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Trying small at JFK

I’ve settled in to life at JFK medical center and Monrovia after a busy first week. The title of this post refers to the Liberian phrase “trying small,” which patients on the ward will often say to indicate they are slowly improving. Things are clearly slowly improving at JFK since the war. I’ll share briefly some of what I’ve learned about the hospital, medical education, and range of pathology in the last week.

The hospital:
JFK opened in 1971 after President Kennedy offered to provide some assistance to the Liberian government. I’ve been told by physicians who worked there in the ’70s that it was the referral center for all of west Africa. Unfortunately, the hospital was looted and partially destroyed during the war. At one point MSF was operating there. It has since been partially renovated and currently has medical, surgical, and pediatric wards, an ER, and a related maternity hospital next door. The medical ward, where I spend most of my time, consists of 10 4-bed rooms and 2 2-person VIP rooms. A central room is the “ICU” for more critical patients.

The people:
There are 4 medical officers (they have finished internship but not residency-there hasn’t been a residency program in Liberia in over 15 years), several senior physicians, 1 intern, and about 15 medical students on the medicine ward. The medical officers take q4 call and the intern is currently taking q2 call (one reason to be thankful for the ACGME rules). I’m the only visiting doctor on medicine; there are several other American physicians currently in other specialties-almost all from Boston, coincidentally.

The medical education system:
There is one medical school in Liberia, and it was not operating during the war. The current system requires 4 years of university, 4 years of medical school (similar to the US, 2 years classroom and 2 years clinical), then 1 year of internship. We have morning report every morning M-F, during which the 4th year students do lectures or oral case presentations. Apparently, a few years ago, the graduating class from the medical school consisted of about 5 students; now there are around 40 in the 3rd year class. Post graduate medical education seems to be the next target for expansion-residency programs in medicine, pediatrics, surgery, and ob/gyn are in the works.

The patients:
The patients on the medical ward are very, very ill. Late presentation to the hospital due to numerous factors (money, distance, weather, use of traditional herbs, low health literacy, family responsibilities, etc) is very common. Some of the more common diseases: HIV, TB, malaria, typhoid, meningitis, soft tissue infections, stroke, heart failure, cirrhosis.

I’ve learned a ton in the last week and a half and will post more about the growth of medical education here and also some tricks I’ve learned from the very creative and brilliant Liberian physicians I’m working with. In the meantime I need to rest up for tomorrow-the 2nd Liberian marathon is being held and I’m running in the 10k race!

20130824-190542.jpg
The back of JFK, on my way to work from the doctors’ dorm. Note the barbed wire

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