Day 61: 24/09/12

Today is my final day in Sri Lanka.

I spend the morning finishing my packing and cleaning the apartment. I double check that I have everything and with the heavy rain, I keep a close eye on the flight status. Anne tells me that due to the rain, the driver will come about half an hour earlier. She also tells me that her eldest son, Mevan, is working at the airport close to the time I should arrive so hopefully I will be able to see him and say goodbye.

These two months have come and gone quicker than I could imagine. Some days have been longer than others but overall this has been really wonderful. I’ve met so many great people who I hope to stay in touch with well after I leave here. Anne and her family have been so kind and welcoming, I really have felt at home. I will miss the local eccentricities. The lady with big round glasses that cycles passed me on the way in and yells, “MOARNEENG!” The dogs that follow me down the road until they realise I’m not playing a game. The bus conductors yelling what sounds like, “Crap! Crap! Crap!” The flashing lights around the Buddha pictures on the bus and the dangling flowers. The rotis, the curries, Unawatuna, Three Coins, arrack and Lion ginger beer. Yes, I might even miss Billy.

Thanks very much for all of the interest in my blog over the past two months. The stats speak for themselves and I can’t believe I’ve had so many readers and subscribers; this was originally only meant as a way to keep in touch with home! I expect that I will take a break from blogging for a little while but will make use of this blog in a different way soon enough, so don’t run off just yet.

London Heathrow, see you soon!

Day 60: 23/09/12

One.

The sun rises and I feel like new. Even after all these hours it is still raining outside just as ferociously as when it began. I eat my breakfast, and shower before hauling my suitcase away from its two month home in the storage room, to my bedroom. It’s finally time to pack.

I don’t have all of my clothes at the moment as Anne insisted on doing some more laundry, though I know it will only be washed again when I get back. Slowly but surely the suitcase starts to fill. In go the gifts for people at home carefully wrapped up and protected. Once I receive the remainder of my clothes, the suitcase still looks quite empty. I have used up and donated a few things but I didn’t expect the suitcase to look so bare. I practically had to sit on it to close it when I was packing at home all those weeks ago.

The rain continues to fall and I know that I won’t make it to the beach. I guess I have already enjoyed the best of the Sri Lankan sun. I write up a couple of days worth of entries for the blog as the Internet had been too poor to do so before, and I have been non-stop lately. I catch up on my book as I have been reading fewer chapters for the same, latter reason.

I watch my final Sri Lankan sunset fall and enjoy my last evening cup of tea here in this apartment. I am handed a big pink book by Anne and am asked to write a testimony. I write plenty and thank each of them for all that they have done, they really have gone above and beyond. If anybody would like to stay here (or you know of anybody going to Sri Lanka), their website is http://annemaisonnette.com/ – they come highly recommended, especially if you are doing a medical elective and want to experience real Sri Lankan food and get to know a local family. I have a photo with Anne before dinner, when I give her a gift biscuit set, and to her son a big bag of Jelly Babies and a bag of Haribo. I hope he shares some with his brother!

After 9pm I try and check-in online. It goes well at first but then after two attempts it seems that there is a fault with their system and the process cannot be completed. It just says to proceed to the desk as normal so I suppose that’s what I shall have to do. I have decided to have a driver from here to the airport tomorrow; whilst being pricey by comparison, it will be much easier.

And so begins my final 24 hours in Sri Lanka…

Day 59: 22/09/12

Two.

It’s an easy night’s sleep for both of us. Anne comes to collect the tray of plates from yesterday and I introduce her to Dave. He then has a bit of an induction into the ways of the house here. Anne brings us both one of her generous Western breakfasts of omelette, sausages, toast, fresh fruit smoothies, and tea. As Anne leaves, Billy comes in and checks for geckos, followed by… uh-oh… the blind cat. Anne leaves us to it and within seconds of her departure, the blind cat does another wee!!! NOOOOOO!!! It sprayed the door: it looked more territorial than the previous time where it just looked lost and frightened. We can’t help but laugh and I get rid of the cats. We have the rest of our breakfast and get ready for the day. Dave pays Anne and goes off to the gym.

I shower and pack my bag, getting to the bus station in Karapitiya for 11.30am, where I meet Dave. Philippa and Rachel are running behind with our plans to go to the beach so they text us asking that we go ahead without them. We catch a couple of buses and by the time we reach Unawatuna it is raining lightly. We are going to a different part of the beach today, farther down the strip. By the time we reach it, the clouds have disappeared. We take two sunbeds, order a couple of drinks, and enjoy the sun. Philippa and Rachel find us about 40 minutes later and take two adjacent sunbeds.

