Medical origami

My first GP tutor at med school was an inspiration. He would often whisk us away from other tasks because he had a patient with an interesting clinical sign he wanted us to see – some poor man with hyperreflexia perhaps, who would then be subjected to a line of six bright-eyed medical students inexpertly bashing his knees. He once drove us for half an hour across town for the sole purpose of listening to a pleural rub. And he’d come out with gems like “If you don’t know what’s going on, send the patient to do a urine sample. It makes them feel better and gives you time to think.”

Anyway, one day he taught us some quick origami for keeping children entertained in clinic. I promptly forgot his instructions, and a couple of years on I’ve lost count of the times I’ve wished I could remember them. I mean, as someone who spends most of her time hanging out in the corner of clinic rooms*, there are a lot of occasions when it’d be nice to have something to cheer up the restless little sister of the boy who’s been brought in with chickenpox or something. Luckily I found the original in a drawer the other day, so here goes:

Take a square of paper (the page from the back of your notebook is fine). Fold it diagonally, then turn over and fold horizontally, as so:

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Bring the corners in and fold down to make a smaller square. (I suspect this bit has a fancy origami name.)

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Fold the top and back layers down so you have this:

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Now fold the top sides down to the centre – both layers – to get this:

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Extract the flap that’s in the middle, and fold it up and over the outside, like this:

IMG_2697Turn over. The next part is the fiddliest, but worth it. Fold out the top layer of each triangle from the middle, like this…

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… and add personality!

IMG_2701Et voila! He fits on the end of your finger.

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Our tutor claimed that he wasn’t doing too well in his paediatrics clinical exam years ago, but then made this, made the kid smile, and passed. I reckon that’s a skill worth having!

*I mean obviously I’m working really really hard at the same time, but sometimes you can get away with this stuff while the doctor’s back is turned.

On learning to love surgery

“The way these things usually go wrong”, says the surgeon, muffled through his green mask, “is when you don’t take out enough bone”.

Several months ago in the deepest darkest English winter, I decided that I wanted to have an interesting summer holiday. To do something useful, something exciting, maybe have a bit of an adventure. Some emails, a grant application and some disorganised packing later, here I am. In the CURE paediatric orthopaedic hospital in Addis Ababa, Ethiopia.

CURE is a private hospital. Operations are performed mainly by local Ethiopian doctors trained at Addis medical school, but funding comes from external donors – national and international. The hospital is relatively small and quiet, the equipment is good and there’s plenty of time. The waiting list, though, is long.

Children come from all over the country for specialist operations they can’t get elsewhere. One very common presentation is clubfoot, a congenital condition that means the foot (or feet) turn down and inwards. At home this would be treated early using combinations of foot supports, braces and special shoes, but here the kids have no choice but to walk, and years of walking means that the bones deform. If they’re lucky enough to get to CURE they can have corrective surgery. Much of the problem with clubfoot is in the tendons and ligaments, so they have ingenious surgeries such as Achilles tendon lengthening, posterior medialis release or anterior tibial tendon transfer. If the bones are deformed they might have a triple arthrodesis, which involves cutting out a wedge of bone in the foot, tearing out the cartilage with pliers and letting the bones fuse in a new position.

I’ve been known to be squeamish about surgery. Hey, this is the blog of a medical student with needle phobia, right? I was fully prepared to come here, the strange medical student from the UK, and faint in the OR while watching something hilariously minor. But I’ve been fine. Actually I’ve watched some of the most gruesome things I could have imagined: a little girl with osteogenesis imperfecta having her femur sawn in two and rejoined with a metal rod; a total hip replacement; a 13 year-old boy having his entire back opened up to remove 11lb of lipomas. I even helped sew a skin graft onto a little boy’s hand, metal rods drilled into each tiny finger to keep them straight – and for some reason I’m just fascinated, and awed.

Surgery here seems simple, and necessary, and utterly life changing. I can see exactly why some people like it so much.