0:00:00 > 0:00:00- *
0:00:02 > 0:00:05- Malo e lelei - - that's welcome in Tongan.
0:00:06 > 0:00:10- Our cameras have been following - students at Cardiff University.
0:00:11 > 0:00:15- You see things you'd never normally - see. You're forced to grow up.
0:00:15 > 0:00:18- 15 individuals on an unique course.
0:00:18 > 0:00:20- We get the creme de la creme.
0:00:21 > 0:00:25- I'm the most competitive person. - I'm itching for the responsibility.
0:00:25 > 0:00:28- From the classroom - to hospitals across Wales.
0:00:28 > 0:00:34- It's going to be more challenging - than anything they've done before.
0:00:37 > 0:00:40- Entering the medical world - for the first time.
0:00:40 > 0:00:42- Young doctors are like chicks.
0:00:45 > 0:00:48- Remember that? It was hilarious!
0:00:48 > 0:00:51- Facing the greatest challenge - of their young lives.
0:00:51 > 0:00:55- This year was the first time - I'd seen someone die.
0:00:55 > 0:00:59- It really hit me - because she's not going to recover.
0:00:59 > 0:01:04- I feel like I'm drowning, - that I'm not doing enough work.
0:01:04 > 0:01:07- Medicine is hard, - the course is hard.
0:01:07 > 0:01:12- We chronicle their every step - to become the doctors of tomorrow.
0:01:13 > 0:01:16- We'll be the doctor on the scene. - We'll be in charge.
0:01:17 > 0:01:20- This is superb. - What made me want to do this?
0:01:20 > 0:01:23- This is not about elitism.
0:01:23 > 0:01:25- You have been given a gift.
0:01:26 > 0:01:29- You must use that gift...
0:01:29 > 0:01:31- ..to do good.
0:01:38 > 0:01:42- The final year is the highlight of - the five-year course for students...
0:01:43 > 0:01:47- ..as they arrange placements - in hospitals all over the world.
0:01:47 > 0:01:52- They gain medical experiences - in very different circumstances...
0:01:52 > 0:01:55- ..so the elective placement...
0:01:55 > 0:01:58- ..is a highlight for many students.
0:01:59 > 0:02:01- We hope that this course...
0:02:02 > 0:02:07- ..prepares our students to practise - medicine anywhere in the world.
0:02:07 > 0:02:09- For an unique experience...
0:02:09 > 0:02:12- ..Guto travels - to the other side of the world.
0:02:13 > 0:02:16- To Tonga, - a small island in the Pacific Ocean.
0:02:16 > 0:02:19- I knew I wanted - to travel somewhere far from home...
0:02:20 > 0:02:22- ..and make the most - of the opportunity.
0:02:25 > 0:02:29- I wanted to gain as much - diverse experience as possible.
0:02:29 > 0:02:33- I think it'll be a very different - experience in Tonga.
0:02:38 > 0:02:43- This is the highlight - of the entire course.
0:02:43 > 0:02:46- I'm going to Tonga - to do my elective...
0:02:46 > 0:02:50- ..and take a holiday - at the same time, hopefully!
0:02:50 > 0:02:53- This is - what everyone looks forward to.
0:02:53 > 0:02:59- We talked about it in the first year - but it felt so far away back then.
0:03:00 > 0:03:03- I haven't thought about it - for ages...
0:03:03 > 0:03:06- ..and now it's here.
0:03:06 > 0:03:09- It's nuts - that it's finally happening.
0:03:09 > 0:03:13- I'm trying to decide - how many T-shirts I should take.
0:03:14 > 0:03:18- It's surreal, in a way, - because the time's flown.
0:03:19 > 0:03:23- To think we're nearing the end, - ready to start a job...
0:03:23 > 0:03:25- ..it's quite scary too.
0:03:26 > 0:03:30- I've a six-week placement - at a hospital in Auckland...
0:03:30 > 0:03:34- ..and then I'll travel for - a fortnight before returning home.
0:03:34 > 0:03:38- We've been looking forward to this - since the first year.
0:03:38 > 0:03:40- It's kept a lot of us going.
0:03:41 > 0:03:44- You reach halfway and you think - you'll never be ready...
0:03:45 > 0:03:48- ..but placements - put theory into practice.
