Wednesday in Lobatse

Went to Lobatse today and spent a little time in the town proper during a lunch break. It reminded me of so many towns (villages if you will) in the hills of Appalachia. The building locations are dictated by the hills surrounding them and the creek bottoms below. Now that it is the Christmas season there are vendors along the streets and sidewalks aplenty. Yes, I said sidewalks. The goods being hawked are genuine imitation African schlock. The real stuff is out there just harder to find. Given that the population of westerners is relatively light most of the stuff is bought by nationals, I guess.

Again the solid merchant class is South Asian; Indian, Pakistani, Bangladeshi, and the like. These guys are real hard core and are able to scratch a living out of Lobatse but at the cost of being real bottom line minders (read jerks).Yet, they provide a good or service and in turn employment, job security, a peek at free enterprise.

As a family doc I can round and offer insight into patients on any ward so we’re still trying to figure out how to integrate me into the fabric of the hospital. My predecessor is an internist so he just saw adults. I enjoy the fact that all the MOs take patients to the OR for C/sections, lumps and bumps, and the like. Today we saw a woman at 35 wks gestation, first baby, with a “contracted pelvis” that “needed a Caesar”. We examined her and she wasn’t in labor, hadn’t had a trial of labor, and was having somatic pain. Discussion ensued but not a C/S, so a good thing all around. Because there is room, patients are often kept for longer than we would think is necessary in the western world, that plus the fact that this is a litigious society (believe it or not) means that we err on the side of too long a hospitalization, at government expense.

Today we saw a young boy with hemophilia who had a sister with a respiratory tract infection and fever. Both were admitted although neither would have been in a developed nation. We saw a schizophrenic man near the end of his natural life who was sent over by the national mental health institution so he would be a statistic at the medical, not mental, facility. We saw a man with crypto meningitis with a new dx of HIV and CD-4 count that had to be in negative numbers. One of our patients was a newborn girl with a slightly redundant labia minora that had the staff worried. A quick snip and that “problem” was solved.

The maternity ward is run by a midwife who is simply extraordinary. She knows all the patients and is delivering children of patients she has delivered in the past. All premies are fed from a cup as there aren’t any disposable “teats” and no one can clean them fast enough. So these premies york down a two ounce feeding in record time and get belly pain, all for want of a bottle. Breast feeding is discouraged in HIV + mothers who are at about 45% in the 20-45yr old population.

The drive continues to amaze. I drive by an area that is famous for a buzzard rookery, with guano on the cliffs and huge, broad winged birds enjoying the air currents. That plus the occasional baboon and life is good. All my best…..