Student Reflection by Methuselah Tirop Korir

Elective Placement – University Of Toronto April/May 2010

Methuselah Tirop Korir and David Kigundu Rutha at the OB/GYN Department, University of Toronto

Methuselah Tirop Korir and David Kigundu Rutha at the OB/GYN Department, University of Toronto.

Preparation
The Medical Electives program of Moi University is a 6 week program during which students go to a health institution of their choice and choose an area of interest. This is done in the 5th year of study of the M.B.Ch.B. program.

The overall aim of medical electives at Moi University School of Medicine is to provide students with opportunities to acquire knowledge, skills and experience in areas of their interest which will be useful in their career. In January, we balloted for the various centers available in North America. I chose the University of Toronto. We were the third group of students to do our electives in Toronto. We knew very little about university of Toronto, but over the three months we were preparing, we got very detailed information from Wycliffe and George who had done their electives there the previous year. We also managed to meet U of T Visiting student Heather miller who was patiently willing to answer any question we had. We constantly communicated with Dr. Rachel Spitzer via e-mail; she was really concerned about our travel arrangements at all the stages especially in the later stages when things got a bit complicated.

Our biggest challenge was getting the visas, our visa application was delayed for more than a week because of new requirements which we were not aware of. We had to undergo a medical examination before the visas were processed.

Travel and Accommodation
It was very exciting traveling by plane as it was the first time for me. We left on 13th April from Nairobi at 8:30AM and arrived in Amsterdam at 5.00PM. We were excited that we were now going to take the final part of the journey to Toronto. Few minutes before we boarded the plane to Toronto. We were informed that the airport had been closed down due to ash from Icelandic volcano. We had to spend 5 grueling days at the airport. Fortunately on 20th April the airport was opened and we left that evening for Toronto. On landing at the Pearson Airport, and after clearing with the customs, we collected our bags and proceeded to the waiting bay where Dr. Filomena Meffe was waiting to receive us. As we got out of the Airport, the reality of cold weather hit. It was extremely cold for us. Filomena took us to Dr. Rachel Spitzers house. We were taken to 89-Chestnut residence on chestnut Street where we checked into room 516, which would be our residence for the elective period. Our room -516- was superb, had ample reading space, neat lavatory facilities and a breathtaking view of the city. A telephone and modem for internet connectivity were also available. The hotel was at about 10-minutes walking distance from the Hospitals of placement – St. Michaels, Mt. Sinai and Women’s College Hospitals. Generally accommodation was very nice. We had two meals per day -breakfast and dinner- at the residence, which were of amazingly diverse variety. At first I thought Canadians eat a lot of leaves(salad). I tasted most of the food for the first time and I really liked it though I never got used to some.

Clinical Rotation – St. Michael’s Hospital (SMH)
I started my clinical rotations at SMH where I spend the first 2 weeks from 21st April to 1st of May 2010. On the first day I was picked very early in the morning from my residence by very friendly UofT students Christe and Julie Registration and orientation went on smoothly with assistance of Sonya Surbek (Education coordinator, Med. Educ., FitzGerald Academy). I shadowed Dr. Adelmo Martoglio most of the time. He was very nice to me and we became great friends. Occasionally, I worked with other Doctors such as Dr. Howard Berger, Dr. Freire- Lizama, and Dr. Andrea Lousman among others. The resident doctors, Nursing and support staff were also very handy in facilitating my learning at SMH. The areas I rotated in included:

  • Labour and Delivery floor
  • Prenatal clinic
  • Women’s Health Care Center–Colposcopy clinic

In the prenatal clinics, I learned how to use the tocodynamometer and interpretation of various tests for fetal well being especially genetic screening. This was quite an exciting experience for me. In the colposcopy clinic, I participated for the first time in colposcopy, LEEP and ECC. I was given the chance to do speculum exam, apply vinegar and TCA, collect pap smears, and vaginal swabs. The experience was just amazing.

I attended several teaching rounds, which I found very enriching and educative. On the overall, SMH was great learning opportunity. The relationship of the health care team to the patients, their relatives and to one another was very warm, cordial and impressively professional. I occasionally felt bad when some patients didn’t like the presence of a student when a procedure was being done to her and had to wait outside.

Clinical Rotation – Mt. Sinai Hospital (MSH)
The last 2-weeks of the electives, I rotated in MSH from 3rd to 14th of May 2010. Orientation to relevant units for my rotation; training in use of power-chart and OBTV and registration to get MSH identity cards, were done in the first two days with the assistance from the very organized Jane Gracey. My supervisor was Dr. Elyse Levinsky. Other Doctors I had the privilege of working with included: Dr. Allen, Dr. Drutz, Dr. Spitzer, Dr. Maxwell and Dr. Farrugia. The team of resident doctors, nursing and auxillary staff at MSH also enriched my overall learning experience at the hospital. Activities of interest were in:

  • Labour and Delivery
  • Prenatal and Postnatal clinic
  • Operating Room
  • Seminars and Grand rounds