Whilst Dave relaxes, three of us go swimming, the water being much calmer on this side. We wonder if it’s because of the rocks in the distance; perhaps they have some effect on how it hits the shore in different parts. As I am swimming out towards Rachel and Philippa, what do I see? A turtle swims underneath me! I can make out its patterned shell but sadly it swims off and we’ve lost it. We enjoy the water and get out to have some more time in the sun. I read more of Notwithstanding, which has been funny in most chapters, though the current chapter is a bit difficult to get enthused about. Dave goes snorkelling and tells us he has followed a turtle for a while. Perhaps the very one I saw earlier. He goes back into the water and the three of us relax until…

Drip… drip… drip-drip-drip… some clouds have formed but it doesn’t seem bad enough for rain. Give it a minute and sure enough, I’m wrong. The rain gets heavier and heavier, the sky darker and darker. Tourists hurriedly pack up their belongings and run for shelter. Dave seems to have packed as many bricks in his bag as possible haha, but I grab the lot and the three of us run in and find a table. As the weather gets wilder and the waves taller, we worry about Dave. We try and find him but soon enough we see he’s on his way. We order some lunch and drink, which sadly isn’t all that great. The company however is wonderful. The rain only grows stronger as the afternoon goes on. Philippa has a Monopoly card game so we play that for a while and before we know it, it’s getting dark. I had better get back.

We pay the bill, pack up, and make our way to the main road. On the way, the girls notice a jeweller that they have been meaning to find as they made an order but the shop never seems to be open when they come by. They don’t have enough money to make the payment here and now, but the shop owner has their jewellery ready. He gives it to them and tells us that his friend will drive us in his tuktuk to Galle for free so that they can use an ATM. Much better than riding the bus! We squash in, in the darkness, Philippa on Rachel and Dave’s laps, and arrive in Galle. The driver receives the money to return to the jeweller and we are dropped off at the bus station. With Dave and Philippa heading to Colombo tomorrow to watch the cricket, and my planning to pack all day (so unlikely that I will make it to the beach to see Rachel) I guess this is the time for goodbyes. Some goodbye hugs later and I leave them to catch the bus to Karapitiya.

The bus seems to take forever and by the time I get back to Karapitiya, I am greeted by torrential rain. The street lights are out and I don’t have my torch. My flimsy umbrella barely protects me but it’s the best I have. I put it up but realise I need to get back quickly. With only the make-do lighting in the roadside houses and the hospital, I run my usual ten minute walk home, bag over my shoulder and umbrella waving in the wind. I must have looked like a complete lunatic. I make it back soaked through, let Anne know I have returned, and dry off in the apartment. Dinner, a Skype call, and a little packing follow before…… Zzz…

Day 58: 21/09/12

Three.

Today is my last day on ward 01 and my last day as an elective student. The time has passed so quickly and although this is quadrouple the amount of time Peninsula students spend in a department (in a restricted time period), it still feels just as short. I make my final walk to the hospital and enter ward 01.

We attend a brief ward round and as it is Rachel’s last day in paeds also, we take a few pictures. She is going to obstetrics next week, Dave finishes on Tuesday and will travel, leaving Philippa as the only elective student on paediatrics. After some picture taking, the doctor that knows my name summons a class for another session on the assessment and initial management of the acutely unwell child.

“We had better test you!” he says to me. I am called up to do the first case. I stand behind a table in front of Dave, Philippa, Rachel and a group of local students (with a few young patients looking on round the corner). On the table, there is an infant manikin lying on a sheet. Behind me is a board to consider my thoughts before the child’s arrival to the ED, and to my left there is an emergency trolley full of equipment, however I must instruct my “nurses” (two local medical students) which equipment I want for this child specifically. I feel a tad nervous but am ready to get going. He tells me the child is called Tom and we are in London (Phew! No tropical diseases then?). He is six months old and his mother is worried as he has been short of breath for two days. I instruct the students about which equipment I will want and I write up a differential diagnosis list, the lead diagnosis being bronchiolitis. I start my ABCDE exam and there is so much information to consider its difficult to keep track. I give him oxygen and nebulised bronchodilators, and reassess. It turns out the case is bronchiolitis after all and Tom’s alright now, hooray!

Dave is called up afterwards. His patient (Stephen) has suffered vomiting and diarrhoea. He writes up a differential and gets going with the assessment and initial management. It was much more difficult than mine but Dave seemed quite cool and collected. Afterwards he told me how stressful the situation feels but it didn’t show. The consultant tells us we did well and then teaches us for a bit before agreeing to sign my elective host form. I take some more pictures and say a few goodbyes before making one final walk along the corridor, out of ward 01 and out of Karapitiya Teaching Hospital.

The four of us decide to grab lunch and eat it at the girl’s accommodation in the Faculty. We watch some TV before heading to Unawatuna. The sky is blue and we enjoy the sun for a few hours. We go for a swim in the sea which is wonderful. As the sun starts to fall we move over to a table and have a drink and a chat. In the distance we spot something which puts us in fits of laughter. I suppose you kind of had to be there, but there is a European looking man taking pictures of a woman that he must know. She is in a bikini and is making the most obviously set-up, ridiculous poses you could possibly see, and the man is snapping away as if they are live on some fashion shoot. She lays back on the shore and pulls some crazy pose, clearly forgetting the strength of the waves and receives a pelt from one which makes the whole situation funnier. Then she stands up and seems to be trying to run in slow motion!! He chases after her and she waves her hair around and keeps pulling all these weird poses. I guess they take their holiday snaps seriously.

