Another week done here in Tonga. This past week I’ve continued in paediatrics, which continues to be an experience in itself. Among things I managed to attend, were clinics dedicated to heart diseases specifically rheumatic heart disease.

One thing I have quickly come to realise is due to the lack of resources, managing paediatric heart conditions in Tonga is challenging. There is no access to echo – diagnosis and management is purely clinical with an ECG. You have to look for signs of disease. You have to listen and quite literally use the murmurs to play it by ear.For me the clinic was great experience in so many ways. Firstly, learning to rely on your clinical judgement without the use of tertiary resources. This is not an uncommon situation that a rural GP would face on any given day. While it may not be rheumatic heart disease we are dealing with, it’s the principals of clinical management that are important. Look at the patient. Listen to them. Listen to the story. Listen to the chest. The answer is in front of you, and you don’t always need the fanciest equipment to figure it out.