Taking Account

4-13-08; adjacent is a photo of the "theatre." As you can see I have finally figured out how to publish the photos. I have added some photos to the older posts if you are interested.

Well, I've been here one week and feel like I have finally settled into the routine here. The only problem is there is no routine.

I am now covering both the Green and Blue team. Dr Paul Jaster from Kansas is on vacation this week before his children start back to school, so I am covering the Green team for him. Overall I have about 14 inpatients on the medicine ward. Three of my patients nave passed away this week. I can't think of any other time in my career that I have lost three patients in one week. Unfortunately, these will not be the only ones I will lose. Death is common here...

Most interesting patients I currently have are related to illnesses that I hardly ever see, HIV/AIDS, TB, malaria. One young lady has Scrofula (tuberculous cervical lymphadenitis) you don't see that often in the US. I have a couple of Somali women who have old femur fractures (2-3 years old) with non-union. I can't imagine how much pain they must have been in until arrival here. I have three patients with TB meningitis/AIDS, they will not make it out alive.

I continue to be amazed at how so much is done with so little. Last night was called to consult on multiple cases in L&D. Lady with severe HTN (BP of 170/110 and normal labs/urine protein); another with twins and a cerclage at 22 weeks who is trying to labor; another who is bleeding at 18 weeks and will likely lose this pregnancy. We have women who are attempting a trial of labor after cesarean. We don't have intruterine pressure catheters, fetal scalp electrodes; there are only two electronic fetal monitors and they only record the fetal heart rate tracing not the toco. We can't print out more than 5-10 minutes of a tracing due to lack of paper. Therefore many of the residents and interns don't know how to recognize fetal distress.

Today is my first night off Labor call in a week. Nice to be able to relax a little. Went to Mama Chiku's for dinner: beef stew, chapatis (tortillas), samosas (beef filled, fried croissants), and Chai (tea). Food was cooked over an open fire. Walked home in a light rain and darkness.