I got into a bit of deep yogurt from the story, name identification, and pics I posted of "that little child in a peds unit with Marasmus" Seems that people sue for that here and that puckers some of the admin folks. Never mind that:
a) her mother died from HIV or abandoned her,
b) so did her father,
c) her brother allegedly has been seen on the streets begging,
d) she now lives in the middle of nowhere and the pics were to celebrate the fact that nurses here are amazing and that she is alive today because of them.
And of course I hear all of this second hand which is typical in our organization if not the culture at large. Nothing about how the blog praises this amazing country, just how I may have screwed up, again. OK vent over.
I have been in the pool a lot lately and have decided to represent Oregon Masters at the national meet in Atlanta. There I said it. In point of fact the pool is less a pond now that we are on the same page about chlorine. So I have run out of excuses other than I have no training partner....I know stop the whining. MJ and Bill have been great motivators and hilarious at the same time; sending me workouts with tongue in cheek commentary. I need to do more fly and IMs. I think I'll enter the 1650 and 400IM as that is where I stand to score the most points for OR. Which is another way of saying that few people in my age group are as dumb and stupid as to enter both. I did a 1650 on Friday and actually did legal turns with a pull out on every turn, all 65 of 'em. Sometimes I do more than a 1650 as I get lost somewhere around the 900 and do an extra 100 just be on the safe side. Ain't hypoxia great?
Last week I went to a remote outpost with one of my Family Medicine mentees only to find that there was no nurse for translation. So we re-traiged and discovered that most of the patients were there for the usual, "altered comfort state" and were after the African equivalent of Tylenol. They all went to the back of the queue and were furious! We triaged to the front any kid with a fever, any HIV+ patient with a fever or change in status quo, and the like. A woman who worked there was kind enough to translate.
In the first three patients we saw a young boy with peri-orbital cellulitis, an infection that can be devastating as the blood from the orbits drains through the brain and the bone there is very thin making meningitis a real threat. Then we saw a 1wk old with pneumonia, then a family with neurofibromatosis. The mother was intact but her kids were either cognitively injured of psychiatrically so. One was in status epilepticus (constant seizure), one with schizophrenia, and one who would go up to anyone and start up a conversation (something that even in this country is considered inappropriate). All had the tell tale fibromas of the face and body. These are small mole-like protrusions from the skin and they cover the body. This is of course bad enough except they can grow as tumors in the central nervous system. It is a genetic disorder that carries a risk of 50% transmission with each pregnancy and unfortunately they all lost the toss.
Never the less, a great teaching moment to reinforce getting control of ones queue. And some great teaching surrounding these disease entities.
Eli and Amber are two weeks away and we can't wait. We'll greet them, let them settle in, and then head to the north to see some amazing vistas and animals in a huge panorama. Lately the birds have been migrating and we are seeing some interesting flights of long legged cranes and others; hornbills, eagles, kites, ducks and geese.
I have been asked to present an interpretation of the effect of HIV on rural Botswana. Somewhere I got a reputation for this and will be giving it to the HIV folks at UB and anyone else that might to wander in. I'll review the history of HIV here than narrow it down to the rural impact. The real story is how HIV is affecting those that live with it and their care givers in rural Bots. These people must travel many km for care, have less reliable access to it, meds, and food. They, and their urban compatriots, are the true heroes in this saga.
Enough already. Will try to keep more up to date. Cheers!
