6-11-09- Thursday

Today was pretty cool. My trip to Thamaga began a little later than planned (about 7:30am) as, of course, we are on Africa time here. It was only about an hour out of Gaberone but, indeed, in the middle of no where. It was tiny hospital with about 3-4 doctors and 1-2 MOs and a bunch of nurses. The COE visits them about once a month, so, the hospital schedules all their difficult pediatric HIV patients for that day. The docs from the COE (Norma today) would come in and show the MOs and nurses and doctors how to treat these patients. What I should mention is that there are no pediatricians and the MOs only have general training. So when it comes to peds HIV cases, they are mostly very lost.

When we first arrived they were having their weekly lecture on adherence of all topics. The patients calmly waited outside. It was in this tiny tiny room (or atleast it seemed that way with the entire hospital staff in there) with one computer and an old projector pointed to the largest wall. It was still a small screen but no one seemed to mind. The doctor, dressed in a pretty fancy suit, gave the talk in a think setswana accent.

After the lecture we went to the ID ward where we will see out pediatric patients (just a tine room with one bed and one computer). They told us that there will be 14 patients. We had to leave by 1 to get back in time for Norma to give her advanced pediatric HIV lecture at the COE. It was going to be tight. To speed things along, Norma had me bring in the patient and start the interview and physical exam while she reviewed the chart. I’m pretty good at the specialized HIV focused exams now. Its basically a quick head to toe to develop a list of possible OI or complicating abnormalities. I have gotten this down to about 5mins per patient.

After the PE is done and I chart the findings, Norma and I discuss the plan. Believe it or not, these “difficult” patients had better adherence and better health than the ones we see at the COE. So most cases were dosing issues, simple enough. On my physical exams I found some things I’ve never seen before. Kwashiorkor, irregular regular heartbeat, Tinea Capatis (lots of this actually; also got a picture of some online) and a couple enlarged livers (one probably due to a mother giving too much medication to “get her son better faster”). Also, the General Lymphadenopathies on these children is always extensive, even if their virus is well controlled. It is a good lesson for me because I was never sure if I felt them on the bodies of patients back in the states. Now I know exactly what it feels, looks and moves like.

The entire experience was very cool and the hospital seemed to enjoy us being there. They asked a lot of questions and generally seemed in good spirits. We bonded well with them and it was hard to leave.

When I got back to the COE, at about 2:20pm, I rushed to get her lecture printed and photocopied and then sat down to get my life organized again. That’s when Mariyah told me that our trip to SA this weekend was a go and we had to fax all our payment info over to them. One problem, it didn’t work. So we left for the night not knowing if out tents were still reserved for us. Mariyah will e-mail them this morning; hopefully this will all work out.

I finished the day going to the gym, eating dinner, and watching no country for old men. What a weird movie. Goodnight!