Musings for a Saturday morning

It‘s been a week! Outreach this week was to Mahalapye, at about half the distance to Francistown (200km) from here. The hospital is new, as in opened in the last year and rather out of place. It is beautiful with huge atria, tall ceilings, very wide corridors and large wards. It is a district level hospital that is staffed by M.O.s of various capability and motivation, not unlike any hospital in similar circumstanced in the US. It is this hospital that is slated to become the home of a family medicine residency in the next two years or so. The chair of the department is a Scot but isn’t in the country as yet. The first class of students at the med school has been accepted as of August ’09; lots to do between then and now.

Things are GREEN. In just a three week period things have greened up amazingly. Where everything was brown, or a shade of it, now is brilliant green and oh so refreshing. The travelling to outreach sites will be interesting in and of itself but with the green vistas it should be breath taking.

Our weavers are nesting and we are expecting in the next month!

As expats in the capital city it is easy to shop, eat, socialize with our like and more difficult than I anticipated to become true friends with nationals. Some of the barriers include ethnicity (read color) where assumptions are made in both directions, class where the national people that are sitting in the same eating establishment are of an income bracket that is elevated but still associate with similarly cultured friends as they are served by members of a similar ethnicity, and the like. Virtually all kids here are educated through secondary school (high school) and many attend college. I hope I can find us in an environment where this intercourse is easier or am I being too naïve?

The wards are full of challenging cases that have been handled with extraordinary skill by our current team: a national (actually Tanzanian)MO, Christine, national intern, Maposa, Penn student, Kate, and Penn residident, Keith. We had a gentleman that we thought had LP negative cryptococcal meningitis and wasn’t rallying after about 10 days so Keith looks at him and decides this just might be Listeria, starts him on appropriate medication and now our patient is laughing with us. A great save.

Another was a woman who had heard some bad news and began to have bonafide heart failure. Turns out the really IS a diagnosis of ‘broken heart syndrome” of which I was completely unaware (add it to a huge and lengthening list) where in the adrenaline (catecholamine) surge in the blood from stress causes the heart to “fail” and pump inefficiently, as the muscle is stunned but not damaged. Whodathought? We have a young guy on the service that has was started on TB meds two months ago and presented with a probable hypersensitivity reaction to INH with a significant rash, mental status changes, liver injury, renal failure and the like. We started him on steroids (dexamethasone in high doses) to combat the inflammatory component only to find out that he didn’t get any for 36 hours as we were “out” (read the ward was out but no one had gone to central supply to get more). The fact was dutifully recorded but no one outside of the nurse who did so was notified and the patient quietly slipped deeper into his symptomatology.
I found my response to this interesting in that I didn’t light up as much as was simply resigned to the status quo; making a mental note to, what…., talk with , who…., about how to fix, what…..Sometimes the energy is there but zeal is required. Frustrating to be sure, but the next patient awaits.