Tuesday, September 28, 2010

Medicine in the Bush

Dinner - Fisherman's Gate on Lake Naivasha with the Fishers, Rod, and Melanie


Cold, rainy Monday but an interesting day at the hospital. I was in surgery clinic from 8am-5pm, and our team saw approximately 60 patients. The most interesting thing was this crazy papillomatous mass on a woman’s tongue. I saw really severe bladder and pancreatic cancer and a ton of prostate and breast cancer. The horrible issue with breast cancer is that the women here are not bothered by lumps in their breasts, they are bothered only when they become ulcerated and foul smelling. One 38 year old woman was here 7 months ago for a biopsy of a 2cm mass in her breast that turned out to be infiltrating ductal carcinoma – she never followed up, but now since it is disgusting and ulcerated and smells she comes in and it may be too late to operate. Many do not have phones here so you cannot just call them up and tell them to get in because their pathology came back badly. I also saw a 30 year old with HIV who presented last visit with a CD4 count of 15 and tuberculosis. He is still being treated for TB and now has esophageal candidiasis…yikers. It is horrible how bad these patients are before they come in to the hospital. I think part of it is how tolerable they are to pain and a lot is money. 500-700 shillings can feed a family of 5 for a week. That is around $6! A culture and sensitivity costs about that much so you have to weigh the value of getting tests against food for the family. Side note: I cannot believe the speed at which these people suck down the HOTTEST BEVERAGES! I had taken maybe two sips of my
Crazy large cactus.
Monday night I was on call with one of the Clinical Officer intern which is like a Physician’s Assistant in the US. He is super bright and helpful. I got to stitch up some guys face by myself, no supervision involved, which was pretty awesome except I took so long I think the lidocaine was probably warn off by the time I finished! He was a tough guy though, and it was his face! So I wanted it to look good!! A 37 year old patient presented to us with what appears to be chronic renal failure – according to the doctors that is pretty much a death sentence over here especially if they are HIV+ (which like 70-80% of patients are) because no one will accept them for dialysis.
Tuesday I spent the day in internal medicine on the women’s ward with the CO intern, Michael, again. Dr. Lechford (sp?) was our attending, and he went to school at UTMB too! Woo hoo for UTMB. We have another really sad patient who looks like she has mental retardation but approximately a month ago was completely normal – she has TB meningitis. So so sad. I am most likely going to seroconvert on my next PPD for all the tuberculosis we see here! I watched one of the radiologists from the states do a core biopsy of a liver mass as well. He is really excited that an American company (I think Siemens) is considering giving AIC Kijabe Hospital and old CT machine that does 4 slices – in the US the most modern CT scanners used do 256 slices! That gives you an idea of how ancient and restricted this place seems, but they do amazingly well (thanks to Jesus Christ) with the little that they have.
Poinsettas grow everywhere here! I love Christmas!
So that was lot of medical talk. Sorry! More interesting blogs to come soon because I’m going on a SAFARI THIS WEEKEND! J
 A note on my sleeping: IT IS HORRIBLE! I tried not taking my sleeping medicine two nights and had the most miserable sleeps ever. My parents especially will find it not at all hard to believe that I am freezing at night wearing PJ pants, 2 shirts, my North Face jacket, a sheet, 2 knitted blankets, and a comforter. Oh where, oh where is my heated blanket!?

Haven’t had a chance to take my large, awesome borrowed camera (thanks Richard) to the hospital for cool pictures, but I will post some as soon as I can!

1 comment:

  1. I cannot understand half of this post - medical speak galore! You're so smart!

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