Today is Wednesday. Last evening was very windy and rainy. By wind I mean like 50-60 mph gusts that shake the whole house! Weather patterns are crazy here. In the span of 5 minutes, the sun shined bright, then you’re hit by a gust of wind, then it starts raining.
Today I attended medicine rounds again. Some things:
- If you are wondering what is going on with the lymph or immune system, just FNAB it! (Fine needle aspiration biopsty). It is as routine as a blood draw here. I’m used to the whole u/s guided… usually with breast lumps. They do them with neck, axillary, and breasts… find the node, squeeze it, and stab it. Gets the job done, and no waiting!
- We had an older male patient, chronic alcoholic. Pt has a dilated cardiomyopathy, but its still functioning well. The attending asked the patient what kind of alcohol he drank… turns out, he drinks xhosa beer. This is a bootleg beer brewed in old iron barrels. So patients can develop hemosiderosis (iron overload)! Not thinking this is that, but he had a unique scaly skin pattern on his legs… pellagra? The differential diagnosis are so different here!
- I wandered into the orthopaedic ward for a bit. In there was an 83 yo elderly male laying still with a full metal neck immobilizer. The intern told me he had a C1/C2 spine fracture. Of course, I assumed this was a car accident or something. Turns out he was assaulted…, robbers broke into his house, then stepped on his neck. How absolutely horrible. I wonder if they found the criminals… if it made the local news… Hopefully he recovers. No surgery for now, likely would need a transfer to tygerberg.
The rest of the afternoon I hung out in casualty. At times it feels like good old United Hospital in Saint Paul. Patients with diabetes complications, minor injuries, syncope. I think I’m just getting used to the flow of things, so the differences are becoming more common.
I’m off to Stellenbosch tonight for dinner and then to meet up with Silvan and some other international medical students. The days are flying by so quickly it is almost scary. Luckily my cold/flu/whatever managed to infect me is improving, thanks to some help from my good old friend augmentin =).
Friday, November 13, 2009
Grant day, and TB madness
Here is the "tearoom", AKA doctors lounge. Female doctors won't let you take pictures of their faces...
Rainer, another medical student from Germany who is doing surgery
Post-op recovery, nice and warm.
"DOKTER" the doctors tearoom sign
Sebastian from Namibia, specializing in family medicine. Interesting scrubs here!
Today at the hospital I wandered into the high risk pregnancy clinic. I found a flustered doctor with a huge pile of files. I tried to help out by taking blood for those being admitted. Luckily some interns wandered in… Haha. This hospital is so random. We saw all different kinds of mothers, white Afrikaans, xhosa speakers, teens to older moms, fancy dressed and some with holes in their shirts. Everyone gets the same care. If you speak Afrikaans or English, it definitely makes things easier to sort out… Here, the interns kinda run their own show. If they have questions they ask, otherwise they just decide the plan… follow up, admit, transfer to tygerberg.
Went around with the Sanet, a senior medical officer, for afternoon rounds. There were some interesting cases (speaking from a pathology perspective), and some interesting people (speaking from a human perspective). Tomorrow is disability grant day, but in order to collect you have to be home with your family. So many patients were feeling much better today =).
-One guy in his 40s presented with delirium and headaches. Dx with TB meningitis. But when he became lucid they discovered his legs were paralyzed. Spinal shock from TB tubuculoma compromising his lower spinal cord. His wheelchair was next to his bed. We updated his medications, and moved to the next patient. He did not say very much, just that he felt “fine” when asked. I can’t help but wonder how he was coping with his new paralysis and dependency on a wheelchair… Emotions are not frequently addressed or brought to the surface in the hospital. This is sad, because some of the most powerful experiences I have had with patients is when we talk about how one copes and processes being in a sick role. I still need to process this a bit more. Internal medicine in the states frequently only focuses on physical disease… To be continues.
- Few stroke patients. One patient does not communicate, can’t move arms or legs. Whenever we say hello to her she just smiles, eyes closed. Patient was not a candidate for a MRI or CT scan (which involves a transfer to tygerberg). No neurology consult... not sure if its needed. They think she had a intracerebral bleed. The most important thing is planning where to transfer her. Plan is to transfer her to Helderberg Hospice, a community supported facility. Usually people go there for about 2 weeks, either for hospice to die, or in transitioning to home. They work with families to train them how to be caregivers. Interesting how this is community and not governmentally funded… This patient has family that are going to take her, otherwise she could be stuck in the hospital for a long time waiting for a rehab center bed.
