Having spent the Easter holidays with my family, I returned to MRC Fajara mid April to a change in accommodation as accommodation within MRC was undergoing renovations. The new accommodation I was given was a little further, however the rooms were very spacious and there was wireless internet too, so it worked out for the better.

I began my audit of liver patients on the ward, along with Hannah Lewis and guidance from Dr Easom, from the 15^th April, for one month. Any new adult admissions with liver disease as the primary diagnosis were included in the audit. I attended handover along with the rest of the ward team at MRC, where any new admissions were discussed. This was useful as any new liver patients for our audit could be identified, but also as I learnt a lot of new medical terms. We presented our final results to the ward team at the MRC.

As part of PROLIFICA, I was given the opportunity to have my own research project, which involved going though the HC4 cohort to see how many patients fit the diagnostic criteria for liver cancer (HCC), cirrhosis and fibrosis. I have created flowcharts for each category, which I hope to soon finish along with a short written report. My project has involved looking through ultrasounds to see how many patients had lesions and what sizes as well as sifting through a large excel spreadsheet, resulting in me learning more about excel than I ever did at school.

I spent a week working at MRC Keneba, which is about 3 hours from the coast. MRC Keneba is a lot smaller than MRC Fajara. It provides free healthcare and prescriptions for patients and can refer patients to the coast if necessary. There is a nutrition centre, where malnourished children can be referred. They are also able to carry out anti-natal scanning, which I was able to observe to see how fetus measurements are taken using ultrasound. In clinic, the doctors were very friendly and helpful in answering any questions I had. They didn’t mind if I spoke to patients to ask any questions relating to their presenting complaint. Since many of the patients in clinic presented with coughs and colds, I was able to use a stethoscope to listen to them. Most of the time their breathing was normal, however on the odd occasion I was able to hear a patient who had crackles or a murmur. Being only a pre-medical student, I had previously not been able to independently distinguish between normal and abnormal breath sounds, as they all seemed to sound the same. However after a little practice, I now know briefly what I am supposed to be listening out for, which is great.

During the week in Keneba, I went out with the field team to Soma, where they conducted finger prick tests to check haemoglobin levels of pregnant women and toddlers, as well as recruit people into a Malaria study and carry out home visits. I was amazed by how much the field team could do with such little equipment. They were very efficient and HBV results were recorded immediately onto a tablet so they could be accessed via database. I learnt to carry out a finger prick test, which initially seemed quite simple however was a little more challenging on a crying two-year old baby. It was in moments like this where I learnt I needed to be firmer and having the correct grip on a baby’s hand so that they do not let go was important. It also came in handy knowing simple phrases of the local language, such as ‘abanta’ meaning ‘finished’.

I was fortunate enough to have the opportunity to spend a week at the Edward Francis Teaching Hospital (EFSTH) in Banjul shadowing doctors in General medicine, Obstetrics & Gynecology, Paediatrics and Surgery. I spent a day in each specialty, with the mornings spent usually shadowing ward rounds. Having already seen the wards at MRC, I was interested to see the difference in the quality of care at the EFSTH. The hospital was more organised and larger than I had expected. I also didn’t expect to see expensive equipment such as dialysis machines in The Gambia. However, I did notice that there was a difference in the scrupulousness in infection control measures.

At first I found it taxing to stand through lots of medical terminology and concentrate for so long during ward rounds. However, after spending a fair amount of time in clinics and hospital wards, by the end I was really enjoying all the clinical experience, simply because I was learning and gaining so much from it. I feel it has given me a huge advantage to starting my medical degree this year as opposed to last year. The terminology was making a lot more sense and x-rays and ultrasounds began to look more like a language I could finally begin to understand. My communication skills have improved immensely. I found ways to make the most out of asking questions to clinicians as well as effective methods of taking down notes. I think skills like these cannot be learnt from a textbook, rather through experience, which is why I am very grateful to have had this experience before medical school.

In my previous report I mentioned regularly visiting three nearby orphanages. I tried to keep up visits to the orphanages on a Friday (which is a half day in Gambia) along with James Frater, where we tried to continue teaching the children Maths and English. The children were of different age ranges and abilities, thus it was challenging to teach them all at once. However, I think the children thoroughly enjoyed our visits, just as we also found it very rewarding. I have put together an album with photos of the orphans from one of the larger orphanages I visited, which I hope to take or send back to the orphanage in Gambia one day.

During my final week of stay in The Gambia, I chose to take a second trip up to Keneba in order to carry out some final charity work, which was incredibly memorable. Using money my family and friends gave me, I was able to purchase 400 kilos of rice, which I distributed equally amongst every household in Keneba. The community held a large gathering to show their appreciation, with leaders and a member from every household in Keneba present. After my ceremony had finished, there were 2 bags of rice remaining, which I gave to a local orphanage, home to 55 orphan children. I also had a box full of donations sent to me from Imperial, which James and I took to the orphanage. We also had a lot of our own personal belongings we no longer wanted along with lots of donations from friends, which we also gave to the children. The orphanage was extremely grateful and the children were very happy. Finally, we also gave away some stationary we had with us to the junior school in Keneba. As expected, they were very thankful and it was also a great opportunity to see the children working in school.

I didn’t really think my stay in Gambia could have finished on more of high note, however I received a phone call on my last day to say my well project, I had began in March, was fully complete and that the community in Farato were holding an official ceremony for its opening. Having being hospitalized twice with bacterial infections, I hadn’t been able to visit the well for 3 weeks. I travelled back to the coast for the ceremony, however was a little late as Keneba is quite a drive from the coast. Despite being completely exhausted by the time I arrived, I couldn’t help but feel a sense of achievement inside. It was great to see locals so pleased and taking water from the well, which they would have otherwise had to have walk many miles for.

To add to all these positives, I received a very important email just before leaving for the airport, to say a paper I had been part of writing had been accepted for publication in the PAMJ.

Words cannot really describe how deeply humbling the whole experience has been for me. An experience I will definitely take with me for the rest of my life.