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Week 2 - Summer Course in Universitas Sumatera Utara

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Week 2 - Summer Course in Universitas Sumatera Utara

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Name: Amirredzuan Bin Mohamad Hanif

Matric Number: A189203

Date: August 11, 2024

How is your progress?

Entering the second week of my elective posting in Universitas Sumatera Utara, Indonesia (which was my final week), we had multiple tentative sorted. For instance, on the first day, we had speeches and visits to molecular and parasitology laboratories of their medical faculty. We had been taught about ligation sequencing amplicons using the Native Barcoding Kit from Oxford Nanopore Technologies. They demonstrated many things such as how to extract DNAs, and how to mix the DNA with the reagents. Additionally, we also learnt about Polymerase Chain Reaction (PCR) theoretically and practically. In the parasitology lab, we learnt about malaria and the characteristics of the mosquitoes such as knowlesi spp., and falciparum spp. We also got to do hands-on on how to do BFMP for our own blood samples.

On the next day, we had more speeches and discussions about program planning and table-top exercises about all the topics we have learnt during the first and second week. The table-top exercises were involving all the participants, including medical students, medical officers, lecturers, and specialists from multiple countries. They gave us the scenarios to be discussed with questions & answer sessions.

On the last day, we actually had a field trip to ‘Perkampungan Desa’ di Kabupaten Langkat, in North Sumatera province, which is about an hour away from Medan city centre. At the village site, we actually got to participate in the surveying and health check-ups for the local communities there. We observed and asked few questions regarding their health and got to measure their height, weight, BP, and so on. Interestingly, during the trip, we can actually appreciate the differences of their demographics and compare them with our demographics in Kuala Lumpur.

Points to remember from week 2!

Points to remember include, different regions have different dominant species of malaria parasite such as falciparum spp., knowlesii spp., and so many others. We also got to learn that DNA extraction has been easier nowadays. Lastly, we can appreciate that different socioeconomic has different impact on the health of the local communities.

Your feelings & thoughts

My thought on the final week of my elective posting is that it was a very fun and interesting summer course as I got to cover many things regarding global health. The hands-on sessions, lab visits, table-top exercises, speeches, and field trip really made the learning more enjoyable.

ONE good thing from what you did that you can practice now!

One good thing from what I did that I can practice now is how to differentiate the species of malarial parasites via BFMP and microscopic procedures. They have distinctive characteristics that made it easier to differentiate one from another.

Any difficulties/concerns? How did you cope?

One concern that I had during this final week is regarding language barrier. For example, during the field trip, when we had to ask questions to the local community, we had difficulties on conveying the questions because they had their own dialects which is slightly different from Bahasa Indonesia (although the Bahasa itself had me). However, that’s the importance of networking or making friends with the locals. I made friend with a local and she helped me on translating the questions to their dialect. It is also important to has few knowledge about the language that the locals are speaking so that we get some ideas on what they are saying.

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CHAN MENG XIAN University Clinical Center Kragujevac, Serbia Week 2

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CHAN MENG XIAN University Clinical Center Kragujevac, Serbia Week 2

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CHAN MENG XIAN

A188342

18 July 2024

How is your progress?
At this week, we continued to attach to Cardiology Department under supervision of Dr. Simić. We are observing percutaneous coronary intervention on basis. On Tuesday, we are guided by a young doctor named “Emma” to go around the ward. We saw a patient with heart failure and mitral regurgitation and had a little chat with the patient. On Wednesday and Thursday, the incoming students of Serbia gathered at Belgrade to prepare for the National Food and Drink Party which we will share Malaysian cuisine with other people and we will taste the other cuisines prepared by the students from different countries. At the process, we met several new friends from Indonesia, Taiwan, Sweden and China. The party really opens up my view by tasting all sorts of food.

After the party, me and Chui Yan followed the trip to Zlatibor for three days and two nights. It is a mountainous region at West of Serbia. We managed to visit a monastery at one of the mountain, waterfall, cave and an open air museum. At night, we will reside at a hotel at Zlatibor. At the first night, we went to a bar and have a deep chat with the tour guide named ‘Stefan’. We talked about the economy of Serbia and Malaysia, the history of Serbia, the Kosovo controversy and the culture of Malaysia. I had a great time chatting with him, unfortunately we didn’t take picture together.