0:03:48 > 0:03:50- I'm ready to finish now.
0:03:53 > 0:03:57- Now everything's been covered - and the exams are over...
0:03:57 > 0:03:59- ..it all feels very real now.
0:03:59 > 0:04:01- I'm looking forward to it.
0:04:04 > 0:04:09- Tonga provides an opportunity to - relax and experience working abroad.
0:04:10 > 0:04:13- It's hard not to enjoy yourself - in a place like this.
0:04:13 > 0:04:19- I have to pinch myself sometimes. - It's so nice here.
0:04:19 > 0:04:21- It's so picturesque.
0:04:38 > 0:04:41- It's obviously - a poorer country than ours.
0:04:43 > 0:04:47- What strikes you right away - is how friendly the natives are.
0:04:47 > 0:04:52- The welcome we've received here - has been incredible.
0:04:55 > 0:04:58- While the fifth year - offers exotic experiences...
0:04:59 > 0:05:03- ..third-years begin their placements - in hospitals across Wales.
0:05:03 > 0:05:06- For the first time in Newport...
0:05:07 > 0:05:11- ..Elen experiences the reality - of the A&E department.
0:05:11 > 0:05:14- I'm on my hospital-front-door block - in Newport.
0:05:15 > 0:05:17- It covers A&E and...
0:05:20 > 0:05:23- A&E, basically!
0:05:23 > 0:05:29- I was in the A&E department as well - as the Medical Assessment Unit.
0:05:30 > 0:05:34- In the third year, - they go on placement in hospitals.
0:05:34 > 0:05:40- The main objective is to see - what the patients themselves see...
0:05:40 > 0:05:42- ..out in the community.
0:05:43 > 0:05:48- It's really busy here compared to - the other hospital I was at...
0:05:48 > 0:05:52- ..where two, three or four patients - were arriving each day.
0:05:53 > 0:05:57- Here, as many as 80-90 patients - are seen every day...
0:05:57 > 0:05:59- ..which makes it very hectic.
0:06:00 > 0:06:04- I doubt I'd be able to do this - every day for the rest of my life.
0:06:04 > 0:06:08- It's non-stop, you're seeing - one patient after another.
0:06:10 > 0:06:12- It's very busy...
0:06:12 > 0:06:14- ..and incredibly full-on.
0:06:15 > 0:06:19- Any person can walk through the door - in the A&E department...
0:06:20 > 0:06:22- ..and the patients - are very different.
0:06:22 > 0:06:25- I'm a third-year medical student.
0:06:25 > 0:06:29- Is it OK if I sit on the bed? - I've been walking too much!
0:06:29 > 0:06:33- The first man I saw, - I didn't think he was too bad.
0:06:33 > 0:06:37- His leg was swollen and I - went through all the conditions...
0:06:38 > 0:06:42- ..that could potentially - cause swelling in my head...
0:06:42 > 0:06:44- ..and each one was a possibility.
0:06:44 > 0:06:48- 72-year-old male with a two-week - history of painful leg swelling...
0:06:49 > 0:06:52- ..that has been getting worse - and moving up to his abdomen.
0:06:53 > 0:06:56- He's got an enlarged pancreas, - asthma, COPD...
0:06:56 > 0:07:00- ..diabetes, angina, hypertension...
0:07:00 > 0:07:02- ..and he's an ex-smoker.
0:07:02 > 0:07:05- He gave up drinking - two months ago...
0:07:05 > 0:07:09- ..but he used to drink three bottles - of wine a day since he was 18.
0:07:09 > 0:07:15- He was very ill, his heart, - liver and kidneys weren't working.
0:07:15 > 0:07:19- I didn't have a clue - what to do with him.
0:07:19 > 0:07:23- This could be a problem with - the heart, the liver or the kidney.
0:07:23 > 0:07:27- Any of those three - can cause problems.
0:07:27 > 0:07:32- In a text-book case, different - symptoms fit certain diseases...
0:07:33 > 0:07:38- ..but in the real world, - all that goes out the window.
0:07:38 > 0:07:41- Watch his belly. - Lift your neck up off the bed.
0:07:41 > 0:07:43- Rest it back down. What's that?
0:07:44 > 0:07:45- Looks like a hernia.
0:07:45 > 0:07:47- Looks like a hernia.- - No. Everyone says hernia.
