Friday, March 14, 2008


So basically everyone has the same hairstyle. Men and women both have shaved heads or really short hair that they will shave in a little while. I heard that the school girls have to keep it short so that they will not be attractive to the boys. The only way to tell school girls from boys is that they wear dressed instead of shorts. But I also think they keep it short because it is more manageable and it is basically the accepted style here. Some women from higher than peasant class have hair a little longer or in braids. But most women wrap their heads in scarves or bandannas tied on the top.

Jerry keeps us working hard on the wards from 8 am to 7 pm every night with a rushed 1 hour lunch break. At least now on the male ward I have 2 med students working under me to help out. We are still getting very sick patients compared to the female ward. On Monday a patient rolled in who was emaciated breathing fast and barely responsive. He looked like he had some kind of chronic disease but we couldn't figure it out. Jerry with his master clinical skills carefully auscultated the lungs and found a small area of bronchial breath sounds underlying the right axilla signifying a consolidation. He guessed that this person probably has TB. We treated him for everything TB and pneumonia because he was so close to death we couldn't afford to be wrong. The next day we got a lab result back of a sputum sample the patient had given. It showed TB. Jerry was right. I mentioned to the med student, Tina, wow I didn't realize you already sent the sputum good job. She responded I didn't send it. No one knew who sent it. Then I noticed the date on the sample was February 18th!

This patient had been admitted one month ago and submitted a sputum sample then had been discharged before anyone bothered to check the results. He could have been started on treatment earlier. Now he is close to death and will most likely die. As of today he is hypothermic and can not swallow. If this happened in the US it would be called malpractice. It would also be a public health outrage letting someone with TB back into the community. The second the specimen was read as positive the patient should have been sought out both to start treatment and to isolate him from others.

In the hospital he is in a separate room but it does not have negative pressure ventilation so his breath can still go all over the hospital. Also we don't have masks to wear when we examine him so we are exposed on a daily basis. Also his family that stays in his room with him in the hospital is constantly exposed to him. Also the other patients in the isolation room isolation like the ones with dysentary are exposed to him too. But this is Africa and there are no means to take other precautions. A difficult situation.

Working hard is good and rewarding. However, it is frustrating sometimes that I am all the way here in Africa and I am just working all the time. Any free time is spent eating, bathing, and sleeping. I barely even have time to check the internet. Now we also have to work both days of the weekend so that we may not be able to go on long treks.


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