Life at Princess Marina Hospital

Though the blog is appropriately titled Travel Notes, I do occasionally go to work while I'm here in Gaborone/Botswana (though don't tell Customs this; officially I'm here for "7 weeks of holiday"). We had a crazy busy call night on Wednesday, and so Thursday/Friday was spent getting to know the 16 new patients (we were entering call with 14) and trying to get through all 30 patients on rounds. It turns out our attending (Specialist Dr Ditlotlo) has clinic on Tuesday and Wednesday, so she only rounds with us 3 days a week (except for when she has random meetings on a Thursday...). The Medical Officer (Moolooki Mathake) and I run rounds and essentially make all major decisions (which happen very slowly here...the decision to get a CT scan may take 2-3 days of hemming and hawing and discussion before it gets ordered, and then another 2-3 days to actually get the scan, since our machine is currently broken and we ship patients to a private facility to get the scans...). We do have a great intern (Celia Odometse) who is very motivated, stays late, and in general is on top of things.

Meredith Edwards is a UPenn student who was on our team until today, when she started another rotation in a community hospital. It was a big loss not having her around, since she was so competent and got lots of things done on rounds. But we did get an infusion of Australian medical students to Princess Marina Hospital, and joining our team today was Nadia, a 4th year (out of 5) medical student. I showed her the basics of the hospital and was able to get in some good teaching, reviewing several chest xrays and procedures (blood draws, cannula insertion, paracentesis). She's a good student and I think she'll be able to help out the team since we're so busy.

PMH is overflowing, as usual, and we went into the weekend with 30 patients. We came in this morning to find 27 patients on our census; since there are rarely weekend discharges, I knew this was bad news. 3 patients had died, all with meningitis. Two were RVD (retroviral disease; or HIV) positive patients with presumed cryptococcal meningitis. When Meredith and I did the spinal tap on one of them on Friday, we actually could not measure an opening pressure because the spinal fluid kept rising in the barometer and then eventually overflowed to an undetectably high level. The last guy was a young suddenly ill 35 year old, RVD negative, who had a horrible bacterial meningitis; he died roughly 48 hours after admission to the hospital. We're still waiting on the gram stain/culture from the spinal fluid, but my bet is strep pneumo meningitis because it's actually really common here...we had him on all the right medicines, but I just don't know if we could have saved him.

Hopefully the next few days brings some better news; we did send home a few people today, including one woman who had been in the hospital since September 28th! We're on call again tomorrow, so I think we'll be okay as long as Moolooki doesn't admit another 16 patients...

On a more cheerful note, I walked by the Peds wards looking for Jyo today, and found her hard at work doing a paracentesis and two very difficult cannulations. Her team was post-call, so she held down the fort very nicely. Strong work Jyo!