The girls invite us to dinner at their house which sounds wonderful. Dave doesn’t have a place to sleep tonight so the girls suggest that he uses Ethan and Sam’s old rooms. We catch two tuktuks to Food City in Karapitiya, buy some things for dinner, and head to the apartment. We shower off the sand and grit, and the dinner is being prepared. I feel a tad guilty that I don’t have anything to do as everyone is so organised and has done most of it already. I’m not sure stirring is a very significant contribution but it’s all I can find. We serve up our rice, beef and vegetables, and watch some TV. We enjoy a cup of tea and a chat, and it is realised that the rooms offered to Dave are locked and they don’t have a key. I give Anne a ring and she doesn’t have a spare room but as I have a spare bed, she is happy for him to stay there.

Just after 11pm we catch a tuktuk the short distance to Anne’s Maisonette (because the area is poorly lit and apparently a tad unsafe so late). I grab some bedding for Dave and I have a quick tidy up as I got changed for the beach in such a hurry today that the room is a bit of a tip. We chat for a while but eventually our busy day gets the better of us both, and we fall fast asleep.

Day 57: 20/09/12

Four.

There are very few students on the ward as they are in clinic today. I find Dave in the classroom eating his breakfast. We chat for a while and then go to the ward to see what’s going on. We meet Rachel who is also waiting for things to get going. Then an old lady walks over to us smiling with a little toddler in her arms. This little girl is the abuse case (there are two on the ward currently) that I mentioned a while ago. The one where the mother has psychiatric issues and made claims about being pregnant and her mother (who is this very lady) attacking her with a bat. These accusations have been deemed as false and with the father on the ward too, it all seems like a happy family. The little girl has become fond of Rachel who often carries her to give her tired mother a break (whom the ward staff suspect has a very low IQ rather than mental health problems). The little girl reaches out for her and Rachel scoops her up. Then the little girl reaches out for me and I carry her for a while before giving her back to her grandmother as a round assembles.

We join the ward round and see many patients in quick succession. Mycoplasma pneumonia, meningitis (the patient was not isolated), thalassaemia, post-streptococcal glomerulonephritis, Dengue fever, and lymphoma are among the cases seen today. The consultant (who is head of the department) starts asking me questions about the final patient who is suffering from an uncommon type of Shigella bacteria, commonly referred to as bacillary dysentry (as it derives from the specific species’ name). He asks me how we treat it in the UK but as it is so unusual I must admit I am uncertain. I tell him what I think and luckily he is quite pleased (I looked up the answer when I got home, so for any medics wondering – it’s 1. Oral rehydration; 2. Paracetamol for fever [& lower febrile convulsion rate]; 3. Antibiotics – ceftriaxone preferred or other 3rd gen cephalosporin [Cochrane review]; 4. Is notifiable disease; NB anti-motility agents are contra-indicated).

Afterwards we examine a couple of patients and Dave goes to the trauma centre as he doesn’t want to go to the class. Rachel and I sit in the class and chat while we wait for the consultant to arrive. One hour later, it seems as though we are not having a class but the students here are so obedient they dare not move. We are somewhat immune from the consultant’s often fearsome teaching style so we stand up and go to leave. The students are shocked that we dare leave but I guess that’s a cultural difference really. When a consultant doesn’t turn up to a CPC mini-lecture at home, we are quick to abandon ship. I go to the Faculty and donate my lab coat before going to Food City. I get some food for the weekend and pick up a gift for Anne. I consider chocolate but as I don’t have a fridge and would need to borrow theirs, it would be a bit of a spoiler. There is a nice biscuit set (kindly labelled ‘Gift’ in the name) so I decide to get that.

I spend the afternoon in the apartment, trapped inside by the raging storm outside. At one point I notice Anne’s partly blind and deaf cat is sat outside my apartment curled up in a ball trying to avoid the worst of the rain. Despite the… ahem… “incident” before… I can’t let him sit out there. I open my door and go to scoop him up but he meows and runs away from me and down the stairs. He seems to prefer the torrential rain to me. Cheeky sod.

Day 56: 19/09/12

Five.

The heat beats me down as I make my way into the hospital through a side gate, up a set of stairs and along the corridor to ward 01. I join a group with the doctor that knows my name. Nothing seems to be happening so I take the opportunity to try and find one of the sisters. I brought a few medical things with me to Sri Lanka – sterile gloves, non-latex gloves, plasters, vitamins and a few other things – and I’d like to donate them to the paediatric ward. I meet a nurse and try to tell her what I want to do but the nurses don’t speak any English and no amount of signing is going to help. I will have to find someone to translate later on.

The doctor that knows my name enters the nurses bay and greets me. I ask him if he will sign my elective host form this week, to which he says he will. Then he says I should come and see a jaundiced neonate with him. I follow him and a group assembles along the corridor around a couple clutching a young baby in their arms who is visibly yellow. The doctor asks us to consider what we would like to ask in the history, what we would look for on examination, and what investigations we would like to do. We ask some questions and it’s a very useful talk, though no opportunity to do the examination myself.

