This has been the week to confirm in my mind why we are here. Wednesday thru Friday I had a chance to teach in clinics that were way off the grid. Wednesday I arrived in a clinic associated with Mochudi district, north of here. The clinic is on the SA border and way off the beaten track.

As in many places in this part of the world, women here are worked to the bone, especially in rural areas. As a result one of the few ways they can take a break is if they are “sick”. So they come to the clinic and are in exaggerated extremis with hand to forehead fainting, general body failure and “altered state of consciousness”. The nurse or physician (if indeed he is there that day) will receive the woman and designate a family member to be her advocate as she rests. She gets an IV as that is what is used to treat this. When you think about it, it makes sense in that she is “forced” to rest for about 3-4 hours as the iv goes in, “recovers’, and goes home to her multiroled and exhausting life.

So as we entered the clinic two nurse practitioners were in the middle of treating a couple of women in this modality. We were invited to evaluate them mostly as a courtesy to us in recognition of our station. The problem was that both were septic. Sick to be sure but getting as IV wasn’t about to address the problem. So this was a great opportunity to reinforce the clinical skills the nurses were demonstrating and at the same time discuss what represents infectious disease in an HIV/Tb infected woman who appears ill, why to take vital signs more frequently and when to transfer. Interestingly each of these clinics has an ambulance on standby for that very reason. We are a touch dollar (Pula) foolish over here: huge new hospitals in many districts that are empty when what we need are more providers and decentralized imaging/lab. Oops, sorry, rant over…So off they went on a 60km odyssey to DRM Hospital in Mochudi, hope they made it.

Yesterday I was at the central clinic in Kanye where there wasn’t a doc as he was “at a conference” so a nurse practitioner and I saw about 50 pts with lots of teaching opportunities involved.

The weather is like late August/ early September back in the Pacific NW, hot and dry. All the grass is seeding out so allergies are at a max and many people come in plugged to the gills. For some reason the grass along the roads is whipped down with a curved machete like tool. It keeps people employed but is unbelievably difficult work. All the vehicles are covered with a fine layer of pollen.

Speaking of which; there are no junkers here, no shanty towns, no homes with cars on blocks in the yard, litter in the street. It is a very fastidious society that is predominantly middle-working class, educated (at government expense), and one used to a tradition of due process. They/we have the usual weird circumstances inherent in an emerging nation with deep pockets (see above and previous rants).

So why am I here and not trying to “make a difference” in, say, Appalachia, the depressed Mid-West, inner city Gulf coast? Well, I only have so much time left in my career and with 1.8 million people here in a country the size of Texas I can find the handle and begin to manipulate health care here as this nation gets its first med school, FM residency, and residencies in peds and medicine. And I am a citizen of the world.