Points to remember from week 2:
⁃ If there is no R wave on the lead, most likely the wall is akinetic
⁃ Contrast medium during angiogram contains warfarin to prevent thrombosis at puncture site

Your feelings & thoughts:
At this week, I felt anxious to socialise with the other incoming students in Kragujevac. I think it’s because I am not used to hangout at night just to drink. I have tried going out with them, they will take a beer, sit and drink. I am okay if this is done once a week, but they will ask us to hangout every night. I felt overwhelmed and I need to take a break from socializing all day long.

Apart from that, I started to adapt to this city and the lifestyle here. People here will sit at the coffee shop at the morning before going to work. For them, 9am is when the work starts. No one is rushing at the morning, there is not much traffic and the city is pedestrian friendly with well maintained sidewalk and good weather.

ONE good thing from what you did that you can practice now!
Well I managed to diagnose a patient has Mobitz Type II Heart Block from the ECG, I guess I can do that in the future as well.

Any difficulties/concerns? How did you cope with that?
As mentioned before, I had problem in hanging out with the other students because they are going out every night. I felt that I needed some time for self healing and private space. So, to cope that, I reduced my time to being out with them and spend more time to read.

Your plan for next week (Week 3)
I hope I can learn more by going to the ward, so starting from next week we will go to the ward more to see more patient.

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Second week of Professional Exchange in University Clinical Center Kragujevac, Serbia

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Second week of Professional Exchange in University Clinical Center Kragujevac, Serbia

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1.        Your name, matric number, date

Hoh Chui Yan, A190102, 17th August 2024

2.        How is your progress?

This week, I was able to spend two days in the operating theatre and three days participating in national social programs organized by the IFMSA-Serbia committees. On Monday, after his daily 8 a.m. departmental meeting, I requested an absence from my supervisor. That same day, I was assigned to observe an elective surgery in the emergency center's operating room—a breast-conserving surgery. It was my first time observing breast cancer surgery, despite having studied it multiple times during my surgery rotation. However, I was unprepared when the surgeon asked me which dye should be used to stain the sentinel lymph node. Although I didn’t get the chance to assist by scrubbing in, I met a very welcoming team of surgeons and anesthesiologists. I watched as the surgeon removed the sentinel lymph nodes, stained blue, and excised the breast tumor. During the waiting period for the pathology lab results, we discussed the healthcare systems in Serbia and Malaysia. I learned that Serbia has its own healthcare insurance, which allows people to receive treatment without payment, although the waiting time to see a doctor can be as long as three months. Interestingly, most Serbian doctors achieve a work-life balance, working from 8 a.m. to 2 p.m. for three weekdays, 16-hour on-call shifts for two weekdays, and 24-hour on-call shifts depending on the weekend. Maternity leave in Serbia can last from 11 months to two years. I was surprised to find that many Europeans prioritize work-life balance, especially when comparing this to the Malaysian healthcare system, which I believe needs significant improvement in this area.

On Tuesday, I observed a cholecystectomy for a gallbladder cancer patient. The operation, which took five hours to complete, was more complicated than anticipated due to the discovery of liver metastasis. The surgeons had to perform a lobectomy and a Roux-en-Y hepaticojejunostomy. It was the first time I witnessed the anesthesiology team so actively engaged, monitoring vitals, inserting a central venous catheter, and transfusing blood. The atmosphere was tense when the patient began to lose blood, prompting additional surgeons to check on the procedure's progress. Fortunately, the operation was successful in the end.

Later, we traveled to the capital, Belgrade, to join the national social programs with nearly 70 international students from around the world. We were housed in a student dormitory with two bunk beds, without any ventilation or air-conditioning, during a heatwave that affected much of Central and Eastern Europe. The temperature reached up to 40 degrees, and the room felt like a sauna. Despite the challenging conditions, I enjoyed the National Food and Drink Party, where we sampled a variety of international cuisines.

3.        Points to remember from week 2!

·        Differences in the healthcare system of Serbia and Malaysia

·        Always grab the chance to rest when you can! Standing for long hours in the Operation Room can be dreadful but the doctors and nurses here always make sure we sit when we can.

4.        Your feelings & thoughts

I was disappointed when the national program was announced to be held on weekdays which meant I would have less days to practice in the hospital but I was rest assured by my supervisor to go ahead and enjoy the city life & culture.

5.        ONE good thing from what you did that you can practice now!

Proactively engage in conversations with doctors to build connections, not hierarchical barriers.

