Student Reflection by David Rutha

Elective In Toronto (5th April – 14th May 2010)

Elective in the fifth year of medical school is a time which each student looks forward to. We get to be out of school for six weeks in a place of your choice and do what you like in medical practice. A few of the more lucky students get an opportunity to go to North America and Europe free of charge. This year I was among the more lucky students and I went to Toronto with my friend Korir.

Preparation
Korir and I spent some time trying to learn about Toronto. Our best resource turned out to be George and Wycliff who went there last year. About a week to our departure we had a good idea of what to expect in terms of work, accommodation, clothing, food etc.

After four weeks of anesthesia course and a difficult examination on a Wednesday morning, I was taking an afternoon nap when I received a call from Mrs. Mamlin, our coordinator for the elective. She said she had some good and bad news for me. The bad news was that our visas were not ready and the good news was we didn’t have to wait for a month to go for a medical checkup required for us to get our visas.

The coming weekend was inconveniently the long Easter weekend, which meant we couldn’t go for the checkup on Friday and we had to miss our flight on Easter Monday.

The long wait
We spent the next one and half weeks waiting to be issued the visas. The days seemed endlessly long, checking e‐mails almost hourly or waiting for a phone call from the Canadian High Commission. We had Dr. Rachel Spitzer and our coordinator Sarah Mamlin to encourage us and cheer us up. We finally left Nairobi on a Thursday morning aboard a KQ flight.

What was meant to be two hours of waiting before boarding a connection flight from Amsterdam turned out to be 5 days. Billows of smoke from Mt Eyjafjallajokul in Iceland resulted in closure of the greater part of Europe’s airspace. Five days in Schiphol airport had its ups and downs. We made new friends, took a tour of the whole airport, got used to eating cheese and basically sharpened our survival tactics.

By the time left Amsterdam we were really exhausted of sleeping on seats and the only thing I was looking forward to was a bed in Toronto. Dr. Meffe was kind enough to pick us from the airport, took us to Dr. Spitzer who took us to Chestnut residence where we stayed for the rest of our electives.

Toronto
I love Toronto, after all we underwent to get there I must say it was more than worth it. I might not remember everything I did in Toronto but one never forgets the first day. We woke up well rested and after breakfast Aaron Yarmoshuk gave us a tour around the city. The city is beautiful, much larger than Nairobi and getting lost is very easy.

Our first stop was the Obstetrics and Gynecology department offices. We met Dr. Bocking the boss around there, Maria, Mary, Franca, Flora and Hannah who were wonderful. We received our cheques, information package and had banana chocolate cake and coffee.

Aaron Yarmoshuk helped us cash our cheques and we went to the university of Toronto electives office for registration. The next stop was the Mt. Sinai Hospital where we met Jane Gracey. She gave me an elaborate work plan for stay at Mt. Sinai Hospital. We took a break for the rest of the day and started work the next day.

Work
I worked at Mt Sinai for 2 weeks and spent another 2 weeks at Women’s college hospital.

Mt. Sinai Hospital
Despite having a map and having been there the previous day I took a wrong turn while going to work on my first day and got so lost that were it not for the help of a kind lady I think I would still be looking for my way to the hospital.

Mt. Sinai is an exemplary hospital. I had heard and read many good things about it. Jane Gracey had given me a red file which had everything I was needed to do for my stay there. My first day of work was in the Operating room with Dr. Heather Shapiro, Dr. Lisa Allen and Beth, Ali and Lyana. Before every procedure I was introduced to the patient something we don’t do back home. I think the best part of being in the OR was seeing Sydney, the machine. Sydney could turn on lights, change them to green, take pictures, insufflate by responding to a voice command. Back home laparascopic surgery is rare and I had only seen three procedures during my general surgery rotation in 4th year. By the end of the day that number increased to six. Unfortunately I didn’t have another day on the OR because of the limited time I had at Mt. Sinai.

I spent a few days in the Labor and delivery unit. Epidural anaesthesia makes the unit very quiet. I thank Dr. M. Morton, P. Hawrlyshyln and R. Greg for all I learnt from them. Probably by just having their spouses present and a dedicated team of a doctor, resident and a nurse made child birth a less difficult experience for the women.

Clinics were wonderful. One gets the chance to learn a lot in a day because the consultant could attend to 30 or 40 patients with a variety of problems and you get to ask questions. Dr. Farrugia’s clinics are unforgettable foremostly because I was fed very well. I learnt a lot from her and Karen. I learnt to use a feto‐tone to listen to the fetal heart beat which is easier than a fetoscope.

