The week in review

The past week has been event filled. Monday and Tuesday I followed a favorite and highly skilled MO who is also a mentee of mine through the Stellenbosch University program in SA. We worked in some rather slow paced clinics leaving time for discussion between cases and review ideas and other “right choices”. On Tuesday A.M. I also lost three hours I’ll never get back standing in line to get a Bots driver’s license. It actually came in quite handy---see below.

Wednesday we went to Mochudi where I gave a talk on HIV and dermatology, and then went to a remote clinic only to find that the MO was at a course in the Gabs area. As it is near the Zim border, and therefore a BNDF (Botswana National Defense Force) outpost, there were several guys waiting for a doc to show. One wasn’t.

 It’s only in these situations that I step in to fill the void, without a MO to mentor. I do so mostly to generate good will and to help the overwhelmed nurses. The first guy had a long course of abdominal complaints with bloating, pain, passage of mucous (pus) and blood and a VERY painful rectal exam. He had had two previous surgeries for hemorrhoids and fistulas.  I’d seen this several times in the states and as he had lost about 10kg in the last year thought he might have inflammatory bowel disease. We only have one med for this here and I started him on it with all the usual discussion and warnings. I made the mistake of giving him my card (I now have one) and telling him to call me with any problems. He proceeded to give it around back at the barracks and I have been screening calls from the outpost all week. It seems an old, western doc is valued more than a new doc from DRC (the one assigned to that clinic). Blast. So now I’ve heard about everything from drips to jock itch from these guys and each time refer them to the remote clinic on the border.

Thursday the new license came in handy as I was stopped twice. Once was just after I had picked up some passengers from a rural bus stop along the way to Lobatse. As I was accelerating away from the stop and listening how no white guy EVER stops for black people and what was the matter with me, I got jerked over for going 90 in an 80km zone. I WAS slowing down but there I was. The cop wanted P460 for the infraction which I didn’t have and let me go with a dismissive wave of his hand. In Lobatse I again went to a clinic without a doc for the day and saw patients for the morning. I was late getting back to the hospital and called there to let them know I was on the way...and got pulled over for using a cell phone as I entered the hospital grounds! Again a quick apology for being stupid and no fine. I have no luck, good karma, angelic presence left around me I’m sure. The bucket of good will is dry to be sure.

Friday I and a cardiologist from Penn who has been in practice longer than I have been alive went to Kanye, gave the same talk and then rounded on peds where we saw two kids with opisthotonus and meningitis. We transferred both here for pediatric intensive care. The prognosis is grim for both.

 Then we went to my new favorite village, Manyana. It is literally at the end of the road. There we saw a raw but very good MO who had accumulated some cases for us; peripartum cardiomyopathy, pregnancy and DVT, complex derm cases, sick kids, bad hypertension…the place was thick with pathology. We had a gas; great teaching and learning, great staff input, great people.