Cardiology.  It is certainly a challenging, difficult, responsible, yet rewarding specialty.  In addition, I had to pay extra hard attention to listen to what the doctors/patients were saying, translate it in my head, keep up and remember the new medical Canto vocab.  So every day I was drained and had tension headaches, but the scenery FROM the hospital and journey back was stunning.  I sat outside with a ice lolly one day after placement in front of the sunset.  And I always stopped off at CAKE shops after placement, visit one set of grandparents with cake, then returning to my other set of grandparents for dinner.  So I was tired, yet happy.

Cultural differences
I don’t think my supervisor has had an elective student with him before and the whole team didn’t quite know what to do with me…as an international student too.  I’m one of those who quite like to build a rapport with the HOs/Registrars and not have a hierarchical relationship.  I like to be able to banter in other words.  But you’ll find that that is not so easy in HK.  Cultural reasons I guess, or maybe 6 weeks was a ‘short-lived’ period, as it was only by the end of the placement did I finally feel ‘settled in/accepted’.  I’ve always been told the medical students and doctors in HK “don’t have a Life”, and is always working and very stressed… which I’ve found to be very true.  The doctors were always ‘serious’ and ‘intense’ on the wards, yes understandably busy, but the hierarchy was very defined.

Patient-doctor relationship is also different.  There’s the rise of the patient’s authority and decrease in ‘respect’ for doctors in UK, whereas in HK, doctors are always authoritative and well-respected.  Patients often waited for more than 1 hour for their clinics…maybe 3!  In UK, patients would either make a formal complaint or leave by that point!  Not to forget HK has a highly dense population, so hospitals are always buzzing.

Student life is completely different.  They have a ‘Student’s Union’ but it is no social hub…more like an admin building.  Alcoholic social events… are pretty much almost non-existent.  I do believe there is a minority of medical students somewhere out there who do enjoy nightouts/drinking but that would be done at their own discretion and in places like Mong Kok, Wan Chai or Central, and would more likely be the Westernised-Chinese/Internationals/Expats.  Alcoholic clubbing activities are not ‘popular’ with (medical) students.  Most don’t drink, some might do a casual beer once in a while, and a very minute minority will ‘get smashed’.  If you told them you casually go clubbing a few times a week, it might just shock them.  The 'locals' prefer Karaoke bars or eating out as a form of socialising.  Most of the students live at home too.  HK isn’t that big and the majority of the medical students are HK locals.  They can live in Halls of Residences next to the hospital, but do so only for short periods if they have to do lates/nights or live on the outskirts of HK.  So basically the HK students don’t get the same experiences we get from living with each other and socialising.  Sports don’t seem to be a big thing either.  Occasional badminton, table-tennis and football (amongst boys), maybe yes.  But other sports/societies… no. 

So basically, if you’re ‘westernised’, be understanding of the culture differences.  It's where East-Meets-West.  Being respectful, well-mannered and PUNCTUAL are very important.  Also modest… and modestly dressed.

Why did I choose HK? (A bit mushy so welcome to skip. I’ve tried to make it short.)

My university allows students to do 2 electives and I always had Canada and Australia idealised.  My best friend was going to Los Angeles and offered me to come with – she had an amazing time.  HK hadn’t crossed my mind but I kind of did a spontaneous turn at this point of time: what was more important – family/grandparents or excitement?  Since having little ‘family’ exposure in my upbringing, family pretty much has become of greatest importance in my life.  Life clock ticks on, right?  When else would I be able to stay this long in HK and get to know my roots and family...and finally grasp onto Cantonese? And I love my grandparents. I asked them to tell me their Life stories (often repeated, yet still enjoyed them) and found out how alike I am to them in terms of personality, skills and principles.  They’re so super cool that I would do my best all-roundedly to do them proud.  I had and still have no intention to study/work in HK.  It was simply ‘family’/personal reasons.

Reflection

On reflection of the whole placement, I definitely learned and gained a lot clinically.  I gained an insight and understanding of the culture and lifestyle of medical professionals and the healthcare system in HK.  I got to know my family and my roots.  So objectives achieved on all levels: academic/clinical, cultural, social, and personal.  Win.

