Hail yes!

I went on outreach to Mochudi yesterday, a town the size of The Dalles in area but with probably 1.5x the population, that has a hospital and a well established medical community. It's only about 45 km from here to the north. They have a nursing school where the female students wear hats and dresses while the male students wear white coats. All are beautiful and eager to learn. We held bedside rounds on numerous patients on the wards that were a true delight. Many nurses, students and staff along with the M.O.s who were caring for the patients were there and entered into the discussion.

For the medically inclined, we saw another case of Progressive Multifocal Leukoencephalopathy (referred to as PML mercifully) a rare neuro-degenerative disorder that is much more prevalent in HIV+ individuals. The prognosis is horrible but the dignity with which the patients here endure is moving to the core. I also "undiagnosed" a series of worrisome problems that, as is sometimes the case with the MOs, are generally over worked up. In medicine the danger in trolling through the lab is that an abnormality even if trivial will lead away from the proper diagnosis. The MOs, afraid of missing a diagnosis, do what we all so often do, compensate for their insecurity about the disease process they are witnessing by generating lots of data and trying lots of remedies. I find I spend a lot of time teaching about “other right ways” of reaching a diagnosis and treating illness.

We had lunch in a chicken place in the downtown area that was interrupted by a HUGE hail storm, stones the size of 3cm. It tore apart the roof of the lunch place and water cascaded in all directions. In all we must have had 5cm of ice and rain in 20min.

The quiet dignity of our patients and attendant families continues to impress me. We are caring for a 16 yr old boy with AIDS from birth (mother had it) who has cryptococcal meningitis. If you make it to your teens with HIV here you are usually cared for by relatives as your father may be dead or never was in the picture, your mother is dead and you are bounced from pillar to post by generally well meaning relatives. By now in your life you look different; quite small for your age, are thin and chronically ill, have a different circle of friends and experiences (the staff at Baylor, other HIV kids, the hospital staff that is indifferent on a good day) and need to take meds daily. And even if you do everything right you still get sick, REALLY sick, with increasing regularity. This boy wears a plastic bracelet with the national football team logo, the Zebras, on it. I wrote a note to the team, conveniently based here in Gabs, to see if one of them could visit with a jersey for our young fan.

My current team has a third year medicine resident, a fourth year student headed into Peds, an outstanding Batswana intern, another outstanding MO, and me. The team is bigger than I’ve experienced and makes for some lively discussions. We (actually they as I was away yesterday) got slammed with 12 admissions over night and to their credit they did fantastic. The Penn people were the only ones there as our intern had a death in the family and was on the road home, our MO is on a two week leave, and I was in Mochudi. So here’s to Keith and Kate, great work by two excellent examples of bright dedicated physicians in training.

And here’s to you all for your support. The comments, letters, chat, Skype are most welcomed and help us more than you can know. We blessed to have you in our lives. Thanks…..