I was in Lobatse today, a town about the size of Hood River 80km southwest of Gabs. I work with the medical staff at the local secondary hospital there. Picture Princess Marina Hospital is one of two tertiary or referral hospitals, and Athalon Hospital in Lobatse is one of many (but less than twenty) secondary hospitals.
These are very familiar places to me as they are run by MO’s or the Bots equivalent of family docs. They are all trained in neighboring countries as Botswana has done a very good job of affording education off shore for its med students but hasn’t figured out how to attract/require them to return. It might start by giving a competitive salary, increasing the number of docs in country, and the like. Interestingly one of the countries that export docs here is Cuba. At last count they had 50-60 physicians spread out all over the country. They come for a two year hitch as they can make more money here than in Cuba. They are well trained and very astute, and bored to the core as there is no night life that can come close to that of Cuba; no passionate music, food, relationships. Yet they come here for a two year hitch and often stay longer.
In Lobatse I met with the medical staff and discussed OB (a 39wk gestation woman with a subjective sense of decreased fetal movement), which lead to a discussion of litigation which is rather common here. Suits are filed against the Health Ministry as they are the employer of the docs here for the most part. After the suit settles as they all do there is an inquisition about the case and it apparently can get rather animated. It was an amazing discussion about how we all practice “cover our ass” medicine even if we are 11time zones away. And more to the point, how do we maintain confidence in our care after said inquisition, how do we continue to practice evidence based medicine even if we are in a resource poor area, a very informative and lively conversation with 8 docs from five countries.
Things always quiet down from 1:00-2:00pm for lunch. I hopped in the car and headed over to the civic center (read regional government) for discussions and to gain permission to travel and teach in the surrounding and more rural clinics. I still need to jump through lots of hoops but am getting close. Back to the OPD to mentor the docs there.
We discussed optimal dosing of one med before adding another, stopping antiquated medications such as methyldopa (still on the formulary here), not using 3gms of metformin and instead spending time getting a 24h recall of food intake and initiating some diet counseling, and the like. All of this is time consuming and therefore frowned upon when one is charged with seeing and treating 50-75 pts in a day. So it is a hoot to have these conversations and see the wheels spin.
As I was waiting to begin the OPD I notice three elderly men standing under a tree with three walking sticks all involved in animated conversation. I was impressed that this social intercourse was so sell developed and present everywhere here; conversation, smiles, laughter, always laughter. They were each here for refills of their blood pressure meds and had to register early in the morning, go without food to maintain their place in line through lunch and wait to be seen, for less than 5min sometime in the middle of the afternoon. Always gracious, smiling, grateful.
I met a rarity today, a euro-Batswana who was 78, born in this country before it was one, who was fluent in several languages, who was full of historical perspective on her experience here in the bush low these many years. What a treat and privilege.
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