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Elective report - Dr Paul Banford

Dr Paul Banford graduated from Warwick Medical School in 2012. Here he tells of the fascinating six weeks he spent at a hospital in Cambodia as part of his Medical Elective.

During my six weeks in Cambodia, I worked evenly between the Infectious Diseases, HIV/AIDS and TB and the Neonatology and Haematology wards.

Patients would often have travelled huge distances to reach the National Paediatric Hospital, having been unsuccessfully diagnosed or treated in local clinics. This meant that the ailments seen we unlike anything I had experienced in the UK, including dengue fever, typhoid, thalassemia, aplastic anaemia, ITP, TTP, infantile beri beri, malaria and amoebic dysentery as well as HIV/AIDS and TB.

I learnt a great deal about the causes, signs, sympoms investigations and management to effectivly treat these conditions. Having never worked in paediatrics, I also learnt vital skills necessary for clinical examinations on children.

On arrival, I was apprehensive that communication with patients would prove problematic due to the Khmer language barrier. And at first, it was (despite my French improving vastly whilst speaking to doctors). However, when dealing with the sick, incommunicative infant, one must rely more on clinical signs than patient symptoms.

To use an infant with suspected meningitis as a paradigm, at medical school I had been taught of the diagnostic importantce of a history of a stiff neck, fever, photophobia and a rash. Yet through my training in Cambodian paediatrics, without being able to elicit a full history, I learnt that the Brudinski and Kernig signs are just as valuable.

A typical day in hospital would involve an 8.00am grand round, where all doctors attended giving details of patient numbers on their wards, an interesting case presentation by a Cambodian medical student or a pharmaceutical representative pushing their latest drug would usually follow.

Ward rounds would then occur with the doctor being trailed by 20-30 students. At each bedside, a medical student would present the patient's case; usually quoting verbatim the findings from the day before. The doctor would do a quick general exam and prescribe a medication before moving on to the next patient.

By 12.00pm, the ward round would be over and the doctor would go to their private clinic, leaving the medical students and interns to assess new patients.

Dr Paul Banford (MB ChB graduate 2012)