Afterwards, the advanced paediatric life support session from the other day seems to have resumed. He calls up a couple of students and they go through their ABCs with assessing acutely ill children, this time the cases focusing on severe vomiting and diarrhoea. The doctor then invites me to have a go, as I am in the higher year group of the elective students here. Not today, but it would be tomorrow or perhaps Friday. I feel a bit nervous but I say yes, I think it would be a good experience, although their style is slightly different to ours.

The class is relatively short and we hear that there is going to be a practical session at 2pm at the Faculty about neonatal resuscitation. That sounds great; I’ve never been taught anything about neonatal resuscitation besides paediatric basic life support. I am scheduled to be with the neonatologists for six weeks in a few months time so this would be a great head start. I employ the help of a local student and give one of the nurses a John Lewis bag full of equipment. I get my form stamped by the Faculty, go home for lunch and then join Philippa and Rachel where we eventually find the correct place. We take our seats and a young woman introduces the session and shows us the equipment. Sadly, it gets worse minute by minute. The main problem is that she goes from speaking poor English, to a mix of English and Sinhala, to Sinhala only. Luckily, the consultant joins before long and she delivers the session in good, clear English. As there were so many students and such little time, only a minority got to practice the resuscitation but I made some good notes and now I know what to expect in a few months time.

Day 55: 18/09/12

Six.

Sleep was easier and yesterday’s nose has finally turned its tap off. I still feel full of a headcold but I think it’s getting better from here. Shower, breakfast, ward 01. I join the round with Dave, Philippa and Rachel. It passes bay to bay but is so fast and with so many students we can barely understand what is happening.

Once it finishes we decide to examine a young girl in the high dependency unit. She is about six, wide awake, wears a Pokémon stick-on tattoo on her right arm and giggles constantly. I listen in and can hear a systolic murmur loudest in the mitral area. It is difficult to tell whether it is throughout all of systole or just specific parts because she is tachycardic, and as children’s hearts beat faster than adult’s when they’re healthy, this makes the job really tough. She is due to have an ECHO. The chart indicates she is febrile so we wonder about rheumatic fever.

Dave has only been on paediatrics for the past six weeks whilst the three of us have all spent time on the general medicine ward, so he is keen to see it. We take him along and I wave at Eva who is still here after all this time. There are two new German students, along with the two Australian boys. I speak with the senior registrar and ask about any interesting cardiovascular patients we could examine. Although the staff and I didn’t exactly chat those weeks ago, we are both pleased to see each other. I am directed to bed 25. Dave speaks Sinhala and gains consent for me. The patient is an elderly man with a displaced apex beat, quiet diastolic murmur, bilateral crepitations and peripheral pitting oedema. His pulse is regular and I find nothing else to note. Dave examines him and we compare our findings. I think he’s in heart failure and I think it’s because of mitral valve disease. Then we go and examine a patient with hepatomegaly among other signs of chronic liver disease. Dave wants to see more patients but I don’t, so I head back to ward 01 whilst he continues making the most of his half-morning on general medicine. Then we have a class and I head back to the apartment.

The Internet seems to get slower by the minute, which with little else to do besides watch the rain fall, is making the time drag a bit. I hope I will be able to check-in online on Sunday night for Monday’s flight. I am looking forward to my fish and chips welcome home.

Day 54: 17/09/12

Seven.

After a difficult night’s sleep, I shower and eat breakfast. I enter ward 01 with a blue drawstring bag containing my Oxford Handbook, stethoscope, and my host report forms which need to be completed by one of my supervisors. Normally this is done by the head of the department but in honesty, he hasn’t seen me that often. I don’t think he even knows my name. I am hoping that the consultant that says my name will sign it. He certainly knows me and involves me and has seen me demonstrating medical skills like when he asked me to interpret that difficult chest X-Ray.

I deposit my bag in the classroom and join the ward round. There are double the normal of local students in this group, probably because another consultant’s session has not started. From this distance I can’t hear a thing. Philippa tells me they are talking about a child that was bitten by a snake. I will have to see the child another time. The round ends fairly quickly and I am told that there is a teaching session of some sort happening around the corner.

Philippa, Rachel, Dave and I go round the corner with the other local students and join a teaching session lead by the doctor that knows my name (though evidently I don’t know his). There is a table in the middle of this space in the corridor and a trolley lined with medically labelled jam jars and some medical equipment such as an oxygen mask and blood pressure cuff. There is an infant sized resuscitation on the table and one at a time, a selection of local students are called forward. This teaching session is about assessing the seriously ill child, which is excellent since it’s one of my learning objectives. He runs us through scenarios with different age groups all suffering breathlessness. He makes the situation seem fast paced and encourages them to devise working diagnoses and formulate plans to deal with the immediate emergencies and dangers. I was really hoping for a go myself but I think this class was partly an assessment for the locals. I don’t have the forms to hand and when the class is over, the consultant scoots off very quickly and with a kind of determination that tells me he is late for something. I will have to ask him to sign my forms another day.

