GREEN

Everything is green! We have had some sustained rains and some hard hail, the size of marbles that dimple a car roof or hood. As a result things are green, damp, and humid. What once was brown is green and all Botswana is glad for it.

One of the interesting things about this place is that it in some way is held hostage to its own lack of food production. Some say that 80% of the food stuffs here are imported. Much of the cereal processing occurs here, much of it in Gabs, but most of the grains are grown elsewhere. The farms that I can see from the air are all subsistence type. We can sustain our own eggs and beef, a LOT of goats, but no significant and sustainable fruits and vegetables. Currently it is kale and cabbage season so much is bought from road side stands (called tuck shops) or harvested at various prisons where it is grown to keep the prisoners occupied.

Yesterday I was rounding on the peds ward at Lobatse (Athlone Hospital), one of my favorite. Recall that this was the place where we had a septic man on the ward and it was met with a touch too much ambivalence to suit me. I had just given a presentation on it and I thought we had this diagnosis well worked out. So onto peds I go to spell the CMO who is up to his "waist" in alligators. First thing I see is an infant with sunken eyes and panting, admitted two and a half days ago with gastroenteritis. She was in deep yogurt to be sure.

We weighed her only to find that she had lost weight since her routine weight 2 wks ago. Starting to sound familiar? She had a temp of 39C, a pulse of >140, and R's of 40. Dehydrated to be sure but truly this was sepsis. She was being hydrated with half strength solution, not the right stuff, and not doing well. I switched out the IV to saline and promptly discovered that her IV site was toast. I tell you I cannot devine how the staff can start IV's on these hypotensive, chubby, African kids. They have the touch and I don't that's for sure. So the nurses brought everything needed for another "cannula" and gave me that "you don't think I'M going to start it do you"? I proceeded to turn this little girl into a pin cushion, finally getting one in her foot.

By now you know the rest of the story; in goes 20ml/kg in a bolus than a flow rate to account for her at least 10% dehydration and baseline fluid needs, and a quick change in antibiotics to get after the things that cause sepsis in kids under 1 y/o. She did her part and promptly fell fast asleep and awoke cooing and hungry. Was a great teaching case in that it so very important to track a daily weight and take accurate intake and output. Oh and diagnose sepsis early and come after it with fluids. A sweet save none the less.

The little girl with marasmus-kwashiorkor is thriving. She is stimulated no end at the nursing station. She is 2 and learning to walk for the first time; and having hissy fits when she doesn't get her way. All of this is to the delight and squeals of laughter from all the adults. She no longer has the "1000m stare" and is engaging with everyone. I held her and she promptly inspected my goatee and arm hair, again to the delight of amusement of the nurses. She might wind up at SOS which is cool in and of itself. Her name by the way is Npo, "gift". Truly.

Rumor has it that she'll be around at Christmas. I probably'll go up there and play with her, show her how to use, hopefully not eat, crayons and generally carry on. Then it'll be over to Mochudi to work in the OPD with the MO on call as the pathology there is always thick and fascinating. And then the next day, I to head to the US!