Dr Pooja Narayan is a registrar in the emergency department at one of the three divisional hospitals in Fiji. This is her third year working in the emergency department and as of March of this year, she joined the post graduate diploma in emergency medicine training program. Dr Narayan completed Emergency Medicine Theory and Practice in 2020 and shares her experience here.

“Being a doctor is the only career I have ever considered. It was my mum who first suggested a career in medicine when I was in secondary school. The idea stuck and everything I’ve done since then, every decision I’ve made, was in the direction of me getting my MBBS degree.

“I was first introduced to the field of emergency medicine in my third year of medical school where we undertook an observership in the ED of the Colonial War Memorial Hospital (Suva, Fiji). While the variety of cases seen and the dynamic environment of the emergency department appealed to me, I was also drawn to Paediatrics and Anaesthesia, especially during my internship rotation through these departments.

“After internship, I was posted at a sub-divisional hospital where we got to see diverse clinical presentations. It was the shifts in the emergency department that I enjoyed the most. The fast pace of the emergency department, the time critical assessment and management of a sick patient, the satisfaction of resuscitating a critical patient and being able to stabilize them for further inpatient management, and the fact that the types of cases that we see each day vary and are unpredictable is what makes emergency medicine great. The best feeling is when we are able to narrow the differential diagnosis for a sick, unstable, undifferentiated patient and through resuscitation and point of care treatment, “settle” the patient and the respective specialities can then come and continue patient care.

“Now I work at Lautoka Hospital which is located on Viti Levu (the larger of the two main islands of Fiji). Lautoka Hospital is the only speciality referral centre for the whole of the western division of Viti Levu. The Emergency Department is open 24 hours with two or more registrars on the floor at all times.

“Our ED currently has one medical officer who has a Masters in EM (our Head of Department) and one with a Post-Graduate Diploma in EM. There are three of us currently completing a Post Graduate Diploma in EM and the rest of the medical officers are service registrars with 2-5 years of experience in working in this field.

“The most common cases we see are Asthmatics, Sepsis – especially with Diabetics, Diabetic Emergencies, Myocardial Infarction, Heart Failure patients, Trauma and the occasional obstetric/gynaecological emergency such as miscarriage or ectopic pregnancy. There are also quite a few Dengue Fever and Leptospirosis cases with haemorrhagic manifestations or shock; especially during and immediately after the rainy season. As Lautoka Hospital is the main referral centre for the western division, all cases accepted by various specialities come through our emergency department and are attended to by the ED Registrar while awaiting specialist review.

“When a colleague of mine forwarded me the email from Alfred regarding the offer of this program, I grabbed the opportunity with both hands. The teachers were very helpful and are nice to talk to… [They] helped put things in perspective with all our learning, gave constructive feedback and helped guide us in a way that we got maximum knowledge out of the course.

“This course had definitely made me a better clinician in terms of knowledge and skills. I still refer to the resources we got through the course. I am more confident in treating patients and at picking up diagnosis/problems that I may have overlooked prior to having done the course.

“After completing my MBBS degree, I had not really studied anything much after that, and even when I had, my studying and hence my learning was always limited to what we can diagnose and treat in our setting. This course forced me to read on what happens in an ideal setting, how a case would be managed in an ideal setting, and in doing so, I feel that now I try and offer as close to an ideal treatment to a patient as possible.”

Clinicians living and working in lower-middle income countries are provided fee support from Alfred Health Emergency Education to undertake Alfred Emergency Education programs.

Please contact etc@alfred.org.au for more information.