I talk with one of the local students for a while. I don’t want to examine anyone today; I am all sniffly and am coughing and spluttering so I’d rather just hold off. These kids are already ill, they don’t need my cold as well! There is no class today so I leave the ward and return to the apartment.

Anne is looking into my transport to the airport and hopefully I should be able to hire a driver for a cheaper price than first expected. We both cannot believe how quickly the time has passed. Two months! Just like that! She says they will miss me and I will miss them certainly.

Day 53: 16/09/12

Eight.

Having had a throat infection for a couple of days, I wake to find my throat to feel better but to be accompanied by coryzal sniffling, running, sneezing and coughing. Of all the places to get a cold, I get one in Sri Lanka! The sky is blue, I shower and eat my breakfast. Then there comes a quick bit of rain but it passes in an instant. I think I will go to Unawatuna again and make the most of the sunny weather. I reach for my blue bag. Towel, sunglasses, suncream, a new book (Notwithstanding by Louis de Bernières) and money. Off I go!

Now, I would just like to take the opportunity to talk about something. I have mentioned before how some of the locals think it’s okay to exploit foreigners and that their behaviour and actions are actually pretty racist. Whilst many locals are friendly and curious, and simply want to learn more about you, many are just blatantly rude and insulting to foreigners. I often have people staring at me as I walk around Karapitiya but I can kind of understand. This isn’t a place for tourists, so it is unusual for them to see this white guy wandering around, though at heart, I really wish they wouldn’t stare like they do. The thing I really hate however, is what happened to me at the bus stop. I go and stand at the bus shelter where there are several other men sitting and standing. They are clearly a bunch of mates and one of them calls over two of their friends and uses his head to point to me. These guys come over and talk in Sinhala, clearly about me and are all laughing. But why? I am dressed just as they are; in shorts and a printed t-shirt. My bag is just like theirs. I am swearing flip-flops like they are. The only difference is my skin and nationality, that’s all there is. I haven’t said or done anything. I’m not a new tourist; I’ve been here for seven weeks, I know this area pretty well and have caught these buses loads of times. I don’t hold the confused or worried look of a tourist in an unknown place. So why are they laughing? Because why not? Why not laugh at the foreigner, who comes here to catch the bus like he’s one of the locals? Do they honestly think I don’t know they are laughing at me? I might not speak Sinhala but llaughing whilst pointing and looking at me certainly mean the same thing here as they do back home. These situations have happened time and time again, and to many other elective students that I have spoken to. Some of the locals are just plain rude and unwelcoming. There are many who are kind and cheerful but these rude people let them down. I am quite surprised by their behaviour since up until recently, Sri Lanka was a place for tourists to avoid. With the LTTE defeat, Sri Lanka is finally a tourist destination and with the money people are bringing with them, you would think they would want to keep it that way. If any Sri Lankans are reading this then I hope you consider this if ever you have or you notice a local laughing at a foreigner. It may well be the last visit they ever make, and like I am, they may tell other potential travellers. This obviously shouldn’t be generalised but I mean it as more of an opportunity for me to moan as well as to warn any locals reading this that if they want our custom, they’d better be nice.

I catch the bus to Galle and as I enter the bus station it starts raining heavily. The way the rain slices diagonally I can see the wind is taking the rain towards Unawatuna. I can only see dark cloud to come with the wind direction so I decide to wait until it gets a bit lighter. Sadly, this takes quite a while. 40 minutes later I get on a second bus and am dropped off at Unawatuna. I snake through the beach access road and get on the fairly empty beach. It is overcast with different shades of grey as I sit at a table. I order some drink and food, and start reading my book. It is quite funny and has me laughing out loud at times. There is no sign of any other elective students. After a couple of hours the weather hasn’t changed at all so I decide to call it a day. I pay my bill and head back to Matara Road to catch the bus to Galle. On my way I buy a couple of souvenirs for people at home and then catch two buses back to Karapitiya, and walk to my apartment.

A shave, shower and cup of tea later and I feel quite content. I have a Skype call home with my dodgy Internet speed and am currently waiting for my dinner.

Here we go. My last week in Karapitiya…

Day 52: 15/09/12

Nine.

Shower, breakfast. The sky is blue and the weather especially hot. This calls for another day at Unawatuna. I hope to see Sebastian again before he flies home. My local phone has stopped working so I can’t message him. The buses here are reliably frequent, reliably cheap, and reliably hot, uncomfortable and crowded. Two buses later and I walk along the beach but cannot find anyone I know. I set up camp at The Yellow end of the beach which is where we usually go. I order a drink, lay down on a sunbed and the clouds form… rain. Great…

Everyone around hastily grabs their belongings and rushes under the shelter of The Yellow’s little restaurant-bar area as the rain hammers down, stronger and fiercer by the minute. I manage to grab the remaining table but there are a few others hoping to hide in here too. A French couple join me and tell me they are on their honeymoon. They only arrived two days ago and we talk about their travel plans. The rain subsides after a while and we wait for the sun to dry the sunbeds.