0:07:48 > 0:07:51- His rectus abdominis muscle - has torn a little...
0:07:51 > 0:07:56- I feel a bit incompetent - when the consultants do something...
0:07:56 > 0:08:00- ..and I think to myself, - I should've remembered to ask that.
0:08:00 > 0:08:04- I also have to remind myself - that I'm still a student...
0:08:04 > 0:08:07- ..and it's my first time - on the ward.
0:08:07 > 0:08:12- As a third-year, I remember feeling - completely useless on the ward.
0:08:12 > 0:08:16- I didn't feel part of the team - because you can't contribute...
0:08:16 > 0:08:18- ..and you're unsure - of what's going on...
0:08:19 > 0:08:24- ..but it's an important part - of your development as a doctor...
0:08:24 > 0:08:27- ..because you won't always know.
0:08:27 > 0:08:32- But you just have to get on with it - and learn as you go along.
0:08:32 > 0:08:34- We know - what is going on but not why.
0:08:35 > 0:08:38- We need to tailor the treatment - to the cause.
0:08:38 > 0:08:42- She picked a complicated case - to start off with.
0:08:42 > 0:08:45- The organs - which can cause fluid retention...
0:08:45 > 0:08:47- ..are the liver, - kidneys and heart.
0:08:48 > 0:08:51- He has potential to have illness - in any one of those three.
0:08:51 > 0:08:56- You work through them in turn to see - which one is causing the problem.
0:08:57 > 0:09:00- Our job - is to build their confidence...
0:09:00 > 0:09:03- ..around - their knowledge and ability.
0:09:03 > 0:09:06- It's not only about, "I know - everything about medicine."
0:09:07 > 0:09:10- You also need to know everything - about human interaction.
0:09:20 > 0:09:22- I've been in Tonga for a week...
0:09:23 > 0:09:28- ..and I'm a few days into - my placement at the hospital.
0:09:29 > 0:09:31- This is Vaiola Hospital.
0:09:32 > 0:09:35- The hospital is relatively small.
0:09:35 > 0:09:39- I'm hoping to take on - a lot of responsibility...
0:09:40 > 0:09:42- ..in order to look after - the patients.
0:09:43 > 0:09:46- I've been put on a paediatric ward.
0:09:46 > 0:09:51- I'm enjoying it so far. - The staff are very nice.
0:09:51 > 0:09:53- The team is very good.
0:09:53 > 0:09:58- There are a lot of - interesting patients to treat too.
0:09:58 > 0:10:02- I'm on my way in now and I have - a ward round to do this morning.
0:10:02 > 0:10:04- I'd better go.
0:10:06 > 0:10:09- There are major differences.
0:10:09 > 0:10:14- There are - fewer resources and so on...
0:10:14 > 0:10:18- ..and they have to rely - on a limited budget...
0:10:18 > 0:10:22- ..compared to our - resources and budget back home.
0:10:22 > 0:10:26- When we take a blood sample, - we take it for granted...
0:10:26 > 0:10:30- ..that we'll only have to wait - a couple of hours...
0:10:31 > 0:10:33- ..for the results to come back.
0:10:33 > 0:10:37- In Tonga, they have to send - some samples to New Zealand...
0:10:37 > 0:10:42- ..and wait up to a week - for the results to come back.
0:10:42 > 0:10:46- It goes to show some of the things - we take for granted.
0:10:47 > 0:10:52- Dr George's daily ward rounds is - a chance for Guto to experience...
0:10:52 > 0:10:57- ..the extreme cases that are - dealt with on the children's ward.
0:10:57 > 0:11:02- The first child we saw - has cerebral palsy.
0:11:02 > 0:11:06- The fact he has cerebral palsy...
0:11:06 > 0:11:09- ..affects lots of things.
0:11:09 > 0:11:13- I think they're a little concerned - about his weight gain.
0:11:14 > 0:11:18- He has tubes in his nose which - go straight down to his stomach.
0:11:20 > 0:11:23- The parents - are responsible for feeding him...
0:11:23 > 0:11:25- ..but he's not getting enough.
0:11:38 > 0:11:41- The father said he'd been ill - himself and couldn't feed him.
0:11:41 > 0:11:46- Dr George said - it was unfair on the small child.