Now just general touristy tips/info about HK

VISA

• If you’ve a British Passport you can enter HK and Macau for free. 
• However you need to pay for a Visa if you go to Mainland China (anywhere else).

General

• It’s very polluted in HK…especially the busier bits (Mong Kok & Central).  You may want to take a packet of tissues to just cover your nose/mouth now and then!
• Market places, Mong Kok and Central can be bustling with people.  Common-sense: hold onto your purse/wallets in packed places.  
• People walk quickly in general in HK. 
• People carry and use umbrellas when it's NOT raining to protect themselves from tanning the in sun.  They like to have pale skin.  But it does help keep you cool.  Very useful if you go to places like Disneyland, Ocean Park, the Peaks in the HOT summer.
• Take/buy bottled water.  They don't drink tap water.  People living there FILTER, then BOIL, then let COOL their water before drinking it.

Weather

• March/April was like UK’s spring/summer – just perfect, a few light showers now and then, but mostly soft sun and light breezes.  I had to wear a cardigan sometimes … and few times wore a coat for the super early morns/late night commute. 
• Hot and humid in summer, no doubt about that – shorts, T-shirts… you want to stay in air-conditioned places. 
• December is like UK’s spring… definitely need a cardigan.

Public transport

Straight-forward and cheap.  Get an Octopus Card (you can use them in convenience shops as well).  The train (MTR) straight-forward and quick.  Trains stop at 11.30/11.45pm…ie. before midnight.

For bus routes, if traveling on Kowloon side : http://www.kmb.hk/en/  . 

If on Island, http://www.nwstbus.com.hk/home/default.aspx. 

There are night buses (12am-) that don’t run that frequently but are a cheap method of crossing the harbour instead of taking a taxi. 

If crossing the harbour bus 970 and 970X (stops at QMH) are quicker than other buses, and actually quicker and cheaper than MTR. 

Tram is HK$2 (15-20p), but not air-conditioned.  Sit on the upper deck so you won’t inhale much pollution!  Fairly slow, but cheapest option for short journeys.  Kind of have to try it once though for the experience!

Taxis: $18 for the first 2km.  Then $1.5 for every km afterwards.  Fast. Convenient. Door-to-door.  Wave your hands on the street if you want to hail a taxi.  Lots of them on the road.  They generally don’t scam you…but you never know if you strike unlucky if they take you a longer route.  Generally it’s safe for a lone female to get the taxi at night.  Just call someone when you get in the taxi that you’re coming home, and note down the registration plate if you want. Taxi drivers know basic English in general.  They certainly understand 'home' and 'see you soon'.

Minibus: quite fast, quite cheap.  You need to shout/call out if you want to get off at the next stop.  So unless you’re familiar of where you’re getting off, these minibuses can be convenient to travel.  If not, avoid.  Minibus stops in general 11.30pm.

Shops

I like cheap stuff.  I’d recommend: Mong Kok (for girls, Argyle Centre, D2 MTR exit); Tsim Tsa Tsui and Causeway Bay.  Central is the posh bit and brand names.   Mong Kok is simply cheap and has the markets.  Tip: have a look around an area before you buy anything.  They often sell the same thing but at different prices.  Patience is a virtue.

There are $2 (20p) shops, and also JUSCO $10 shops…like UK’s Poundland.  

Entertainment 

Arcades are cheap and common.  Time Crisis 2/3/4 always a classic.  Have to be 16 years old to enter.

Ice skating - at 'Sha Tin', 'Tai Koo', 'Kowloon Tong' (Next to MTR stations).

Cinemas - slightly more pricier than UK.