6.        Any difficulties/concerns? How did you cope?

The extreme temperature was dreadful to tolerate for the whole week. The only way to avoid getting a heatstroke that I did was to set a mini fan beside my bed as I was sleeping on the lower bunk beds where ventilation was bad.

7.        Your plan for next week (Week 3)

Get back on track in the hospital to join more operations as I can.

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Phase 2: Week 1's Social Phase in Dublin, Ireland.

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Phase 2: Week 1's Social Phase in Dublin, Ireland.

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1. Adam Neo Wei Meng, A189489, 5/8 - 10/8

2. In between my clinical attachment at St James Hospital, I managed to visit 2 main places on my days off during Week 1, which are Howth’s Summit and Cliffs of Moher. Howth’s Summit was a 40-minute bus ride from Dublin’s city centre, and another 10 minute walk up to the summit. The view on the summit was breathtaking, and thanks to tips I got from a senior who visited earlier, I had my selfie stick with me to take pictures. Cliffs of Moher was around 3 hours out of Dublin, so I had to go via tour bus. It was a little pricey but I think it was worth it as it saved a lot of time and effort figuring out how to get there myself, and the tour guide explained a lot of the history of landmarks we passed by along the way. We were given 2 hours to explore around the Cliffs, but as it was a 20-km trek, I only managed to walk a small distance before I had to turn back.

3. In the social phase of my first week here, I learned that people in Ireland are quite friendly and helpful. I was very confused when looking for my supervisor, and one of the staffs came to ask if I needed any help. It was a pleasant surprise, as I definitely will not get half as good a treatment in HUKM (no offence). Another example would be that if someone trips over on the roadside, there will be a lot of people coming over to help them up and ask if they’re fine; unlike in Malaysia, where you have to check if your belongings are safe if you are lucky (or not) enough someone even came up to help you.

4. It felt refreshing to go out into nature and enjoy the views. I feel quite blessed to get this opportunity to travel, especially somewhere so far from home. While I did learn a lot at the hospital, it can get boring watching procedures all day, so a change in scenery was much needed.

5. One good thing that I was taught to do here is to communicate with patients in terms of informing them on the procedures planned and getting proper consent from them. The nurse gave me a quick demo, and let me practise on a patient under supervision. I observed that they take these protocols very seriously and will treat patients almost as equals, allowing the patients to discuss the plan and voice out any concerns. Honestly I feel like this is quite different than what I have seen in Malaysia, but I am not confident in my clinical experience to say exactly what aspect is different. However, I do know now to make it a habit to clearly explain things and treat patients with due respect.

6. While the people here speak English, I found it difficult to understand their accent at first. My first way to cope was to smile and nod, and they usually will leave me alone. However, when it came to important stuff, I realised that it was better to repeat what I thought I heard and ask for clarification. Soon, it became easier to understand them.

7. My plan for the next social phase is to visit the last place on my bucket list – Glendalough’s sheep farm, and to pack and rest up before my trip back to Malaysia. I tried my best to try all their food here, especially beef, because it is their main produce here, but I am starting to miss Malaysian food.

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Top left and right: Dr Oumaima and Dr Tom, the 2 residences who guided me throughout the first week, making my first week in UZ Brussel so much more bearable! (Posted them in the 2nd week cause i just got the pictures recently :3) | Top middle: national social program to Liege and Leuven | Middle row: sunsets and moon in VUB campus | Bottom row: went to Netherlands on the public holiday and I'm in love with the vibe of this country! 

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2nd Week Clinical Exchange in Vrije University of Brussels (VUB), Belgium 

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2nd Week Clinical Exchange in Vrije University of Brussels (VUB), Belgium 

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1. Your name, matric number, date

Teh Ying Yi

A188721

18 Aug 2024 (Sunday)

2. How is your progress?

I've been learning Dutch daily, not only with the help of the Duolingo app but also with the guidance of the surgeons, nurses, anesthetists, and friends I've met here. Initially, I focused on everyday conversation, but in the operating theatre, they began teaching me medical jargon in Dutch. To my surprise, I've started to understand some of the words, even though I still find it challenging when they speak quickly. What I'm really proud of is my ability to assist in surgery, recognize the surgical instruments, and accurately deliver the correct ones even when the instructions are given in Dutch.

