Nsanje District Hospital
My office is in the Nsanje District Hospital (NDH) with the mentors whom I supervise. Here there is no WI-FI and I have to wind my way for about ten minutes through the backyards of villagers’ homes running into guinea fowls, chickens, goats and dogs back and forth to the MSF office to use the internet to check my work e-mail which seems to inundate my mail box all the time; or I could call for the land cruiser to give me a ride but I prefer to walk. The various health facilities that I visit regularly have no access to internet either.
There are daily “Handover Rounds” or morning reports at 7:30 in the morning except on Wednesday when they have “Grand Ward Round” when a group of senior clinical officers, medical officers, nurses and students, about forty to fifty of them go around different wards to round on a few cases for diagnostic and management issues. I have started to come to these rounds and when the District Health Officer (DHO) is in town and attends the round becomes interminable. I often have difficulty piecing the story together because the presenters tend to speak softly and fast and oftentimes the same presentation is peppered with both Chichewa and English interchangeably.
The Grand Ward Round of an entourage of forty to fifty people is too big for it to be an effective teaching forum. If one were out in the periphery of the circle, one would be out of luck hearing the whole presentation. Be that as it may, I have attended three of them so far and saw a few interesting patients that I would not see in US. A 30-year-old man was bitten in the left cheek by an adder snake which I was told was a poisonous snake. There was no anti-venom. His face was bloated like a big balloon, eyes swollen shut, lips so fat that they were everted and he had trouble breathing. The difficult decision here was whether they should intubate him with the only ventilator in the hospital in the operating theatre thus no emergency operations could be performed or cross their fingers and treat him with dexamethasone. The latter was chosen and I heard that he did alright overnight. In the pediatric ward there was a youngster who presented with seizure and he was thought to have cerebral malaria. A young woman who tried to kill herself with organophosphate was recovering. The x-ray machine did not work when a young man who stabbed himself in the chest was treated for a hemopneumothorax. A twelve-year-old girl who looked like an eight-year-old had a spleen so big that one could see it through the thin wall of her enlarged belly. She had malaria and was severely malnourished and tested positive for HIV. If she were infected vertically she had survived all those years with no treatment. A middle-aged woman presented with a chronic back pain, likely from Pott’s disease. There were other cases that would benefit from CT/MRI but NDH just has an x-ray machine and ultrasound. Because of MSF’s presence the lab can do CD 4 counts and viral load. Cryptococcal antigen has yet to be brought here, Indian ink is still the way to go to diagnose cryptococcal meningitis.
I am cut off from any current happenings in the world except what is being delivered to my e-mail: the conflict in Congo, occasional news about the Syrian War but frequent update of Red Sox’s standing in the AL East. I am glad they are ahead of the Yankees and if all the stars are aligned correctly perhaps heading for the play-offs.