The picture is another of the bush / village clinic pictures from Leslie's adventure with the Mobile clinic. Thursday she accompanied Dr. Diane Young (the part time doctor at ABC clinic) on her weekly seizure clinic visit. Leslie says it is a tiny room, where they do a very basic medical check and dispense seizure medications. There is no testing to see why they have seizures, they just treat. Jose was at the Korean hospital in the afternoon, starting the long process of getting some sort of EMS set up. Everything here is done in small steps. EVERYTHING. And everything takes much longer than you think it will take. MUCH LONGER. Oh, well.

My afternoon was spent in the clinic, faced again with the idea that you just treat as best you can. It is interesting when one part of your brain thinks 'this is what I would do back home' and another thinks 'what can I realistically do here?' ***The following may be much more interesting for the doctors / nurses/ scribes in the group*** The lady who in the USA would have gotten a CT scan of her abdomen and a full lab work up, gets a blood count and a plain film of her abdomen, some antibiotics and warnings about possible appendicitis. The girl with a bleeding tooth extraction site (who thinks she is anemic) gets a blood count... she's not anemic but her platelets are very low, so she gets instructions on how to control her bleeding and to come back if it doesn't work... and what will I do about her platelets? Just watch them, I think, and hope they correct on their own... The most disturbing was a man with a very unusual rash / plaques on his face and arms, who has refused - and still refused - an HIV test ('If I find out I am positive, then I will think about that all the time and right now I feel fine').. the rash still has me mystified - leprosy (likely), porphyria (maybe), Kaposi's sarcoma (not quite right for that..) ?lupus? and then he opens his mouth and I see thrush... oops, I am certain he is positive. But he continually refuses the VCT (voluntary counseling and testing). He needs not only an HIV test, but also a biopsy and a skin specialist. I told him to think about the VCT and return if he decides to do it. Perhaps he will before he gets too sick. I also saw a couple of malarias and assorted other ailments. Most of the clinic patients have the same problems as those in the US - pneumonia, ear infections, bronchitis. Lots of sinus infections this time of year due to the dust (dry season) and the smoke from cooking fires. Skin rashes of all kinds. But on top of the 'usual', you have to constantly factor in worms, malaria, HIV/AIDS, TB, and other things we don't routinely think of in the US. The further out in the bush, the more the 'other things' factor in...

Today, back at the clinic. Leslie has made some great strides with the nurses writing additional information on the medical record forms. It was very helpful yesterday. I am looking forward to another challenging day.

The Malawian people are some of the friendliest, most charming people I have ever met. They are a delight to work with and be around. Please join me in my prayer that this country will continue to be peaceful and to move -albeit slowly- into the modern world of medical care.