Internship Secrets: Bahamas Edition

“The average person will never help you become better than them on purpose.” 
― Mokokoma Mokhonoana

After years of dedication and commitment to completion of a medical degree, most new doctors look forward to their internship year. Why? Well for most it's more than a rite of passage, it is a means of achieving new goals and becoming one step closer to their ultimate goal of consultancy, financial freedom and the ability to practice medicine in the private sector where they can set their own hours and enjoy a better means of life.

Most of you may be ignorant to the fact that in the Caribbean, internship year is not necessarily considered as a year filled with personal and career growth, but more of a year of misery, disrespect and dreaded belittling.

In the Bahamas, there is one public hospital on the island of New Providence; The Princess Margaret Hospital. Over the last decade the internship program has seen many changes which hospital administration and past and present Ministers of Health have mandated. There has been implementation of rankings which means that as a graduate of the University of The West Indies, you are no longer automatically given a spot in the internship program, regardless of the fact that the government financed your tuition for the last 5 years.  Imagine the frustration.

Recently, the Bahamas Doctor's Union utilised their strike vote, which allowed all Junior Physicians to leave the hospital grounds until matters were resolved. You can read more about it here.  So as a new physician, looking to work in the Bahamian system, find below an outline of what to expect as it's not always a bed of roses in paradise.

Everything, everyone failed to mention about Internship Year in The Bahamas

1. Application Process

Prior to the start of internship year, everyone seeking employment as an intern (also known as a House Officer) at the Princess Margaret Hospital which falls under the Public Hospital Authority (PHA)Unit, is required to fill out an application which can be obtained from the Hospital Administrators office or the PHA Corporate office or online here. It would be in your best interest to keep a copy for your records as paper documents often are misplaced. 

2. Duration of Internship

The internship program runs for one year starting in July of each year. It is broken down into three month increments and divided over the four core specialty rotations; Internal Medicine, Surgery, Obstetrics and Gynaecology and Paediatrics. 

The incoming internship group is divided into an even number of persons which would allow for ten persons to be allotted to each specialty for the designated timeframe. Last year was the first year where it was mandatory for two persons of each group to complete their rotation in the sister hospital on the island of Grand Bahama, at the Rand Hospital. Prior to this, an intern could request to complete a number of their rotations at the sister hospital. 

3. Purpose of Internship

Have you ever wondered where the term "intern" originate from? After performing a very superficial Google search, I found that it originated from the medical community. It was a term given to a doctor who held a medical degree but lacked a medical license prior to World War I.

It was then adopted by other professions and each profession tailored the purpose to suit the demands.

During our orientation week, we were informed that the sole purpose of the internship year was to gain clinical competence in the care of the adult/paediatric patient, with the "patient" being the curriculum.

Despite it feeling like everything but this, make it your duty, to learn guidelines and standard of care medicine even if it is not practiced. At the end of the day, successful completion of each specialties exam and gaining your internship completion certificate if the overall goal and your purpose.

4. Work Hours

Trust me here, as an intern your work week will equate to more than 40 hours. They will paint the lovely picture that your days is to commence at 8a.m. and end at 4 p.m. unless on calls. 

You will learn that you get to leave when your Senior House Officer or the team/service you are on no longer has work for you to do. Some areas and persons understand the meaning of teamwork and will ensure everyone has at least one day off per week, and that everyone leaves in a timely manner each day. Pray to work with those people! It will make learning material fun and interesting and will allow you time to read around your patients to have engaging discussions on consultant rounds. 

5. The System

The system is not one that is set in place to help you grow. I never thought I would be writing such a post but sadly, this is the reality. 

After working here, wanting to help my fellow Bahamians, the health-care system is deplorable. You will be frustrated, you will be exhausted and you will find yourself on your knees daily in intercessory prayer for your patients because there is so much that can be done but isn't and in the eyes of administration you're just an intern. 

In light of all of this, do your best to keep your personal development at the forefront. Please don't get buried in the system. It lasts but a year and before you know it you will be done with it. 

If you can afford to do so, make plans to sit the necessary board examinations prior to your final year in medical school (and yes you do have time). You won't regret it. 

Are you a new graduate? an intern? taking time off before internship? Let me hear from you. How's your journey been thus far? 

Rotation Essentials: RMH Edition

“By failing to prepare, you are preparing to fail.” ― Benjamin Franklin

I'm still in awe, how quickly a new year began. The first month is practically over and before we know it, another year will be rung in. With new beginnings comes new resolutions and the feeling of wanting to be better, wanting to improve ourselves and to finally get our lives together-as a colleague of mine would say. So today's post will touch on preparation. 

I am definitely big on preparation even for the smallest of things, so I surprised everyone including myself when I hadn't packed for my out of town rotation the 'normal' two weeks before. I'll share how I'm regretting that but still managed to make the most of it. 

Just some background for those who may not be familiar with the medical internship rotations here in The Bahamas. Our internship program runs for a year, from July-July. It usually starts the month following the University's graduation date. There are four major specialty rotations which each has their own set of requirements for completion in order to be eligible to apply for a Senior House Officer position at the end of the year. 

