Random randomness

Some random thoughts and observations:

-Having Matt here is GREAT. He is a natural teacher and mentor, and a great partner with whom to discuss medicine and life.

-I went out to Kanye to teach my Family Medicine residents from Stellenbosch (did I mention I PASSED the boards?). They are all bright and gifted docs. Three are national Botswana, two are from DRC and one from Uganda. I spent the next day with one of them where she was working in what is known as the IDCC (Infectious Disease Care Clinic). The euphemism breaks down in that everyone who is there is aware that they are in the queue because they have HIV and are getting their monthly clinic appt. We saw a 50'ish woman with a year long history of post menopausal bleeding, and she was a classic "last patient of the day" story. She was bleeding enough that she was concerned and mentioned that she had to wear a pad. My MO was close to blowing all this off as she needed the time to study and for other things. I recalled to her that a wiser attending than me had once said that I should never miss the opportunity to place my finger in a bleeding orifice. So after an appropriate eye roll she went to the clinic next door and found a speculum, brought it back and inserted it. She is really good but I I had to get a touch testy saying that this is what I, as her mentor, expected from her.

We couldn't visualize the cervix easily for all the blood. So recalling that adage from an attending smarter than I, we did a manual exam; the first in a year as this was always temporized by other MOs in the out-patient settings. She had had an ultrasound of her pelvis and a PAP smear but no true exam. The PAPs are done under dim light often without a manual exam and then they become important only because we finally did one and found a fungating squamous cell carcinoma involving the cervix and vaginal side wall.

Blast and damn, this should have been picked up months ago and wasn't. It occurs much more frequently in HIV and should have been expected.

-These talks we give are all patient based and have apparently become quite popular. There was discussion about substituting another speaker for us on a Wednesday in Mochudi and the hue and cry was flatteringly great enough that they scheduled around us, WOW!

-We flew! Yeah, out to Tsabong where I felt so at home it was a touch spooky. It is a town in the far west of the country that takes 6-7hrs to drive to or 56min to fly. We took off with me in the right seat (thanks for the suggestion For') and had a gas out there. Very reminiscent of Hood River and the old Hood River Memorial Hospital; small number of beds, small staff, everyone knows everyone, and great comprehensive general care.

We spent a fair amount of time dissuading them from transferring patients to Gabs as the care here offers little more than what they get there except some more comprehensive testing. Specialist consultation can be obtained over the phone and is often sketchy depending on the motivation of the specialist. I swear some of these guys (all expats from various backgrounds, training, and medical cultures) look for reasons NOT to intervene when it stares them right in the face. They embody an arrogance and indifference that is the ugly side of medicine. The only indication for transfer to the ICU here is imminent death (i.e. an 02 sat of less than 60!), and one has to get on bent knee to plead with an anesthetist(!) for transfer. We tend not to look for quality as much as to fill the specialist slot with a widget. As long as the slot is filled....

Hope all are well. Now that the boards are over I can try to learn Setswana. Ke a leboga! (Thank you)