“Michael!” a voice calls.

To my left is Philippa and Rachel who have just arrived having spent the night in Hikkaduwa with Sam and Ethan, which is about an hour north of Galle. They tell me they are going to grab some sunbeds further up at Taratuga after a quick shower and I say I will join them at the sunbeds soon. Just as they are about to leave, one of the local hassler-sellers comes along carrying a boa snake round his neck with a little monkey walking by him with a string leash. They charge for you to pet them or take photos and sadly Rachel didn’t do a good job of hiding her interest in the monkey. The man strolls over and lets go of the monkey’s leash. The monkey then jumped on Rachel and climbed up her. She screamed and the monkey started pulling her hair before springing from her and onto Philippa doing the same. I must admit, from the safety of my seat inside The Yellow, it was pretty funny to watch, but if I was them I’m sure I would have hated it. The guy moved further down the beach, and Philippa and Rachel leave as well.

I read some more of Mockingjay and as the sky clears and everyone is going back to their sunbeds, I get a sunbed next to Philippa and Rachel at Taratuga. We laze in the sun for a while and get a drink each. The monkey/snake guy comes back to see us later but is sure to keep the monkey by him. Philippa and I ignore him really in the hope that he will go away, but Rachel chats to him. Upon learning that he is carrying a bag that contains a cobra, that’s enough really, she doesn’t want to know anymore and I certainly want him to go away. He goes off and leaves us in peace.

We enjoy the Sri Lankan sun and even get a glimpse of a turtle swimming along the shore right in front of us. Dave and Jared appear along with a house officer from the paediatric ward, who tell us they were further down the beach but sadly we didn’t see each other. They head back to Galle Fort and I go along the beach but cannot find Sebastian. I might return tomorrow if the weather is good, otherwise I will have to send a goodbye on Facebook, which isn’t really the same. The three of us catch a tuktuk back to Karapitiya for 350 rupees and I walk back to the apartment. As I wait for dinner, at last I finish Mockingjay and in doing so conclude the trilogy. These books come so highly recommended from me. Honestly, read it! I was talking to Philippa about them on the beach as she had only heard the violent bits in the first book, but didn’t know there is a love story, political struggle and all sorts of complicated friendships and relationships. As the end was drawing closer, I became frightened as to what it was going to be. Obviously, I won’t spoil it, but what I thought was going to happen didn’t happen (thank goodness, I didn’t want it to!). The ending was perfect, I can’t wait to see the next couple of films!

Day 51: 14/09/12

Ten.

It is just Dave and I along with the other local students this morning. Hearing a rustle in the bin last night I worried about monkeys, though it just turned out to be a gecko, though I have gotten little sleep. I feel drained as we begin the ward round with the doctor from yesterday who speaks very quietly. We march around barely paying attention. My tiredness is not helped by the especially strong sun, its temperature reaching 30 degrees Celsius as I left the apartment this morning at 08:20. We follow the white coats like sheep and join a second round after with fewer students. On its end, we try and show a bit more enthusiasm. I listen to a baby with pulmonary hypertension but cannot hear a murmur. We also listen to a boy’s chest – the one that was crying yesterday. He was embarrassed, hiding his face in his pillow, but he clearly liked the attention, giggling now and then.

The class is lead by a female consultant and being a tad late we got seats at the back, which sadly means that we can barely hear what’s going on. Dave seems tired too, closing his eyes now and then. I am struggling to stay awake but I manage to look alert even if I cannot find the energy to fully involve myself in the presentation. Afterwards, Dave asks if I would like to go to Unawatuna today, and I say I will see him there this afternoon. I go to Food City as I forgot a few things from the other day. The female consultant spots me and comes to say hello. I feel relieved to have been seen by the fruit and vegetables instead of the biscuit aisle. I head home, change and catch two slow buses to Unawatuna.

I go to The Yellow, order a Lion ginger beer (far better than any I have tasted in the UK), which permits me to use one of their sunbeds (and it only costs me 60p!). On with the sun cream, I receive my ginger beer and I open up Mockingjay, now approaching its big finale. This beach is really beautiful. Crystal clear water, golden sand. The only downside really are the hasslers trying to sell this and that but they go away with a quick, “No,” or two.

After about an hour I see a familiar face approaching. It is not Dave, but Sebastian! I haven’t seen him in weeks. We started on the same week in July and it’s great to see him again. His girlfriend has gone back to Germany and has started work in a new school. He has been travelling and has finally finished his time on general medicine, due to go home after the weekend. Then he tells me that he owes me a drink, which I totally forgot about. I bought him a beer a few weeks ago when he was short on small notes, and so he buys me another ginger beer and says he will cover my first since together they equal the price of one beer. Fantastic!

We relax in the sun for an hour or two. There is no sign of Dave. I wonder if he is further down the beach and simply couldn’t find us, or perhaps his sleepiness got the better of him. Either way, the sun is starting to fall and I should go back before it gets too dark. As I am about to leave, James and Jordan arrive (the two guys from Melbourne). They say they will be spending their weekend at Unawatuna, so I intend on coming back too so that I can see Sebastian again before he leaves. I pack up my things and catch two very crowded buses home.

