Tuesday, November 8, 2011

Referral hospital, dodo birds, elections, and coffee with friendds

Greetings from Hawassa!
Achoo! Sniffle! Spent the last couple of days sampling Hawassa viruses and seem to have come on one of the top 10 Sneezogens. Stayed in bed yesterday but got so depressed reading about malaria that I decided it was healthier to go to work. So I did, and ended up rounding with one of the teams in a much more intense way. These are sick, sick folks that are being treated without the support of decent lab, radiological or cardiology services. I have never, even in Eritrea, felt so much like we were flying by the seat of our collective pants. 
Sickness of patients: One man who was probably 30 but looked like he was 60 admitted for AIDS and gastrointestinal tuberculosis. No possibility of abdominal ct to rule out obstruction, just iv fluids and oral tb meds and hope for the best.
Another man just came in with lower extremity paralysis and headache. It might be guillain-barre syndrome, or perhaps tuberculosis of the the spine. Intern did what she was supposed to do -- a spinal tap, but the lab wrote back that there were no cells. Extremely unlikely! And then they (the lab) did not and will not send the fluid for culture.
Two other young men with valvular heart disease, both in with shortness of breath and cough. One man had obvious pneumonia by chest xray, the other probably had just congestive heart failure. They had VERY different chest xrays but both were read in the same way -- congestive heart failure with possible pneumonia. Not helpful. 

Another elderly man came in with a cough and fluid overload probably from renal failure. But the numbers from the lab about his kidneys were completely unbelievable (a bun of 211 in a man who was answering questions lucidly) and I found out that we are unable to check the most basic chemistries, sodium and potassium.
Another man with HIV and tuberculosis who has been on anti-tb meds for months, but has a huge abscess vs. cavity in his lung, a massive bunch of bloody fluid around it and has been coughing up blood. We cannot culture the fluid even though twice we have taken it out of the pleural cavity, so we don't know if it is caused by bacteria or by tuberculosis. If it is tuberculosis then we have no means of treating, in Hawassa, Multidrug-resistent tb (mdrtb) and he would have to go to Addis. If it is a bacteria, we don't have vancomycin, which is what we would use for Staph infection. If it is actually cancer, we can't get the lab to do cytology on the fluid, either.
I was knocked out by the responsibility that these young men and women are taking. I asked my boss and the general practicioner if it would be all right if I rounded regularly with the same team so I could become more familar with the patients, something that I had not done previously but sort of flitted from one team to another. I feel kind of arrogant here -- I am not an infectious disease specialist by ANY means, but I am reading like crazy.
Have also decided that I will precede with ordering pulse oximeters and peak flow meters and have gotten, perhaps, a line on the Gates foundation so that we can see if we can buck up the lab a little. My boss has agreed that he will go with me to investigate what is going on in the lab that produces such unreliable results.
If you would be interested in sending money for the pulse oximeters  and peak flow meters, or would like to donate a book using your cme money, write to me.
On a less heavy note, took a wonderful walk yesterday and took pictures of some women harvesters and of the ncete plant (false banana) that provides Sunama people with a whole lot of their calories. Also have had wonderful storms and sunsets -- see pics.
And, miracle of miracles, an embassy lady came down from Addis with our absentee ballots and the DVD's from my Malaria Distance Learning Course from the London School of Tropical Medicine and Hygiene! Whoopee! El and I have enthusiastically filled out the ballots for Mayor and Councillors and voted to save the CPA. We send our warmest wishes to the team in Northampton!
We had a great lunch and coffee ceremony with El's colleague Mulye and his wife and sister in law. See pics.
And finally, for those who have been following the blog, you may remember the "dodo bird" that we found living near our house soon after coming here. Well, he is not a dodo bird, he is an Abyssinian Ground Hornbill, he is as big as a domesticated turkey, and he has a novia!!!! I took pictures of him (whom Adam and Emilia downstairs have named Marceau) and novia (llamada Gloria) and attached. His wattle is red, hers is blue, and in the Ethiopian way, he feeds her. We hope to see little dodos, that is hornbills, soon.
Love to you and please respond. Marty

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