0:12:15 > 0:12:20- You can see by him that he's - emaciated. There's nothing of him.
0:12:21 > 0:12:25- It's hard to see someone like that.
0:12:25 > 0:12:29- A small child can't help himself, - can he?
0:12:35 > 0:12:37- It's hard to watch someone suffer...
0:12:38 > 0:12:40- ..due to the negligence - of someone...
0:12:40 > 0:12:43- ..who's meant to be - responsible for him.
0:12:46 > 0:12:48- Things like that happen at home too.
0:12:49 > 0:12:52- Obviously something - needs to be done.
0:12:52 > 0:12:57- Nobody's healthy if they're - as underweight as that child.
0:12:59 > 0:13:01- It needs to be sorted out, I'd say.
0:13:04 > 0:13:04- .
0:13:06 > 0:13:06- Subtitles
0:13:06 > 0:13:08- Subtitles- - Subtitles
0:13:09 > 0:13:14- For students, the elective placement - is the highlight of the course.
0:13:14 > 0:13:17- Work experience, - anywhere in the world.
0:13:17 > 0:13:21- I've decided to do my elective - in Auckland, New Zealand.
0:13:21 > 0:13:25- I'll be doing Obs and Gynae - for six weeks in hospital.
0:13:25 > 0:13:29- The placements put - the information you've learnt...
0:13:29 > 0:13:32- ..and your communication skills - into practice.
0:13:33 > 0:13:36- The current fifth years - are brilliant.
0:13:36 > 0:13:41- We effectively expect them - to be able go out and be doctors...
0:13:41 > 0:13:45- ..and be shadow doctors and have - the clinical skills necessary...
0:13:46 > 0:13:48- ..by Christmas of the fifth year...
0:13:49 > 0:13:53- ..to go into the final part of the - course and be surrogate doctors.
0:13:53 > 0:13:55- Doctors, all but in name.
0:13:56 > 0:13:58- On placement in Tonga...
0:13:58 > 0:14:03- ..Guto deals with the challenges - of working in the developing world.
0:14:05 > 0:14:10- I did a placement on - a paediatric department last year.
0:14:10 > 0:14:14- Children obviously come with - their own set of problems.
0:14:14 > 0:14:17- Treating adults - is completely different.
0:14:18 > 0:14:20- It was different again in Tonga.
0:14:23 > 0:14:26- There were ailments - we'd never see in Wales.
0:14:28 > 0:14:31- The patient we've just seen - was interesting.
0:14:31 > 0:14:34- The patient has heart failure.
0:14:34 > 0:14:39- When you hear about heart failure, - you assume the patient's old.
0:14:39 > 0:14:44- But this female patient - has rheumatic fever...
0:14:44 > 0:14:47- ..which is something - I've never encountered.
0:14:49 > 0:14:53- Apparently, it's very prevalent...
0:14:53 > 0:14:55- ..in the Pacific Islands.
0:15:00 > 0:15:02- Not as big as here.
0:15:06 > 0:15:08- No.
0:15:10 > 0:15:12- Her heart is very big...
0:15:12 > 0:15:16- ..and you can see - the heart beating in her chest...
0:15:16 > 0:15:18- ..because she's very thin.
0:15:20 > 0:15:25- When the doctor examined her, - she could feel the heart pumping...
0:15:26 > 0:15:29- ..and she could feel - the blood flow.
0:15:29 > 0:15:33- They fear there's a build-up - of fluid in her lungs...
0:15:33 > 0:15:36- ..and that's why - she finds it hard to breathe.
0:15:37 > 0:15:39- She has pneumonia.
0:15:41 > 0:15:43- She's very ill.
0:15:46 > 0:15:48- It's sad to see, really.
0:15:49 > 0:15:52- As I said, it's not something...
0:15:52 > 0:15:55- ..you associate with children.
0:15:56 > 0:15:58- Heart failure.
0:16:04 > 0:16:08- Back at the A&E department - at the Royal Gwent Hospital...
0:16:08 > 0:16:11- ..Elen tries to deal with - the workload...
0:16:11 > 0:16:13- ..due to a high volume of patients.
0:16:17 > 0:16:19- I'm an insulin-dependent diabetic.
0:16:20 > 0:16:24- I couldn't hold down food or water - last night.
