Outreaching

I went on my first outreach yesterday to a community WSW of here about 75km. Lobotse is one of the older settlements of Botswana. The hospital is old, built in the 1920’s with walls that are half a meter thick so the inside temp can be 10-15 degrees C cooler than the outside. The drive is very reminiscent of eastern Oregon and the high desert around Jordan Valley. The flora and fauna are strikingly different (beginning with troops of monkeys and baboons!) but the geology and relatively dry climate are very familiar.

Once there, my partner, Daniel, gave a great and quick talk on the treatment of epilepsy and we adjourned to the wards to consult on inpatients. The pace there is refreshing, a more deliberate rhythm. We saw a deeply comatose man who had not received treatment or substantial workup since his admission two days previously in anticipation of our consultation. As diplomatically as possible I offered that this was guy on whom one could damn the workup and start treating for Tb, to encephalitis, to jock itch without our input and offered up some contact information so they could consult me over the phone. The workup and treatment were initiated but too late and he died that afternoon. We then saw a woman who was discharged from Princess Marina Hospital and was promptly driven home to Lobatse where she was admitted again with what amounts to significant psychosomesis (she’s nuts, but isn't malingering). She was in bed and the closer I got the longer her stare grew. She looked as though she had suffered a significant psychological insult and most probably had. I was able to walk the staff through some tricks to determine this and expand their comfort zone about how to best care for her.

We saw some outpatient consultations that were just bread and butter family medicine, and I of course was in my element. Then lunch at a local hotel with a fairly famous buffet and back to the IDCC (euphemism for HIV clinic) for some more consults. I loved every minute of it; the interaction with the MO’s, staff, patients, the rural nature of the experience and the drive, all great.

Today I’m on call for the hospital and as such get to round without all the attendant teaching. It is faster and much more efficient, just not anywhere near as fun. We currently have a 15y/o boy with HIV in end stage who doesn’t take his meds, making him no different than any other 15y/o with a chronic disease. Unfortunately this has lead him to have MDR Tb and end stage HIV, an incredible story of bravery and just plain guts. May I and the ones I love never have to show half that much courage in the face of such daunting odds. Many of these kids are orphaned on top of that so reliable adult input is at a premium and often is provided by the staff of the hospital, Baylor, or us.

As most of you know our home has been stood on its ear with tile floors being replaced. The process has left the place a dust heap. Lynne felt uncomfortable leaving the place while they were here so she was trapped as it were for four days and now is cleaning up with my help when I’m not at the hospital today. As she so aptly points out, “this too shall pass”. True, a home on its ear is no big deal in the context of why we're here. Still we're both running a little too close to empty (at least I am) and this "one more thing" is an unwelcome challenge. I think of Lynne and am struck by her courage and grace, and am eager to see how this chapter of her life unfolds. I’m a lucky guy to be sure.