That’s all for now. I’ll do my best to get more pictures. Time to recover in bed. Cough cough sputter.
Cape town, Braai's, woodstock, and miller beer
Hello again. It is Monday again… weeks are already flying by. This is my third week at the hospital. Last week I developed a sore throat, then some laryngitis, big honkin lymph nodes. Well by the weekend it turned into a barking cough, and sinus congestion headache. Not fun at all. Many of the other staff have similar symptoms. Yet, that does not stop them from trying to scare me into thinking I have TB or am seroconverting. Very funny… not! On a positive note, atleast its not diarrheal disease….
Last weekend I went into Cape Town again to stay with relatives. No night casualty shifts for now due to my health. My friend Silvan, the swiss medical student, moved to Tygerberg hospital for the month. That is the tertiary care center where we transfer our complicated patients. He is staying at an international dorm, which has medical students from Germany, Netherlands, Switzerland, US (Illinois) and others. It is so much fun to meet other students in the same field but from such different places.
Last night I went for a Sunday evening Braai (aka BBQ), a local end of the week festivity. I actually went with a local colored guy named Donnovan (this is a politically correct adjuctive in SA) who I met on a taxi ride home. After just meeting him he invited me to come… why not? This seems to be another common theme here. One of inclusion... People are just very chill, and excited to make new friends. Maybe its because of the vast diversity of cultural backgrounds and geographic upbringings. The braai was at a backpackers hostel, where Donnovan is friends with many of the staff. We cooked up some porterhouse steaks and boerrivores (this awesome spicy sausage thing). So much meat in this country!! And lots of beetroot (same things as beets), which is amazing cause I love beets.
Around the fire, a local was telling me about the continued issues of violence in this country. She told me that “life is cheap here.” People die from HIV, violence, accidents… most never make the news… This is not immediately obvious if you just came to visit as a tourist, but is apparent from working in the hospital. Despite the flaws of the country, she told me she wouldn’t want to live anywhere else. People here firmly believe in the potential of South Africa.
Over the weekend I also visited a food market in Woodstock. Luckily we had a car attendant help us park… just kidding. Not sure if this is an Africa thing or just South Africa, but whenever you park on the street there are people who help you park and will watch over your car. I mean everywhere. “I watch your car boss.” Even at like grocery stores. Most are unofficial. The going rate is like 1-2 rand, which is like 15-20 cents. At the market, a couple funny things happened. Silvan was offering me and Jonas (another swiss student) a piece of gum, and this random guy said “oh sure, I’ll have one.” Whaa… Why not? Then I was talking to Jonas about the music playing and how I thought it was swiss folk music, and someone behind me said “actually I think its German.” Whaa… People just interact a lot here. I love it. In the states I often do similar things, but am given looks that say “mind your own business.” We met lots of people, a student from California, someone from the republic of congo, Zambia… what a mix! Silvan and I ended up doing some polka dancing… why not, no one cares what you do here. My kinda place.
While I’m on a roll of random thoughts. So Miller beer is popular here! Haha. My cousin offered me one and I was quick to inform him that the Miller brewery is in Milwaulkee, WI. They have a brewery here in South Africa… random. Their local beer is Castle. At a bar its about 12 rand (which is 1.50 USD) a bottle.
Last weekend I went into Cape Town again to stay with relatives. No night casualty shifts for now due to my health. My friend Silvan, the swiss medical student, moved to Tygerberg hospital for the month. That is the tertiary care center where we transfer our complicated patients. He is staying at an international dorm, which has medical students from Germany, Netherlands, Switzerland, US (Illinois) and others. It is so much fun to meet other students in the same field but from such different places.
Last night I went for a Sunday evening Braai (aka BBQ), a local end of the week festivity. I actually went with a local colored guy named Donnovan (this is a politically correct adjuctive in SA) who I met on a taxi ride home. After just meeting him he invited me to come… why not? This seems to be another common theme here. One of inclusion... People are just very chill, and excited to make new friends. Maybe its because of the vast diversity of cultural backgrounds and geographic upbringings. The braai was at a backpackers hostel, where Donnovan is friends with many of the staff. We cooked up some porterhouse steaks and boerrivores (this awesome spicy sausage thing). So much meat in this country!! And lots of beetroot (same things as beets), which is amazing cause I love beets.
