Its been a week

I, finally, feel well. And found out that I wasn't, by far, the only expat with this annoying African Tic Fever. Thanks to Rickettsia africae I felt a touch beat up for a week. And the interaction of the doxycycline and Keppra lead to some rather hairy dreams and, (&%$@!!!!), an episode of seizure activity lasting about 5secs.

 

Friday I was in Moshupa with a favorite MO/mentee/Stellenbosch resident of mine, Cathy. She had some patients come to the clinic there about whom she had questions and we we able to take some time to go over them and review. We saw a post op "Caesar" ("Brit speak" for C/section) with some oozing at the site of the abdominal wound. Cathy did a great job of reassuring the patient and removing the sutures. And then we had a great "last patient of the day".

As we were preparing to leave the clinic there in walked a teenage mother with her 3 month old daughter who had a fever. I had given a talk on "fever in a child three months of age or younger" to the residents the previous week and had given the talk to all the hospital staffs I had visited the previous week.  So all we knew was she "had a fever of 38.5C" taken axillary, a great teaching moment if there ever was one.  The timing was sweet!

So we did something we rarely do in the clinics which is take a bonafide rectal temp. The axillary temps are a great way to screen but are really too peripheral for my comfort zone. The rectal temp was met with a little eye rolling but was 39.5C (103+F), so another teaching moment....What next? As I was visiting Cathy that day with a real and genuine UPenn FP resident, also a Kathy, we had a great cross cultural moment about what is appropriate, reassuring, and how to get there from here. 

We (well...me, because I love to care for sick kids) unclothed the child and began to assess whether her behavior and exam were reassuring or non-reassuring and discuss where our comfort zone was and what was evidence based.  Ultimately she had a non focal, reassuring exam and the result of our 2 1/2 heads being put together was to send her to the Kanye hospital to have some blood drawn (an FBC, equiv to a CBC) while she was re-examined there. One of my pet peeves is the lack of conversation between outlying clinics and hospital staffs.  I demonstrated how to do this and why it was so necessary. So off she went, and so did we about 40m after we had originally headed for the door.

Tomorrow Lynne and I head to Mahalapye, a town about 200k north of here to see if we could live there as this is a great place to establish a FM residency. If the answer is "no" then no sense in continuing the conversation about having a role in the new FM residency. 

I have my sweetie back, my health (such as it is with a bleepin' seizure disorder) back, and have a bright future. I'm a lucky guy.