0:16:25 > 0:16:26- Are you feeling tired at all?
0:16:26 > 0:16:28- Are you feeling tired at all?- - I've been sleeping a lot.
0:16:28 > 0:16:34- 20 hours out of 24 hours I tend - to be asleep over the last few days.
0:16:34 > 0:16:38- Now I've seen the patient, I need - to track down the consultant...
0:16:39 > 0:16:42- ..and give him - her history and her symptoms...
0:16:43 > 0:16:45- ..so he can figure out - what to do next.
0:16:48 > 0:16:49- When I spot him.
0:16:52 > 0:16:56- There were very few people - available that day.
0:16:56 > 0:16:58- The doctors on call - were either ill or absent.
0:16:59 > 0:17:03- The poor consultant - was running around.
0:17:03 > 0:17:07- That's the reality of the situation - in busy departments...
0:17:07 > 0:17:12- ..where there are too many patients - and not enough doctors.
0:17:12 > 0:17:18- It's very busy - there are - loads of beds and trolleys...
0:17:18 > 0:17:21- ..where people - are waiting to be seen...
0:17:21 > 0:17:26- ..and there are even more outside - because there's no room for them.
0:17:27 > 0:17:30- The doctor's rushed off somewhere.
0:17:30 > 0:17:33- We'll have to wait - till he gets back.
0:17:34 > 0:17:39- I hope a doctor arrives soon because - the patient's been waiting...
0:17:40 > 0:17:45- ..since the early hours and she just - wants to know what's wrong with her.
0:17:45 > 0:17:50- She wants to know... Oh, here he is. - I hope I can ask him.
0:17:52 > 0:17:54- Maybe not.
0:18:00 > 0:18:04- A&E departments - in South Wales are frenetic.
0:18:04 > 0:18:08- There's no time to take a break.
0:18:08 > 0:18:12- But that's the nature of the NHS.
0:18:13 > 0:18:17- Every doctor tries to see every - patient as quickly as they can...
0:18:17 > 0:18:21- ..but it's not always - as simple as that.
0:18:22 > 0:18:24- She takes injections - four times a day.
0:18:25 > 0:18:28- She's usually well controlled - with insulin...
0:18:28 > 0:18:33- ..but she's been vomiting - and couldn't keep any water down.
0:18:34 > 0:18:38- She's had a UTI for 1.5 weeks - and only had Trimethoprim yesterday.
0:18:39 > 0:18:40- Your diagnosis, doctor?
0:18:41 > 0:18:43- I think she has pyelonephritis...
0:18:43 > 0:18:45- ..or an ascending UTI.
0:18:45 > 0:18:48- That's what it looks like, isn't it?
0:18:48 > 0:18:53- I assumed it was a UTI that had - travelled up to her left kidney.
0:18:53 > 0:18:56- They're going to give her - an antibiotics IV.
0:18:56 > 0:18:58- So what are you going to do?
0:18:58 > 0:19:00- So what are you going to do?- - Can you give IV Methoprim?
0:19:00 > 0:19:01- Doesn't exist.
0:19:01 > 0:19:04- Doesn't exist.- - What about IV Nitrofurantoin?
0:19:04 > 0:19:09- You can't give Amoxicillin - because it's resistant to it...
0:19:09 > 0:19:11- ..so, um...
0:19:13 > 0:19:17- You can learn all you want - about UTI, about urine infections...
0:19:17 > 0:19:21- ..and diabetes but then you have - someone with a urine infection...
0:19:21 > 0:19:27- ..causing a decompensation of their - diabetes and everything falls apart.
0:19:27 > 0:19:29- No, doing grand.
0:19:30 > 0:19:32- Thank you.
0:19:32 > 0:19:35- It makes you realize - how much pressure we'll be under...
0:19:36 > 0:19:39- ..in two years' time. - but it also makes me realize...
0:19:39 > 0:19:44- ..that I know quite a lot - and we're only halfway through.
0:19:44 > 0:19:48- It's a bit daunting to think - that in two years' time...
0:19:49 > 0:19:52- ..we'll be - prescribing medication for people...
0:19:52 > 0:19:57- ..and deciding which treatment - to give patients who are brought in.
0:19:59 > 0:20:03- It's obvious that all the staff - are tired by now.
0:20:03 > 0:20:05- It's nearing the end of the day...