A cold shower and a cup of tea later and I feel rejuvenated. The Internet has become very slow again. Please, give me a weekend of sun.

Day 50: 13/09/12

I don’t welcome the scorching sun on the way to the hospital in the morning. It is punishing alongside an uphill post-breakfast walk and the high humidity to contend with. It is just Rachel and Philipa so far. We join the ward round lead by the Head of Department. We take note of some interesting cases to return to and once the round ends we go and see them.

Firstly, we visit two young boys with respiratory problems in the bay on the far end of the ward. They are both a similar age, about four. The first has very quiet breath sounds though no signs of respiratory distress. There is little else to hear. The second boy has some widespread wheeze but again, not a lot to hear. We continue around and enter the neonatal area. Tiny babies are lined up along the wall either in tiny cots or incubator-like shelters. Philippa knows the baby’s conditions well as she learned about them yesterday whilst I had a rest day. She takes me to the baby to our left. There is a scar on the left side of his forehead where he has had a burr-hole procedure. His CT scan shows a large, dark lesion in the left side of his frontal lobe which is quite tall and wide. The students tell me they wonder about a haematoma, but I thought that that would have shown up as being bright white? We look at all the old CTs and they are all dark, so I am unsure what the diagnosis is eactly. It seems the diagnostics are still ongoing for this baby.

Next, I see a neonate with scalded skin syndrome, caused by a specific type of bacteria. His face and arms have healed well and look crusty, kind of impetigo-like. However previously his face and arms appeared as though he had been burned by something, which is typical of this condition. He is recovering well with antibiotics. Another baby has very, very wrinkly skin and I am told that she is very malnourished and they suspect a malabsorptive problem. Finally, I see a baby in an isolation container with signs warning about infection control (the first bit of infection control I have seen so far!). I am told that this young baby has suffered from seizures but also has an infection. His mother is still an inpatient on a different ward one month after the birth though I do not know further details surrounding that.

The three of us move to a different bay. We look for some cases to see. We intend to approach one boy and his mother but he seems upset about something (not us) and so we decide it’s a bad idea to examine him. Instead there is a younger child of about two years in the adjacent bed being examined by one of the students. We are told that we should do a respiratory examination. The three of us take turns listening to his chest whilst others distract and occupy him as he tries to wriggle away. When I listen I initially hear an expiratory, musical wheeze, but there an additional noise. It is sort of squeaky but not quite so high pitched and is contained to his left side. We consider whether it might be a pleural rub and what the problems could be. Finally, in another bay, I examine a tiny baby with an oddly shaped head. She has brain atrophy secondary to malnourishment (I didn’t know such a thing could happen) though she also has some dysmorphic features. Her eyes are close together and her ears low set. She has two palmar creases in each hand and there is nothing else to note. Her anterior fontanelle has not closed and is palpable but the posterior has closed. She has poor head control for her age also. I intend to examine another child in the baby who I hear has a cyanotic heart defect but time is pressing and the lesson is about to begin.

We take our seats in the class. Sadly the only ones were at the back. A doctor I have met only once enters. He is one of the younger consultants though unfortunately speaks just as quietly as the local students. From the student’s presentation, I understand we are talking about a four month old child who suffered a tonic-clonic seizure and was found to have a fever. The class talks about meningitis for a while but when the rain starts to pour outside, it is impossible to hear any more. The class ends soon enough, as does the rain, permitting me to walk home without getting drenched.

I only have six days left to spend in ward 01.

Day 49: 12/09/12

The alarm goes off at 07:15 and with a cloudless blue sky I decide to have the day off as I originally intended. I went to Casualty last night, if only for a bit. I could really do with a day away from that boiling hot ward. After breakfast, there is a sudden, unexpected downpour which grows stronger and stronger over an hour. I read my book as I wait for it to pass and look up the forecast which indicates that I can expect this weather all day.

Before long, the rain ceases but the dark clouds persist for another hour. Lighter grey patches blossom within the enormous dark cloud and just as I think I could see some sun, they shy away and Karapitiya sees another hour of monsoon rain. Such a shame, I really would have loved to go to the beach today. Instead, I watch The Return Of The King, which I haven’t seen in years. I also go on Skype when the Internet allows me to, and consider my plans for the weekend. I have not been on many big trips here. A lot of my original plans were put aside because of what others had told me. I think now, I just want to relax. I don’t want to travel for hours and hours to see some new sights. I would rather just lay on a beach, sip a cold drink and just enjoy it.

I have reached the point where now, I am looking forward to going home. This place is wonderful, don’t get me wrong, but I am now missing my home comforts. Hot showers, thick mattresses, English home cooking. That would do nicely just about now. I am looking forward to moving to Exeter also and settling back into my normal routine.

Lightning flashes and thunder roars. Wednesday ends in apocalyptic fashion.