Labour floor, prenatal clinics and operating room On the labour floor, many aspects of labour management were at first intriguing for instance: Use of OBTV and Powerchart computer programmes in managing patients data; continous electronic monitoring of fetal heart rate and uterine contractions with in-built alarm systems in case of deviations in normal parameters; routine use of epidural and Patient Controlled Analgesia; External Cephalic Version and amniocentesis under ultrasound guidance; for every delivery, the resident and attending Doctors were always present. I was surprised too that the husband/partner always accompanied the woman throughout the process of labor and delivery. I was given the opportunity to participate in many deliveries, repair of episiotomies, ceserian sections, triaging of patients among other learning activities. The 24-hour calls provided a great chance to master various skills on the labor floor. I however witnessed for the first time a laparoscopic hysterectomy and the use of “Sidney” computer programme to control insufflation, white balance, etc during laparoscopic operations.

Research Meetings
We had the privilege of attending three research meetings related to OBGYN which proved very informative. These were:

  1. The 9th annual neonatal and maternal fetal medicine research day.
    It was held on April 27th, 2010 at JJR McLeod Auditorium, Medical sciences building, 1 Kings College circle university of Toronto. It was an educational session focusing on advances in research in Neonatal and maternal fetal medicine.
  2. The 52nd “Marlow lecture” for Society Of Obstetricians and Gynecologists of Toronto.
    It was held on the evening of April 29TH 2010 at Park Hyatt Hotel. The lecture was delivered by Dr. Albert Yuzpe and the title “Reproductive medicine in Canada: Retrospective”
  3. Obstetrics & Gynaecology University of Toronto 27th Annual Research Day.
    Held on 7th May ’10 in Northrop Frye Hall, Victoria University, University of Toronto, 73 Queen’s Park Cres. This is a yearly event in which students of the UofT at various levels –undergraduate, residence, and fellowship etc- make research presentations, to a panel of Judges (Lectures). Posters are also put up, presented, and then assessed for awards. The key note speech- THE HENDERSON LECTURE- was titled “Being born too soon-do obstetricians have anything to offer?” delivered by Jane Norman MD. The organization of the conference, quality of researches, posters & presentations was great learning experience.

Extracurricular Activities
Despite the shortened electives time and busy academic schedule, we sought to learn other aspects of Toronto city and the Greater Toronto area.

Cycling
We cycled a lot in Toronto courtesy of Dr. Martoglio, who provided us with nice bicycles and biking suit. We also managed to cycle with one of the residents, Alice Han. We cycled around Lake Ontario twice.

Visits within Toronto city
We made daily walks about the city every evening to savor the rich architectural designs of buildings, the road network the parks and the populace with its rich diversity in terms of racial descent. Specific places of interest we visited included:

  • The Toronto Islands
  • Art gallery of Ontario
  • Movie theaters
  • Various restaurants
  • CN Tower
  • Eaton centre and other shopping malls

We did enjoy the dinners we had with friends, most memorable being:

  • The invitation to Dr. Spitzer’s. We had a wonderful fellowship with her family. It was nice to have Ms Rosen and Ben. Seth around though he was deep asleep all the time we were there.
  • Had lunch with Abu Shriharan, who work at the Peter Silverman Foundation – an organization started by Peter Silverman to fund international health initiatives by members of MSH. Also present were 3 UofT medical students. We were able to meet Dr. Astrid Christoferson who was going to work in Kenya.

We sampled the transport options in Toronto, by using at various times the streetcars, the subway trains and the Greyhound buses.

Visits outside Toronto
Dr. Spitzer took us down to Niagara Falls. Niagara Falls is a very spectacular scene.

We visited several Kenyan families, first in Waterloo-Kitchener and were taken to Waterloo University where the couple is doing their PhDs. Then in Scaborough was the 2nd family.

Conclusion
Doing my electives at the University of Toronto gave me a very good experience both clinically and socially. It was a great learning opportunity, an eye-opener to technological advances in patient management. I learnt many things which I took with me back to Kenya. It gave me a chance to interact and make friends with people of all walks of life. It was worth every dollar spent.

Acknowledgements
I wish to register my heartfelt gratitude to every single person I interacted with in Toronto and facilitated my academic and social development, one way or the other. Of special mention however were: Dr. Alan Bocking, Dr. Rachel Spitzer and Mr. Aaron Yarmoshuk, who ensured that our stay at UofT and hospitals of placement was worthwhile. My primary supervisors: Dr. Adelmo Martoglio of SMH and Dr. Elyse Levinsky at MSH made learning so much more interesting. They were great teachers and mentors. I the hospitals would have been impossible without the facility of Sonya Surbek at SMH and Jane Gracey at MSH –you made me achieve so much in such a limited period of time, their organizational abilities are left to be admired. I wish to acknowledge other Doctors, residents, nursing staff at the two hospitals for aiding my learning at various levels of supervision. Medical students at the UofT made great friends. Mr. Sospeter Kaai & family, Mr. Julius & family made us feel Kenyan away from Kenya. I appreciate their hospitality.