Friday I was feeling almost back to normal, so Luke and I went to KCH to do hand over rounds with the surgeons and then surgery rounds. They had changed interns but many of the patients unfortunately were the same. So many infections after surgery, so many cases of wound dehiscence. I know it must be terribly discouraging to the doctors. During hand over rounds it was announced that neither the CT scan or the plain radiographs are currently working. How do you run a central hospital with only a sonogram machine? We saw a gentleman who had a GI bleed... he spoke English and his first name was Whiteman, which is funny enough, but when I asked him if he drank alcohol he replied 'of course' and his wife chimed in 'he is a drunkard'. They both spoke English. His wife said 'someone needs to tell him what will happen if he keeps drinking'. One thing I find fault with in the current medical system is the hesitancy for clinical officers or doctors to give patients information. I told Whiteman that if he continued to drink, he would likely bleed again and could easily die from a GI bleed. He acted as if those ideas had never crossed his mind. He was a very cheerful sort, but his wife was obviously taxed to her limit with his behavior. Another elderly gentleman was there for 'palliative care' according to his chart, with a history of esophageal cancer diagnosed in January. He was literally wasting away. When I inquired of the interns if anyone had discussed his diagnosis / prognosis with him or his family the answer was no. I suggested that meeting with the patient and his family and having an honest discussion was the best thing for his care. I am not sure that will happen. In the medical field, we seem to do poorly when faced with death; I don't remember a single class or even lecture in 'how to tell someone they are dying' when I was in school. It is a shame because we are who many people turn to in their time of trouble, their illnesses, their despair and we should be able to share the truth with them in compassion. It is hard to walk that fine line between honesty and destroying hope, but folk need a chance to 'get right' with their friends, families and most importantly their God. Otherwise, I am always surprized by what ends up on the surgery ward - ascites diagnosed as an abdominal mass, an allergic reaction to bee stings (treated in a most extraordinary way), and an abscess that appeared to be in the joint and needed ortho attention. I also ran into the Cuban Urologist who complained last year that he never got an theater (OR) time to do his patients. He is now over 1,000 patients behind who need surgery! What a shame for these patients, most men, who have some increased prostrates and suffer with difficulty urinating! All in all, it was an interesting morning.
Tomorrow we are hoping to be at the Maula prison for a clinic. There was apparently a jail break from there sometime in the last year. Charles said it was the first jail break ever, and it involved Nigerians I think (not Malawians) who freed their friends but left every one else locked up. Now there is a new director at Maula, security (which was so lax it was scary) has been tightened up, you can no longer drive your car up to the gate and unload stuff (or actually drive onto the prison grounds as we did many times). I had to write a letter requesting to do a clinic and now we are waiting to see if they will approve for tomorrow. I respect that they needed to increase / tighten security, but it is a little tiresome at times.
Enjoy the photos! Keep us in your prayers, as our plan next week is to go to Salima and Pothawira again, then escape for a couple of days at Nkhotakota so Luke can really see the lake, then drive back through the central part of the country. Should be an adventure!
Our 'offices' - a school room. Luke is getting ready to examine a patient while TK (his translator) looks on. in the background you can see Nancy doing a malaria test.
I am at my 'desk' the elderly gentleman had some prostate problems I could no fix, but referred him to KCH urology (see notes above for how well this might work out!) The lady leaning over intensely had just had a malaria test done.
Here I am examining a ladys' hand. I always try to position my 'desk' by a window so that I have a breeze and some light!
Luke and TK talking. Notice I positioned him by a window, too!
Some of the secondary school girls at the project. They currently have an infestation of bed bugs in their 'dorm' and had to burn all their mosquito nets but the critters are in their mattresses, in the cracks in their bunks, etc. If anyone has a heart to help these girls (this is just a sample, there are a bunch of them) contact me and I will attempt to put you in contact with the lady that is helping these girls.
One of the secondary school girls presented with what I think are keloids on her feet / ankles. She stated that her feet swelling 'very big' and when they went down she had these scars / marks. She is unsure why they swelled and did not have her health passport with her.
Nancy McGlawn doing some wound care on a gentleman's thumb
Henry ('Lidson') doing some triage. Well, actually he did all the triage!
The team minus TK, Jessie and Luke. From the left - Nancy, Winfred, me, Lidson, Lewis, Joey.
My after dinner activities - pulling a tooth in my dining room with Luke's assistance. I am holding his tooth in that piece of gauze. I am going to try to NOT make this a habit. I really don't like teeth!
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