Around the fire, a local was telling me about the continued issues of violence in this country. She told me that “life is cheap here.” People die from HIV, violence, accidents… most never make the news… This is not immediately obvious if you just came to visit as a tourist, but is apparent from working in the hospital. Despite the flaws of the country, she told me she wouldn’t want to live anywhere else. People here firmly believe in the potential of South Africa.
Over the weekend I also visited a food market in Woodstock. Luckily we had a car attendant help us park… just kidding. Not sure if this is an Africa thing or just South Africa, but whenever you park on the street there are people who help you park and will watch over your car. I mean everywhere. “I watch your car boss.” Even at like grocery stores. Most are unofficial. The going rate is like 1-2 rand, which is like 15-20 cents. At the market, a couple funny things happened. Silvan was offering me and Jonas (another swiss student) a piece of gum, and this random guy said “oh sure, I’ll have one.” Whaa… Why not? Then I was talking to Jonas about the music playing and how I thought it was swiss folk music, and someone behind me said “actually I think its German.” Whaa… People just interact a lot here. I love it. In the states I often do similar things, but am given looks that say “mind your own business.” We met lots of people, a student from California, someone from the republic of congo, Zambia… what a mix! Silvan and I ended up doing some polka dancing… why not, no one cares what you do here. My kinda place.
While I’m on a roll of random thoughts. So Miller beer is popular here! Haha. My cousin offered me one and I was quick to inform him that the Miller brewery is in Milwaulkee, WI. They have a brewery here in South Africa… random. Their local beer is Castle. At a bar its about 12 rand (which is 1.50 USD) a bottle.
Friday, November 6, 2009
Medcine rounds, plaster of paris, and TB-o-rama
Only doing a single entry this week. I have somehow gotten a nasty sore throat, lots of posterior lymph nodes, and not sleeping well. Not been easy to focus when I leave the hospital.
This week I was assigned to the medicine team, but still attended community and orthopaedic clinics. Medicine team is constantly slammed with a number of very sick HIV+ patients, with various TB related issues. In order to receive anti-retroviral treatment at the ARV clinic, patients with TB need to be on atleast 2 weeks TB treatment. If you start ARVs right away then can get IRIS, an immune reconstitution syndrome where your white cells gain strength at HIV is suppressed and then vigorously attacks the TB. I only knew about IRIS with regard to chemotherapy and transplant patients. Only issue is figuring out who has TB… They do an X-ray, sputum looking for TB, and then a screening ultra sound. The u/s was surprising to me, but I guess they frequently can see lesions in the spleen and liver. Many patients are just treated for TB with enough supportive sx (night sweat, spiking fevers, cough) and family members with TB.
Some of you may be thinking, so what precautions are taken for these patients to prevent hospital workers from getting TB. Well… there is an open window policy, and some patients are made to wear masks, So basically minimal. No negative ventilation rooms, or fancy hepa masks. I still cringe a bit when someone is coughing and sputtering… Just kinda the way it is here.
There are serious limitations on the hospital financially. Deep venous thrombosis prophylaxis has been an issue, since they do not have pneumo boots or even TED socks. I guess those simple socks are not cheap in south Africa. So they rely on heparin. LMWH is too expensive.
Resources to address psychiatric and psychologic needs are very limited in the region. They have issues getting of those positions filled in the public sector. Social workers take on a lot of that responsibility. There is no psych ward or anything like that at the hospital, again managed to the best of their ability by the family med docs.
On Thursday I went to ortho clinic again. It is so much fun to play with the younger patients. There is not very much play or fun with patients. I think that is a by-product of the high patient load, and possibly the more old school doctoring. I am slowly introducing them to my clown nose…
In ortho we had a really crazy case. A 40 year old wheel chair bound guy came to clinic cause he thought his elbow was infected. The notes were very skeletal, so all we knew is that he had two recent open reduction internal fixations of his distal arm. Presumably from trauma. His x-ray was so abnormal, severe osteomyelitis, just eating away at his bones. We took off his bandage and plasma like fluid just gushes out… What a mess. Not sure what led to the breakdown of his care, but he bought himself a ticket to tygerberg to sort out a repair.
