Last night I went out with my roommate Silvan to the fanciest restaurant in Somerset West. I ordered the Kudu (a huge antelope animal) carpaccio, and for main course had Ostrich fillet, topped with mushrooms and parmesan, on top of sweet potato discs and drizzled with a port wine sauce. Of course we paired it with a local bottle of pinotage red wine. It is incredible! Ostrich is like a beef filet mignon, but little softer. Absolute bliss. The food here is spectacular. All total it cost about 200 rand, with is 7.5 rand to 1 USD, so it is about $26.
The last two nights have brought heavy storms, winds up to 150km and pelting rain. It really destroyed a bunch of vegetation, and woke me up like very hour.
Today at the hospital I went with Dr. V, Silvan, and two local University of Stellenbosch medical students to a clinic in Gordon’s Bay. We arrived at a single level white building, full of people waiting for us. From children, to elderly, white, black, colored, and everything in between.
The head nurse, also known as the head sister, brought over a huge stack of patient files. The building had a large waiting area, plus a pharmacy, and then our medical care open space with beds against the wall. Dr. V said, “ok, grab a bed and a chart...” We proceeded to just see patients one after another. No time to for being shy or hesitatnt. 10 minutes per patient was the challenge to us.
Every patient has their blood pressure, heart rate, weight checked. Diabetes patients get a HGT, which is a blood glucose, but it is in mmol, so normal is like 4-6. Some also get urine dips.
I saw all sorts of people. Many patients with chronic diseases come every 6 mo, since they need to get their governmental prescriptions renewed.
Some patients I saw:
- 55yo male with dermatitis, and concerns about weight loss… turns out he was observing Ramadan, problem solved.
- 19 yo guy, who looks about 14. Very charming smile, his mom tell me he has Prader Willie syndrome. Turns out he has had issues with hygiene and repeated episodes of dysuria. Plan, referral to the hospital for a circumcision. The other issue is his out of control diabetes, with glucose levels at 19, which is like 3 times normal; and spilling glucose into his urine.
- 84 yo female with hx of CVA, angina, hypertension… She is very frail, but well dressed, and has a nice little zippered flower purse. She had a number of symptoms she was concerned about. Listening to her heart, she has a loud systolic murmer, and has an irregular rhythm with dropped beats. She had just been seen recently at another clinic for angina, but never had any cardiac work-up… Referral to the hospital for a ECG and possible echo. Not sure how long it will take, we checked the box for urgent. --- It is so wild to be given almost full responsibility with patients. If I had not listened to her heart diligently, I might have missed her heart block. I wonder how long she has had it, since she is symptomatic from it…
- Then I had a patient that was dealing with concerns for her safety and domestic violence issues. Privacy is pretty much non-existent… Yet I pulled the curtain around. She became tearful. I learned there aren’t many services for women in abusive relationships.
That is just a snapshot of my first away clinic day. I can’t believe its only been two days, I’ve done and seen so much already. Dr. V pulled me aside and asked me to reflect about my experience yesterday. He is a true family doctor at heart, very interested in how we process experience, and our psychological welfare.
In a follow up to the mom from yesterday who was breech. I also told Dr. V about some articles I had read about using Chinese medicine for breech presentation. A few recent reviews have shown greater success by using moxibustion compared to control, which is burning a Chinese herb, and placing the warm end on the lateral fifth toe. Sounds crazy right… Well its cheap, no side effects or risk (that’s been studied too), and could potentially reduce their c-section rate. He laughed, but said, well get this moxi, and lets give it a try with our breech pregnant moms.
I’m exhausted. Time for bed.
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