Dragged myself out of bed at 6:10, because Kat had to be back at the hospital for a meeting at 7:15, and I wanted to go to morning rounds with Dr. Kung at 7:30. Ugh. Also, forgot that I was planning to wear sandals to walk to work, then change to heels, so my feet were already a mess by the time we got there. Double ugh.
We were a little late to rounds because Dr. Kung and Kat were still trying to work out a glitch in the database program. Residents were giving presentations on the patients they admitted from the night before, which was super interesting. The diagnoses were not particularly different from what you’d see at home – a bunch of pneumonias, an obstructive jaundice, and a few more complex ones that the attendings GRILLED the residents about. I felt kind of bad for one of them. Almost.
After presenting their patients (each one had four), an intern gave a presentation about “fevers without known source/fever of unknown origin” (aren’t those the same thing?). Let’s just say that reading off of their Powerpoint slides is a weakness among presenters everywhere.
Things finished up around 9, and then Dr. Kung gave me free reign until the clinic opened at 11. I went back to the peds ward to start working on the patient list she had given me, and woah buddy, do I have my work cut out for me! I mentioned the logs yesterday, but let’s backtrack a bit here – there are two computers here, for the entire hospital. Charts are all handwritten. So when a child comes onto the ward, the only record that they’ve been admitted here is this logbook. All of the entries for a given month fit on two to three pages, but somehow they’re not actually in chronological order. My guess is that kids aren’t always entered right when they get admitted, so things get pretty jumbled when they finally do get entered. Which makes my job, finding a specific admission date and trying to decipher handwriting spelling names that I can’t even pronounce, pretty difficult. I made it through about a third of the list, then headed to clinic. Being my usual directionally challenged self, I had assured Dr. Kung that I would be able to find my way to the clinic on my own, but as soon as I walked out of the ward I realized that I had no idea which of the buildings it was in. I walked in circles a few times, but I generally followed the signs to “Clinic” and actually made it there before Dr. Kung. Go me!
I already knew that today would be busier, because I had seen the list of patients the day before. To put it in perspective, yesterday we saw 5 patients; today, we planned to see 9. We started off a bit late, but then got even further behind because we were being super-thorough on one of the new patients. There was a brother-sister pair that both had pretty bad asthma, which wasn’t helped by the fact that the mom wasn’t giving their medications like she should. Dr. Kung performed a lung function test on them, which was very fancy and computerized, but she had brought all the equipment from home and had to lug it all back with her at the end of the day. It was interesting, because the program uses a graphic of the Big Bad Wolf from the Three Little Pigs, to tell kids to “blow the little pig’s house down” for the test. Unfortunately, none of these kids knew that story. Needless to say, the makers of that program are not culturally sensitive.
Clinic seemed to go on FOREVER, because we had so many more patients. Dr. Kung kicked me out around 2 to get lunch. I only missed one patient though. The last patient of the day was THE cutest kid I have ever seen. The poor baby has been sick since age 3 mos. Part of the right lung collapsed because the illness was so bad, and it still hasn’t reinflated properly. An invasive procedure would let us look inside and see what’s wrong, but there’s neither the equipment nor the pulmonologist to perform it here. The family would have to go down to South Africa to get it. Boo.
Earlier in the day, I mentioned to Dr. Kung that with the medical record numbers I had found in the morning, I was thinking of submitting a request to medical records to start pulling the patients’ charts. We were anticipating that it would take a while for our request to be processed, so I thought it would be good to get the ball rolling. She told me that she was still waiting for IRB approval, even though she submitted the paperwork at the beginning of April! This is beyond normal Africa time delays – there has been a strike going on here since Easter, with almost all of the teachers and government employees asking for a 16% salary increase. A few other interns’ projects have been affected, but this is the first time that I’ve encountered a problem personally. Ugh.
After the last patient, Dr. Kung, a nurse and I cleaned up, then she gave me a ride home again, which was nice because I was really tired. In spite of that, we decided to go to Riverwalk when I got back, because the Rice girls hadn’t been there yet, and we needed groceries for dinner. Between the three of us who are splitting groceries, we somehow managed to spend over 600 Pula. That food better last us a few weeks.
We knew before we left that we would have to take a taxi back, because it was after dark, but we realized as we got ready to go that we had 5 people, and taxis here are only allowed to carry 4 people. We tried calling a few of the numbers for reliable taxi drivers that we had in our phones, but they were all too far away, so we grit our teeth and decided to negotiate with the rando taxi drivers that hang out in front of Riverwalk. We ended up having to split up into two taxis, but we bargained the price down to 20 Pula (normally it’s 25). Lina and I made it back before the other two, and we had time to pull a splinter out of Lina’s finger (received from one of the lovely roadside bushes on the way there), put away all of our groceries and boil a pot of water, and the others STILL weren’t back. Minor panic moment, but it turned out that they had just gotten dropped off at the South gate and got lost trying to find the dorm. Whew.
Made pasta for dinner, yum yum! We had bought kumquats at the grocery store, because we were intrigued that the label said you could eat the skin. Basically it’s like a bite-sized orange. But Julia bit into one, and it was black on the inside, so now we’re all terrified to eat them. At least we tried.
Also, Lina managed to load the Grey’s season finale on her laptop while she was at work, so we all crowded around her computer to watch it. IT WAS AWESOME. But it meant that I stayed up later than I meant to, which does not bode well for tomorrow morning…
Life Lessons Learned in Africa, Part III:
1. Interns/residents are terrified of attendings no matter where you go.
2. It is a bad idea to become addicted to any TV show before going abroad, let alone three shows (DON’T TELL ME WHAT HAPPENS IN THE GLEE SEASON FINALE).
3. Instant coffee does not provide anything near the same level of caffeination as regular coffee.
4. If you don’t put away your food, bugs will crawl in it. In fact, bugs will crawl in/on anything. Including your bed. If you don’t like squashing them, you are SOL in Africa.
5. Grocery shopping while hungry is not advisable – even when bread only costs $1, all that crap you put in your cart adds up.
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