The day after Thanksgiving

It’s been a week of outreach and fun. It will come as no surprise to my family and those that know me when I say I finally felt like I was in my element. I had the pleasure of sharing three sites with Daniel this week as he is signing off and moving back to Oz where he is to do some locums in N. Queensland and at some point begin a fellowship in Infectious Disease. His input and hand holding have proved invaluable.

On Tuesday we were in Kanye, a town of about 50,000 NW of here by about 100km. The hospital sits on a bluff overlooking the town. The staff there is well trained and dedicated and eager to have discussions about alternative ideas for care of their inpatients. Like many places at the district level and below, they over treat and do so out of fear of missing something. It is always a pleasure to reassure them that they are treating the patient appropriately and that what I have to offer is simply one more right way to care for their patient. Generally they are relieved to hear that they can use fewer meds and have as good a therapeutic effect.

Wednesday we were in Lobatse, about 100km WSW of here and had a large outpatient clinic waiting for us. The frustration is that the medical staff, while quite strong, view me not as a teacher but as another provider so they can go about their hurried and harried professional lives without my teaching component, which after all is the purpose for outreach. I’ll need to slowly work on them. I spent a fair amount of time undiagnosing and withdrawing meds from patients, spending LOTS of time reassuring them that their doctor is quite intelligent and that mine is simply another idea based on more experience/mistakes, that’s all.

Yesterday we were in Mochudi, about 60km NE of hear where I finally, after three months, had a chance to round on some (lots of) sick kids. I of course loved it and discovered I was actually able to teach more about this aspect of care than adult medicine. We were again able to reassure the care providers and basically clear off the service for the weekend. There were toddlers everywhere with scalding burns, febrile seizures, asthma/bronchiolitis, marasmus (malnutrition; really took me back to South Sudan), cellulitis, pneumonia, and the like. We saw some clinic patients in the afternoon that were very reminiscent of the US. One was a man, with his wife of 35 years, who was becoming progressively demented. Her care for him and the discomfort that each had for the current status quo was exquisitely touching.

Then is was home for a traditional Thanksgiving dinner at Mallach House with all the Penn folks and students/housestaff. It was a hoot. And I ate like one would back in the US, waaaaay too much, delightful.

Tomorrow I’ll climb a local hill early in the morning before the bad guys who rob and harass you are up. It should provide some beautiful vistas. Then Lynne and I will drive some of the back roads around here out into the desert and enjoy the green wide open spaces, and rest for the coming week. It’s my intention to get farther out into the sticks and visit the primary hospitals as well as the nurse run clinics and get a sense of how things are done here. I only hope I have something to offer in return for the privilege of doing so.