The major specialty rotations are inclusive of Paediatrics, Internal Medicine, Surgery and Obstetrics and Gynaecology. Each rotation spans a three month timeframe with an examination at the end. Depending on the schedule you may find yourself at the Rand Memorial Hospital, the sister hospital on the island of Grand Bahama. All rotations with the exception of the Surgery rotation are for three months on Grand Bahama, for surgery it is split into two six-weeks period. 

So now for the important stuff. As the hospital is by far smaller than the Princess Margaret Hospital in New Providence, it allows for more hands-on opportunities and one-on-one teaching if you take advantage of it. Depending on the specialty your calls may be one in four, five or six. 

The island is more slow paced than Nassau, however the hospital is a revolving door for everything, so you won't be sitting around twiddling your thumbs.  

Freeport Essentials 101

1. Transportation is Limited

It's no secret that the transportation system in The Bahamas is lacking, on the islands of The Bahamas, they're practically non-existent or non-existent the further down the chain you venture. Hence, putting your car on the boat and having it brought over would allow you unlimited freedom to explore the island when your schedule permits. 

For some this may not be cost effective if you're only there for a maximum of six weeks, but it all depends on whether or not you can handle the unreliability of the transport system. 

2. Prepare to Spend

With its close proximity to the United States, one would think the cost of living here would be a little less expensive than it really is. Consider bulk/wholesale purchases for your stay here as it will be less expensive than purchasing fast food every day and gaining weight that you would not have wanted. 

There is a Cost-Right on the island that is similar to Cost-co or Sam's Club in the U.S. There are some local farmer's markets on the island but you'll have to be sure to ask the locals or pay attention to the advertisements to find out when they will be popping up. 

3. Exploration is Essential

There is so much to do from shopping at the stores in Port Lucaya, to venturing down to West End for the famous pancakes and fried fish that it would be a crying shame if you allowed work to consume all of your time. 

While exploring Port Lucaya, be sure to visit Bootlegger's Chocolate Shop if you're interested in trying out new flavours of chocolate made in The Bahamas. You won't be disappointed. 

If you're interested in sports or land adventures, there is a local tour group that offer ATV tours! 

4. Pack for chilly weather!

I had no idea how different the weather was in Freeport, compared to other parts of The Bahamas especially Nassau. The worse thing I did was to pack one sweater, which was more like a windbreaker than a sweater. The weather changes often and whatever the weather is like across the ocean, we're sure likely to get remnants of it here as well-more often than not, unexpectantly. 

5. Be vigilant! 

Like any new experience, or when visiting a new place, always be vigilant. In Freeport, since the last hurricane, the lampposts and road lights haven't been repaired so driving after hours can be difficult if you're not familiar with the area. Road traffic accidents are high, and the last thing you'd want to do is to find yourself hospitalised. 

This post has been long overdue, and I wished I had stayed on track and finished it during my 6 weeks in Freeport. Overall the experience was life-changing. I met some really wonderful people and it gave me a new outlook on embracing new beginnings. I hope you come and visit. 

Strength in Weakness

“She made broken look beautiful
and strong look invincible.
She walked with the Universe
on her shoulders and made it
look like a pair of wings.” ― Ariana Dancu

It seems like yesterday, I was just sitting in the University's library preparing for final examinations. I'm half-way through my internship year and I must say despite it being a drastic change in learning styles, it has given me a greater appreciation for this opportunity of learning how to master certain skills in order to save lives. It requires a certain level of determination, discipline and camaraderie to conquer these skills. 

For the last three months, I found myself frustrated at the system, frustrated at the bitterness that seeps from the pores of Junior doctors who voluntarily signed up for a Senior House Officer position in the Department of Internal Medicine and frustrated at the overall outlook of seasoned, Consultants who knew more about criticising and degrading Junior staff than fostering an environment of growth, encouraging curiosity and the desire some Junior doctors have to advance academically. 

During these moments, it was the patient interaction which saved me time and again from throwing in the towel and allowing these frustrations to break my spirit and crush my curiosity and dampen those Eureka moments when things finally clicked in terms of putting the pieces together and understanding the molecular basis of pathology and the ways to combat further immunologic response (which tends to be the heart of most diseases). 

Beyond the service to others, my time in the department of Internal Medicine showed me the importance of strong communication skills and professionalism in all aspects; as the slightest break in the chain of communication between Physician and nursing staff could result in not only poor patient care, but even patient demise. At the end of the day we're all human, seeking respect from our peers, our superiors and from those with whom we come in contact with. It's as simple as that. Once there is no respect, then the system is damaged and the urge to seek revenge in the name of getting even because our feelings were hurt can take precedence over the oath we took to do no harm. 

Having to do it all over again in order to advance to the next phase as a Senior House Officer is going to be a whole other set of worms, to be honest, I don't care to deal with but such is life. Moving forward, I can only hope that I won't take my preconceived notions and the terrible experiences had into this opportunity to do it again. 

Here's to making broken look beautiful and strong look invincible in face of broken systems, disgruntled and overworked staff and patients frustrated with healthcare in The Bahamas.