Women’s College Hospital
I spent my last two weeks at Women’s College Hospital. Dr. Janet Bodley kindly prepared my work schedule. I rotated through clinics, labor and delivery and Create fertility center. I had 2 night calls, one with Dr. Akoury and the other Dr. Pittini. Night calls were actually nice. There always was a nice dinner courtesy of the consultants before we got down to more serious work. It always was a fulfilling experience to follow a patient from triage until she delivered. Dr. Akoury taught me to collect cord blood something we don’t do back home.

Clinics never disappointed me. I felt I had mastered how to interpret an obstetric ultrasound by the time I left Dr. Akoury’s clinics. I still have his mini‐lecture notes on twin pregnancy for future reference. I wish I had more than a day at Dr. Blake’s clinic. A day at the fertility center with Dr. Baratz was truly a new experience. IVF, embryo transfer etc were things I had only seen in text books until that moment. At the end of elective I found that clinics were the best places to learn and I hope next year’s students will get that opportunity.

Conferences
The 27th annual research day was simply mind blowing for me. I don’t know whether that is the level of research in all Canadian universities but the quality of research being done at UfT is very impressive. I feel challenged to at least do some research back here at home and also encourage my friends to participate in the same. I congratulate all the people who put in their contribution to make that day successful.

We also did attend the 58th Marlow lecture at Park Hyatt where Prof. Usbee gave a lecture detailing the progress made in the field of Obstetrics and Gynecology for the past 50 yrs. Apart from Prof. Usbee I also got to shake hands with Prof. Bob Casper who told us he has invented some very peculiar goggles which help you not to sleep during night calls.

Free time
On the first Friday of our stay, Dr. Spitzer and Mark her husband invited us for a Jewish supper. Neither Korir nor I had been to one before and we enjoyed it. Delicious food was in plenty and we ate to our fill. Mark led the prayers in Hebrew if I’m not mistaken.

Dr. Spitzer, her husband Mark and their son Seth took us to Niagara Falls on our last weekend. I confirm that the falls are as beautiful as they are said to be.

Dr. Martoglio took us cycling on a Sunday morning to the peninsula on Lake Ontario. Cycling in Toronto is very enjoyable because there are cycling paths and one doesn’t have to hustle for space with motorists.

Lesley Hawkins, UofT student, took us for our first 3D movie. Heather Millar, who visited Kenya earlier in the year and learnt Kenyans love meat, took us to a Korean restaurant where one eats as much meat as one can accommodate which made Korir and I feel very much at home.

We liked to walk around the city in the evenings to relax after a day’s work. With the sun setting at 9PM we had enough time for site seeing. My favorites were Chinatown, the subway, Bloor St. west, and Dundas Square where we could get some entertainment. Other places we visited included the Toronto Islands, art gallery and the bottom of the CN towers.

We met enough Kenyans living in Ontario. We went to Waterloo and Scaborough and met a few Kenyan families. It was nice to have some Kenyan food and talk about our home country.

Summary
All in all I had a great experience which cannot be adequately covered by this few pages of my reflection. Now I’m back home in Kenya, working hard and already trying in my own small way to bring the Toronto experience to my brothers and sisters by introducing myself, seeking consent and explaining every step of an examination/procedure to them and I’m loving it.

Appreciation
All the people who made this elective experience an unforgettable one are many and I can name only a few. First I thank to God for everything. Secondly Mrs. S.E. Mamlin for all her persevering efforts in ensuring we finally got to Toronto amidst all the problems we encountered. My appreciation also goes to Dr. Rachel Spitzer for taking care of us in Toronto. The university of Toronto for the accommodation and funds for the elective, Dr. Allan Bocking, the Head of Obstetrics and Gynecology Department at the University of Toronto, Ms. Jane Gracey and Dr. Janet Bodley who planned my daily activities at the two hospitals. Dr. Michelle Farrugia, Dr. Hani Akoury, Dr. Jennifer Blake, Dr. R. Pittini and Dr. Ari Baratz, Dr. Heather Shappiro, Dr. Martoglio, D.r Ryan Greg, Dr. M. Morton for all they taught me. I would also like to thank Dr. Filomena Meffe, Aaron Yarmoshuk, Maria Wowk, Franca Conciatore, Lesley Hawkins, Heather Millar, Alice Han and all the wonderful Kenyans in Toronto who made my visit a memorable one.