It is 10/6/10 and I just finished my second full day on the internal medicine wards at Tenwek Hospital.
I've been struck with extreme realities. 1 is that it's not that bad to live here! I know that my preconception of Africa was that it was some arid, sun-soaked land of yesteryear, but you know it can't be bad if I can post something up on my rarely used blog.
So, you know I have wifi up on our penthouse apartment that is lovingly called Twiga, apparently named after a character in Lion King. I'd google exactly who that is and perhaps be so bold to post a picture of it, but it would take me about 20 minutes to do that with the speed of this internet. I have never got more than 5Kbps of speed here. Remember back in the 90s when we were excited about 14.4K modems, and here I am 20 yrs later with 1/3 of the speed of dialup. Nevertheless, aside from the amoeba-like speed of the internet, I am sitting in relative comfort. I have electricity, running water, hot water, and "house help." House help means someone boils & filters our water for us. Every Thursday, we will also have "house help" come to clean our apartment and do our laundry. Now I know what you are thinking, what kind of luxurious mission trip is this, but we are actually encouraged to get house help b/c it provides valuable income to the locals who work at the variety of missionary's homes.
This is a picture of the guesthouse from our room.
That said, this leads me to my second reality. I am struck by how little I know--meaning how much I need to learn and how hard this is going to be!
Yesterday, I fell asleep trying to learn as much as I could about HIV. So now, I have just written three columns on my paper ---- about therapies for HIV treatment. Why am I learning this - well we have probably 6-8 patients now with HIV who are on therapy, and so I can't just politely nod like I know what d4T is... or "yeah let's stop the AZT b/c of hemoglobin of 5". So here are the three columns (I'm doing this so I can remember later and basically study it now) --1st choose either AZT, D4T, TFV, or ABC. Do not use AZT if anemic or neutropenic. Do not use D4T if having peripheral neuropathy. Do not use TFV in renal insufficiency. Do not use ABC if has history of hypersensitivity. Next add on either 3TC or FTC --- both have similar side effects of hepatitic steatosis and rare chance of lactic acidosis. Then finally add either EFV or NVP.
See how crazy that is? So i'm apparently the attending/consultant and my interns are rattling on how the patient is on AZT, 3TC and NVP and I'm like---what/!?!?! So I have first learned what everything stands for and now why they are on it!
So anyways, I have a lot to learn.
My next extreme reality is the crazy cases. I have at least 3 patients who were admitted with hgb in the 2s! The normal for those who aren't in medicine is typically 13-15. I have one patient with AIDS who has a CD4 count of 1, and another one with a CD4 count of 3 (normal 500-1400). One patient who has a hgb of 2.2, has also stopped walking in the last 3 weeks due to bilateral lower extremity weakness, he has excruciating spinal tenderness, and has urinary retention. I am highly suspicious for a prostate cancer with metastasis to spine as well as to marrow, but my lumbar films don't show anything, and I'm wondering if it's worth it to send him 3 hours away for mri/ct imaging of his spine.... the point is, if the guy has stopped walking for 3 weeks now due to spinal cord compression, there is little chance that he will walk again -- so why even go through with the expensive test that he would have to pay for. These are the difficulties I have to deal with here, that is not even an afterthought in the states. If I had this guy in the states, we'd have a stat CT spine and likely MRI spine done and probably would already have rad/onc "on board."
What else - - oh apparently cheryl has a kid who has pertussis, coughing so much that the poor kid becomes cyanotic (blue) and passes out, or coughs so much that she throws up, oh and what did she threw up---worms. It's just ridiculous here.
No comments:
Post a Comment