Today was one of those days that confirmed for me why I/we came here. Outreach can be a bit of a crap shoot in that I never know what will be out there and if there is anything I know well enough about which to teach. Not unlike an average day in the clinic back in Hood River in that each day was a new one and represented a challenge in and of itself. That is what makes family medicine so fascinating to me.

 Today I visited outlying clinics and outposts in the Kanye district that is SW of here. I introduced myself and then was promptly enveloped in the patient sitting in front of the health care provider and actually had something to offer all of them at each clinic. I saw acute on chronic pediatric malnutrition for the first time and was able to invent a way to save the child an IV and a referral. The nurse provider and I had a great conversation about how to detect dehydration in a child who already has a quasi-positive tent sign from lack of calories, let alone fluids. I demonstrated how weights were essential in the evaluation of a child especially one on whom you have previous measurements; all this in the middle of nowhere. It was all very reminiscent of, dare I say it, “MSF”. The TFC kids taught this old family doc so much and some of it actually stuck, imagine. And now that I’m on anti-seizure meds things are recallable so much more efficiently, as much as I hate to acknowledge it.

 I came home through Molepolole, a town the size of The Dalles, with three times the population and a spanking new hospital. The building is so very out of place with corridors that are 200m long, empty wards, no specialists (at least a radiologist would be nice), and now CT scanner. We’re learning slowly here and in the process make many of the same mistakes well endowed developing nations make; equating physical plant with quality care.

 The drive was amazing; the African sky extending on forever with clouds and sun, brisk wind and green everywhere. We are at the equivalent of late August with the nights getting longer and days brighter and shorter. Fall, like back in OR, is more of an acknowledgement than a date.

Lynne leaves in 10 days for a tour of the kids and then the advent of our second grandchild. That would be Aven and TJ’s first, a much anticipated daughter.

 While she’s gone I intend to hit the road and visit some very remote clinics that will take a couple of weeks to really see and evaluate. Should be a hoot.