Rest of the clinic was looking at some dramatic spiral and oblique fractures from various traumas. I find it strange that none of the kids draw on their casts! When I broke my thumb in elementary school I got this awesome glow in the dark fiberglass cast and had friends draw on it. I’m encouraging the kids to do it, next week I’m gonna bring markers and stickers.
What else. Oh, so I have seen a common trend with patients in which they are referred to the hospital by their private general practitioner. My understanding was that the private system was only for people with ample money, but it seems many will pay some money to be seen urgently at a clinic. Still the private hospitals are reserved for those who can pay upfront or who have insurance plans with them.
It is so refreshing to work in a place that has no money exchange between patients and providers. No talk about insurance or hospital representatives coming into your room to make patients sign their payment responsibility forms.
That’s all for now. I was in casualty until late last night, so am struggling a bit energy wise. This weekend I will be in Sea Point staying with family.
This week I was assigned to the medicine team, but still attended community and orthopaedic clinics. Medicine team is constantly slammed with a number of very sick HIV+ patients, with various TB related issues. In order to receive anti-retroviral treatment at the ARV clinic, patients with TB need to be on atleast 2 weeks TB treatment. If you start ARVs right away then can get IRIS, an immune reconstitution syndrome where your white cells gain strength at HIV is suppressed and then vigorously attacks the TB. I only knew about IRIS with regard to chemotherapy and transplant patients. Only issue is figuring out who has TB… They do an X-ray, sputum looking for TB, and then a screening ultra sound. The u/s was surprising to me, but I guess they frequently can see lesions in the spleen and liver. Many patients are just treated for TB with enough supportive sx (night sweat, spiking fevers, cough) and family members with TB.
Some of you may be thinking, so what precautions are taken for these patients to prevent hospital workers from getting TB. Well… there is an open window policy, and some patients are made to wear masks, So basically minimal. No negative ventilation rooms, or fancy hepa masks. I still cringe a bit when someone is coughing and sputtering… Just kinda the way it is here.
There are serious limitations on the hospital financially. Deep venous thrombosis prophylaxis has been an issue, since they do not have pneumo boots or even TED socks. I guess those simple socks are not cheap in south Africa. So they rely on heparin. LMWH is too expensive.
Resources to address psychiatric and psychologic needs are very limited in the region. They have issues getting of those positions filled in the public sector. Social workers take on a lot of that responsibility. There is no psych ward or anything like that at the hospital, again managed to the best of their ability by the family med docs.
On Thursday I went to ortho clinic again. It is so much fun to play with the younger patients. There is not very much play or fun with patients. I think that is a by-product of the high patient load, and possibly the more old school doctoring. I am slowly introducing them to my clown nose…
In ortho we had a really crazy case. A 40 year old wheel chair bound guy came to clinic cause he thought his elbow was infected. The notes were very skeletal, so all we knew is that he had two recent open reduction internal fixations of his distal arm. Presumably from trauma. His x-ray was so abnormal, severe osteomyelitis, just eating away at his bones. We took off his bandage and plasma like fluid just gushes out… What a mess. Not sure what led to the breakdown of his care, but he bought himself a ticket to tygerberg to sort out a repair.
Rest of the clinic was looking at some dramatic spiral and oblique fractures from various traumas. I find it strange that none of the kids draw on their casts! When I broke my thumb in elementary school I got this awesome glow in the dark fiberglass cast and had friends draw on it. I’m encouraging the kids to do it, next week I’m gonna bring markers and stickers.
What else. Oh, so I have seen a common trend with patients in which they are referred to the hospital by their private general practitioner. My understanding was that the private system was only for people with ample money, but it seems many will pay some money to be seen urgently at a clinic. Still the private hospitals are reserved for those who can pay upfront or who have insurance plans with them.
It is so refreshing to work in a place that has no money exchange between patients and providers. No talk about insurance or hospital representatives coming into your room to make patients sign their payment responsibility forms.
That’s all for now. I was in casualty until late last night, so am struggling a bit energy wise. This weekend I will be in Sea Point staying with family.
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