Thursday in Mochudi

Have a few moments before we meet as a group to try and decide our future course, here in Gabs and Greater Bots.

Yesterday I was in Mochudi where the morning got off to a fast start when an ambulance pulled up and out from it were poured 7 victims of a roll over out on the main highway that runs N-S. The public transportation sector is predominantly “combis”, Toyota vans with four bench seats that have a capacity of about 18, no seat belts are driven all over by guys with Pula signs in front of them. One can go anywhere locally for P3.00, about $0.50. One vehicle rolled, ejected three passengers, killing one, and injuring all the rest. By the time all was stable (used loosely here) we were way behind the rounding and outpatient visits. Patients cue up at 0700 to be seen here and are at the mercy of what little system we have on any given day. If they leave for a meal, they lose their place in the line so more often than not a day at the doctor’s office is 12-14h and without food.

In my clinic I saw a man who was 105, looked 65, and was a true delight.

On the way home I stopped in a rural clinic off a dirt road in Morwa. It is one of many that feed into Mochudi. I think that I’ll be visiting all the remote clinics in this catchment area as a model for outreach for the rest of the country.

Last night female medical had a clean kill. A woman was admitted from A&E with “DKA”. Except that while she was diabetic and did have ketones in her urine, she wasn’t acidotic and oh-by –the-way had crushing substernal chest pain and was in shock. She died this morning of her MI, blood sugar be damned. It is interesting how the emergency docs here latch on to lab abnormalities in the middle of a chaotic shift to admit the patient, absent a cogent history. And this in no way separates them from their counterparts throughout the planet.

Hope all have a good weekend,

Mike