0:20:05 > 0:20:08- ..and some will work - into the early hours.
0:20:09 > 0:20:11- It's odd to think - that in two years' time...
0:20:12 > 0:20:15- ..it'll be us who are here - from dusk till dawn.
0:20:20 > 0:20:23- Preparation time - is running out for Guto.
0:20:23 > 0:20:27- In a few months, - he and his fellow students...
0:20:27 > 0:20:28- ..will graduate.
0:20:28 > 0:20:30- ..will graduate.- - I've finished the ward round.
0:20:31 > 0:20:33- It was a general ward round...
0:20:33 > 0:20:37- ..checking - on the same patients as yesterday.
0:20:37 > 0:20:40- Checking to see if they're stable.
0:20:40 > 0:20:42- Each one is in the same state - as yesterday.
0:20:43 > 0:20:46- The baby checks are next, - so more hands-on experience.
0:20:46 > 0:20:49- How's the baby? Good, yes?
0:20:49 > 0:20:51- Have the bowels opened?
0:20:54 > 0:20:57- Can you ask - if the bowels have been opened?
0:20:58 > 0:20:59- Yes? OK.
0:20:59 > 0:21:03- The foot seems to be nice and flat.
0:21:03 > 0:21:05- In the Pacific Islands...
0:21:05 > 0:21:10- ..club feet are quite prevalent...
0:21:10 > 0:21:13- ..though there are few back home.
0:21:13 > 0:21:16- I have to look out for that...
0:21:17 > 0:21:18- ..if the foot is odd.
0:21:22 > 0:21:26- What we do here - is the same as we'd do back home.
0:21:26 > 0:21:30- We have to check everything, - from top to toe.
0:21:30 > 0:21:33- We're all done. Baby's fine, OK?
0:21:33 > 0:21:38- Today we get to know - where we'll be working in August.
0:21:38 > 0:21:41- I've put Wales - at the top of the list...
0:21:41 > 0:21:44- ..and I hope I get a place in Wales.
0:21:45 > 0:21:48- But we'll see. I'm a little nervous.
0:21:49 > 0:21:51- I just hope I get Wales.
0:21:52 > 0:21:54- After years of hard work...
0:21:54 > 0:21:59- ..Guto's dream of gaining employment - as a doctor in Wales has come true.
0:22:00 > 0:22:02- While I was away...
0:22:02 > 0:22:05- ..I heard that I'd been - offered a job in Wales.
0:22:06 > 0:22:08- Yay!
0:22:10 > 0:22:11- Relief.
0:22:11 > 0:22:16- I was very relieved because - it's what I wanted from the start.
0:22:16 > 0:22:18- I wanted to stay in Wales...
0:22:18 > 0:22:21- ..and find employment in the south.
0:22:22 > 0:22:24- I was nervous about it.
0:22:27 > 0:22:29- I didn't want to go anywhere else.
0:22:38 > 0:22:42- Working in a hospital the other side - of the world was incredible.
0:22:42 > 0:22:45- It was interesting - to see how they worked over there.
0:22:46 > 0:22:50- The chance to travel was incredible - too. The elective was amazing!
0:22:52 > 0:22:54- The elective - was a highlight for me.
0:22:54 > 0:22:57- It was a remarkable experience.
0:22:57 > 0:23:00- That was the best thing - about the course for me.
0:23:00 > 0:23:03- I miss the place already, - to be honest.
0:23:04 > 0:23:07- It was completely different...
0:23:07 > 0:23:10- ..from hospitals in Wales.
0:23:10 > 0:23:15- It made me realize how different - healthcare services work...
0:23:16 > 0:23:19- ..and how lucky we are in Wales - to have the NHS.
0:23:20 > 0:23:23- We have 100% employment - when they graduate.
0:23:23 > 0:23:26- Some individuals stay in Wales, - some travel abroad...
0:23:27 > 0:23:29- ..some go to all parts of the world.
0:23:29 > 0:23:31- So when you travel around...
0:23:31 > 0:23:35- ..chances are you'll bump into - a Cardiff graduate at some place...
0:23:36 > 0:23:39- ..and sometimes - in the most unusual of places!
0:23:55 > 0:23:57- S4C Subtitles by Adnod Cyf.
0:23:57 > 0:23:57- .