Getting schooled

Mark here again. This week, I worked on the male ward and, not unlike home, it seems that men here tend to come to the hospital when they are more than “just a little” sick. Often taking a detour through a traditional healer, they arrive to be admitted in pretty grave conditions. I examined a young man in his 30s who was HIV positive and stated that he started poorly about 6 days prior. When I assessed him, he was breathing 5x faster than normal and had a temp of 104F. He indeed had full blown pneumonia and was going into septic shock.  He had a white blood cell count of 1.8 (normal 8-11 or so) and had no way of fighting this due to his HIV. I saw him at 10:30am and we gave fluids and antibiotics, the only real tools we had. When I returned from a short lunch, a nurse stated “that guy you saw this morning is dead,……..but he’s the ONLY one.” It seemed to me that she was used to seeing many more and I realized again that I was not in Missouri anymore. This week I’ve seen HIV, TB, pulmonary embolism, malaria, gas gangrene of the leg, cryptococcal meningitis, psoas abscess, acute respiratory distress, bullous impetigo, alcohol withdrawal and drumroll…….2 crocodile bites. Many of these conditions, which are very treatable at home,  get a futile attempt with an ill-suited antibiotic and a shake of the head as if to say “that’s a real shame”. I’ve also performed several lumbar punctures, removed ascitic fluid off abdomens, repaired a hydrocele and inguinal hernia, and emergently removed fluid from a adolescent’s penis which was being constricted by retracted foreskin. No boring days.

            I’ve become more efficient with my assessment of patients, learned to think quickly about how to best use the limited resources I have, and gained more confidence in procedures. I also know that as a whole, we complain about our health a lot more at home. Also, crocodile bites look very painful and I don’t ever want one.

            We are having a quiet weekend in Mangochi to save some cash and to figure out a strategy to get our visa extensions without paying an exorbitant amount of money. Sweating it out in our hot accommodations will make holiday seem all that much better. On to maternity ward next week. I am excited but nervous as I expect to see lots of complicated births. Stay tuned and stay well.

If you see this sign, pay attention