Some Vignettes

Yesterday I was in Lobatse where I usually round on the pediatric ward. I feel I have something to teach and the kids are sometimes not seen for several days as the MOs are swamped. As I was seeing a particularly sick child I heard some kid-chirping from the ward next door. I turned around and saw three toddler boys, in for malnutrition and recovering well, who had all discovered their reflection in the glass that separates the two wards. Well....wasn't this just more fun than a two year old should be allowed to have! They were all giggling and laughing that infectious toddler laugh that immediately had the rest of the adults howling. Soon we were all a puddle of laughter and tears. What made in more fun is that I could see it from the "other side" of the mirror/window. The look of absolute joy that was shared between these guys was priceless.

After I rounded, I connected with my friend Roger and we worked the "casualty" (ER) together. Soon after we arrived we were alerted by a nurse that a child was "looking poorly" and could we take a look. Out into the hallway (isn't there always one in every ER, in every country?) we ventured only to find what turned out to be another in what is becoming a long line of septic kids. This one apparently had a seizure disorder and had been doing so more frequently the last three days, probably leading to aspiration pneumonia. He looked the usual for this disease; pallid, sunken eyes, temp of 35C (!), very irregular respirations, in short circling the drain.

It is always tough to get a line in these kids but after too much poking, including two IOs we (well Roger) finally got in an e.j. and I poured in fluids, gave him some antibiotics, and was reassured when his breathing became more regular. Then he fell asleep.

Today I returned to Lobatse. It is a national holiday and I really enjoy teaching/working along side of the MOs without all of the background buzz that is any hospital on a common work day. I rounded with another close friend of mine, Asumani. We first saw a horribly affected man with HIV and Tb. He had started anit-Tb (ATT) meds and had had a terrible reaction to one. The medical term for it is Toxic Epidermal Necrolysis, a term that sounds as bad as it is. Picture a man who is loosing his skin to the depth of a partial-full thickness burn all over his body including the mouth and esophagus and you get the picture. The nurses wanted to transfer to Gaborone. I assured them that the care he was receiving in Lobatse was on a par or better than in Gabs and we started to address his needs. I put in a feeding tube as he is profoundly protein calorie malnourished and simply can't eat the 3500 cal he needs per day. We changed the ointment to be applied to his skin and eyes and now hope for the best.

I went back to peds to find the child from the day before walking around and acting the willful two year old! Whew....

Another guy who was admitted with chest pain yesterday was all over the ward, with, as it turned out, nothing other than malingering. Something seen frequently surrounding a holiday.

Then a five week old with gastroenteritis and dehydration: iv-fluid-meds-ward.

I bid Lobatse farewell and went to Kanye where we had a hugely busy afternoon with a great MO there, Samuel. In came a guy with his head split open, BY HIS SON. The son had been beaten about the head and both were still yelling at each other. One of the med students asked in horror if they had been drinking to which a knowing nurse replied, "Of course they have been drinking!"

The local "beer" is a very irregular swill that is made from fermented sorghum; lumpy, and tastes like the after taste when one roops! Yes, I can say I've tried it. You can smell it from across town and on the breath (if your are brave/stupid enough).

Then off to home.

One of the true delights as I drive home from Kanye is the rural areas on the way to Gabs. I try to pick up as many hitch hikers as is prudent (the roads are full of them on a holiday weekend) and take them to their door, to their great surprise and pleasure. This of course happens only in our vehicle, not UP's ( insert insipid smiley face here). It's a fantastic way to embrace the people and culture.

I stay fortunate in all these roles; with Lynne, our kids, and here.