Additionally, I scrubbed in four times within two hours and assisted in the wide excision of lipomas and melanomas, all without supervision and without breaching sterility, which was a significant improvement from my first week. I also learned and assisted in the induction of anesthesia, which I believe is a great preparation for the upcoming anesthesiology module. I’m particularly glad to have had the opportunity to intubate a patient under the supervision of the anesthetist.

3. Points to remember from Week 2

study hard, work hard, and dont forget to play hard!

Dr Vanhoiej: 'Every action and assistance matters, no matter how subtle or small. Remember YIng, every action you take, contributes to every breath the patient is taking now and will continue to take for the rest of their life.'

You only live once, so enjoy every moments while you can

4. Your feelings and thoughts

I’m incredibly grateful to have had Dr. Jana, the resident who guided me through my second week. She generously shared her summary notes for every surgical patient and even drew the surgical instruments with their Dutch names for me. This was a huge help, especially since I was struggling to understand the instructions from surgeons who spoke Dutch when asking for instruments. Now, I feel a bit sad knowing she’ll only be in the thoracic oncology department for one week. On the bright side, I’m proud of myself for learning, adapting, and pushing myself every day to make the most of this opportunity.

Waking up early and immersing myself in the world of surgery has become much easier; I can now get into the right mindset quickly while still enjoying my life here in Belgium. I am really happy to see myself adapting and making 1% improvement every day!

5. ONE good thing from what you did that you can practice now

Learning and understanding a new language

6. Any difficulties/concerns? How did you cope?

In the second week, I faced challenge with balancing study time with social activities. I typically prepare for the next day's operations by researching and studying relevant information. However, since I usually leave the hospital around 4 or 5 PM and the evenings are reserved for social events like parties, café hopping, or picnics, I often struggle to find time to revise and prepare. Consequently, waking up early the next morning to study is difficult due to sleeping at late nights. Fortunately, I’ve found an effective solution: I now prepare for cases and study in the afternoon using the hospital's computer, and I take a nap when I get home at 5 PM. This method not only allows me to prepare thoroughly for cases but also lets me fully enjoy my time outside, knowing I am well-prepared and don't have to worry about falling behind.

Additionally, I struggled with managing the large amount of information I needed to learn without a system for organizing it. To address this, I created a Google document to record everything I’ve learned and made lists of topics to study, making it easier for future reference.

7. Your plan for next week (Week 3)

* memorise the dutch name of surgical instruments

* assist in thyroidectomy and BCS

* continue with dutch learning

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2nd Week of Professional Exchange in Vjire University of Brussel (VUB), Belgium

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2nd Week of Professional Exchange in Vjire University of Brussel (VUB), Belgium

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1. Your name, matric number, date

Lim Qi Wei, A187883, 12/8 - 14/8

2. How is your progress?

So far, so good. I have become more comfortable with the vascular team and can help more because I am now familiar with the procedures. I assisted the surgeons in scrubbing in seamlessly without making any mistakes regarding sterility, phew! I also helped the nurses move patients in and out of bed. The highlight of this week was scrubbing in and assisting in a surgery. It was the stripping of the great saphenous vein. I had to quickly learn the equipment and procedure, assisting the surgeon accurately in real-time. I'm glad I adapted and learned quickly, managing to assist properly!

3. Points to remember from Week 2!

One memorable and meaningful moment was when the surgeon praised me for being a fast learner and doing a good job after I anxiously tried my best to assist. This recognition was very rewarding and motivated me to do even better.

4. Your feelings & thoughts

I believe that with time and effort, any adversity can be overcome. Challenges present opportunities for growth, and I’m confident in my ability to improve and solve problems as they arise. I've also had the chance to learn so much here, including assisting in the operating theatre—an experience I never had at UKM. It’s interesting how the doctors prefer to be addressed by their names rather than with the 'Dr.' title. At first, it felt unfamiliar, but I am able to say it more naturally now.

5. ONE good thing from what you did that you can practice now!

Good observation helps in learning fast

6. Any difficulties/concerns? How did you cope?

This week, I faced challenges in quickly adapting to assisting in a surgery and learning on the spot. I coped by staying focused, observant, asking questions when necessary, and practicing what I learned immediately.

7. Your plan for next week (Week 3)

Next week, I plan to deepen my understanding of the surgical procedures and take on more responsibilities in the operating theatre. I aim to assist in more complex surgeries and continue building strong relationships with the team.