Day 48: 11/09/12

It is Lisa and Lara’s last day on ward 01 as they are due to start their rotation in surgery from tomorrow. As well as Lisa, Lara and Dave, we are joined by Philippa and Rachel, the two girls from Brighton and Sussex Medical School that lived with Ethan and Sam (before the guys finished their elective and went travelling). We go around with the consultant, two registrars and one house officer, along with about a dozen local students. The Casualty night is tonight so most of the beds are still empty. We think this is why the consultant labours the points he makes as he asks everyone questions, trying to fill the teaching time. In the heat I really wish he would stop.

We see another patient, the one whose mother came to the consultant last week saying that their child had been abducted by her father, and with claims that she is pregnant and has been beaten by her family. The child is there in front of us and the story is ever flipping and changing and I do not fully understand it because it has become so complicated. The consultant asks a group of students to go in the afternoon to interview their neighbour for a collateral history. The two Brighton girls volunteer to accompany them and the ward session ends. We have a teaching session for about an hour in the class room based on an infant who has lost weight and is severely dehydrated. We have heard from the students here that tonight is the Casualty night where they take in new admissions. Dave has been to one before and says that it is really great. Plenty of patients and you go in groups examining child after child, much better than in the day. That sounds good so all of us minus Lisa and Lara intend on going at its start time of 6pm until 10pm.

Philippa, Rachel and , Dave and I pick up some lunch and go to the girl’s accommodation in the University Faculty building. We eat lunch and chat. Dave is going to a local gym and says that he will join their home visit afterwards. I am going to Food City so we agree to meet at 6pm in ward 01 for the Casualty night. I leave them, do my food shop and strong sun pushes me back all the way home.

As the sun starts to fall, I pack my bag, dress in my clinical clothes, and am in ward 01 at 6pm. It is very quiet; nothing is happening. I look around and see no sign of the other elective students. They must be on their way so I take a seat in the class room round the corner and read my Oxford Handbook for a while. I wait a while before going around to check again, only to find the same situation as when I entered. Fifteen minutes pass… thirty, forty-five. Where is everyone? The local students are here but they are only taking histories which I can hardly join in with. They are not doing examinations and the local doctors are doing admin work. There is no sign of the elective students. This is definitely the correct time and place, I am certain, we said it several times.

7pm passes and my patience is wearing thin. I give it a few minutes more, check around the paediatric department and then decide that enough is enough. This is such a waste of my time. I figure the other elective students are probably tired out from their home visit as I think they had to travel up the coast a bit, and perhaps don’t want to come after all. My local phone is not working well so I cannot use it to check for messages. I decide to leave as the ward is just as it was over an hour ago. I am so disappointed. I was expecting a really interesting night. They also said that if we attend Casualty, you have the next day off. I feel so frustrated. Never mind, there is no use in feeling frustrated. I return home, watch a film and head to bed.

Day 47: 10/09/12

The monkeys make a lot of noise in the night but don’t enter. Still, it makes sleep difficult and I struggle to get out of bed once the alarm goes off at 07:15. Shower, breakfast, ward 01, joining Lisa and Lara on a ward round with the head of the department. Most of the beds are empty like last Monday so they must be having a Casualty night soon. David joins after a couple of patients are seen. The round is completed fairly quickly and so the four of us go to ward 36, a second paediatric ward, to see some more patients.

I take my camera and find opportunities to take some photos here and there. One of an old, dusty incubator for newborns. Another of a dirt oxygen tank stored in a back corridor. David examines a young boy who tries to squirm away from him. Dave shows him his stethoscope and tries to make it all seem less frightening. The boy’s mother distracts him with some glittery stickers and Dave is able to examine him. He says there is little to find, which I am pleased about to be honest, as I figure he was one more examination away from getting angry or bursting into tears.

We move to the next bed where there is a young boy, perhaps nine or ten. One of the house officers from ward 01 joins us and tells me that the boy’s main presentation was a fever. I gain consent for the examination and find that he is boiling hot to touch. His heart is racing and is clearly unwell. He still manages a smile here and there however. I listen to his lungs when Lara tries to get my attention. She asks if I would like a picture taken for my elective presentation. The house officer translates and we get consent providing that I am able to hide the boy’s face in the image. I put the settings to automatic and briefly teach Lara how to use my camera. I resume the examination as she takes a few pictures. I thank the child and his mother as we leave the ward, realising the time, the post-round teaching will have started.

Lara opens the door to the teaching room slowly and it is crammed with students in their white coats, and who is leading the class? …. it’s the doctor with grey hair and glasses, the one who asked me to define the word define… he is the worst of them all. We find some spare seats and listen in. He seems to be telling a student off, what a surprise… She didn’t present the case as he likes, and he keeps labouring the point. I read my Oxford Handbook hoping the time will pass quickly. Eventually, the doctor makes for the exit and the students stand as a sign of respect to him. I grab my bag and leave feeling drained.

There is a little rain on the way home but it is actually quite nice. I watch Lord Of The Rings: Fellowship of the Ring which takes up most of the afternoon; I forgot how long these films are. Home is just two weeks away.