Recommended Sights:

• Disneyland.
• Ocean Park most definitely.  Animals, rollercoasters, etc.
• Victoria Peak most definitely.  Take the Peak Tram up. Madame Tussaud’s is also up there.
• Tsim Tsa Tsui (TST) Harbour.  At 8pm there’s a flashing light display.  Walking along TST harbour at night is considered a ‘romantic’ stroll.  This is also where you get to see stone hand-prints of celebrities on the ground like Jackie Chan and Jet Li.
• Big Buddha (Ngong Ping).  Take the cable car up.
•  Lamma Island and Cheung Chau Island for seafood and beaches.  
• Just wander around Central and TST.  Check out the architectural sky scrapers and brand-name shops.  
• Macau. Take the ferry across. Famous for its Casinos and Portuguese egg tarts.
   

Nightouts

Lan Kwai Fong in Central (http://www.hiphongkong.com/drink/bars/nightclubs/dance) : probably the closest thing to the ‘clubs’ in UK.  It’s where expats and International High Schoolers and ‘Westernised-Chinese’ go usually.  There’s no ‘massive 4-floored clubs’ in HK, they’re all small-medium sized. Wednesdays and Thursdays tend to be Ladies’ Nights, so free or discounted entry/drinks.  Guys on the other hand... pay full price for drinks, and some places are ‘Open Bars’ costing $200 (£18-20) for the whole night.  Clubs and Bars change quite often.  There was a bar back in 2010 called Sliver – Wednesday Ladies’ Night: FREE Cocktails, and I had my favourite oh-so-yum (but oh-so-strong…beware!) Lychee Martinis.  Don’t know if it’s still there, but look out on the internet for Ladies’ Night or drink offers.  There's a bar called Balalaika which you have to go to - a Russian Ice Bar, where you can stop melting in the hot weather and put on a fur coat.

Wan Chai and Mong Kok also have bars popular for drinking.

Most Chinese people prefer Karaoke and Drinking Games (dice games, 'game of 5s') over ‘clubbing’.

Food

• Amazing food…EVERYWHERE!  Local Chinese places that look a bit shabby (stools, circular tables) can offer sometimes the most amazing bowls or plates of noodles/rice and are super cheap.
• Cakes: in SOHO (eg Causeway Bay) they sell expensive-ish but beautiful cakes.  For mid-range nice cakes: Maxim’s,  Arome, St Honor’s and A1.  I’d recommend local family-business bakeries for fresh egg tarts and Chinese buns, best in the morning/lunch.
• Dessert places and Bubble teas are very popular.  You can get Mango, Coconut, Aloe Vera, Watermelon, etc drinks with tapioca (small glutinous balls) or aloe vera/grass jelly.  There are lots of fruit/jelly desserts, and  traditional Chinese sweet dessert soups “Tong sui”.  They’re everywhere…and cheap and YUM!  Be adventurous.
• Try the Pizza Hut, KFC and McDonald's there.  It's slightly different to UK and yum!
• There are also Starbucks and Krispy Kremes.
• Go to food shops and check out all the Japanese and Korean candy/chocolate/delicacies there.
• There are vegetarian restaurants, where they use tofu and beancurd imitating meat! It was amazing!
• Hotels do really good value buffets of EVERYTHING!  Give it a google. 
• There's a restaurant in Wong Bo (Whampoa) has the most amazing Dam Dam Meen (Sichuan Spicy Noodles).  My absolute favourite!
• I have a ridiculous amount of food pictures from HK...

1st row: Bakery shops: Maxims, Arome, St Honor's
(Toffee, Blueberry, Mango, Chocolate, Japanese Cheesecake, Green tea and Lychee, Oreo, Chestnut, etc.)
2nd: Hotel buffets.
3rd: Chinese-y style and dessert places.
4th: Bought from food/convenience shops
(Japanese fresh cream mochi, sesame ice cream, red bean ice lolly, ice cream mochis)

Beaches

There’s lots.  Yellow sand.  Some waters are murky, but Stanley beach is probably the most popular.  You can rent umbrellas and floats.



 




Well, hope you've found this blog entry useful or insightful!

Avatar Fancy Dress

 

Market: feathers and beads £2.

Primark: Other accessories £2.

H&M: blue dress £3.

Ethel Austin: blue flats £3.

Ebay : 2 shades of blue + white face paints.  £2.50 each.

Own garden: stick.

4-5 hours.