A medical twilight zone

In Botswana, the Dermatologists are the hardest working doctors in the hospital and all the other residents are home by 2pm. It's like a medical twilight zone. On my first day in clinic, we saw 35 patients and 2 in-patient consults. The other Derm resident and I walked home in the dark after taking our culture swabs and biopsy bottles to the National Health Laboratories building and found the other residents lounging around, drinking ginger beer and rum, having been home for hours. They looked at us with barely repressed glee, clearly thinking how the shoe was now on the other foot. Derm needs better PR.

Flipping another convention on its head, the patients are responsible for bringing their own medical charts to their visits. They walk into the exam room with hand-written charts, in varying states of upkeep, and you simply add your note to whatever space is available. Prescriptions are written directly in the assessment and plan. It's amazing. If I could just dictate the note then I would be perfectly content. The hand cramps really get to me by the end of the day.

One of my first patients had "Keloids" written on his chart and I thought, oh, I got this, I treat keloids all the time. Then he took off his shirt and I thought, ok, THOSE are keloids. Apparently this was all secondary to acne.

I hope to have these pictures printed on a card to show my patients back home when they feel like they have it bad.

TB is endemic to Botswana, and an N95 mask is a must whenever entering the wards. You write your name on a mask and leave it at the entrance so you don't have to carry one around all the time. There's a table full of masks at the entrance of every ward, like this one:

I wrote my name on one and left it there my first day and it was gone when I came back the next. Judging from this picture, the white masks are ostracized and eventually kicked off the table. I'll bet that's what happened.

HHV-8 is also endemic to Botswana, so Kaposi's sarcoma is a very common diagnosis, and not just among the HIV/AIDS population. We get several consults a day that are sent to rule-out KS, and it is often quite a challenge. The lesions of KS can mimic lots of other benign diagnoses so we almost always have to do a biopsy, which is a whole new level of olympics when done without any assistance from nursing. I feel like I am playing a game of twister each time. It's interesting to have to pour formaldehyde into the biopsy bottle myself each time, too.

I don't have too many other pictures from my first day that would be interesting to non-Dermatologists, unfortunately. I'm sure more will come along, though.

Signing off from Gabarone.

Gabz

Welcome to Gabarone! That's pronounced "Hab-ah-rhone-ee", or "Gabz" to the ex-pats, of which there are many. Botswana was formerly Bechuanaland, a British protectorate, so there are still lots of hold-overs from that time. One of the most immediately obvious hold-overs is that the cars drive on the wrong side of the road.

They also apparently hang their toilet-paper the wrong way, as I discovered when I moved into my new apartment.

 The toilet-bowls still seem to swirl the correct, American way, though.

My apartment is within a complex that is rented by the Botswana-UPenn partnership called "Pilane Court". It is a walled complex with an unnecessarily complex gate-locking mechanism that takes me about 5 minutes each morning and evening to open and close successfully. Based on the prolonged rattling (and occasional cursing) that I can hear from my window, I'm not the only one. 

My room is a pretty no-frills affair, with two single beds and some particle-board night-stands. There is a nice balcony though, and there is a maid that cleans and does laundry every single day. I am definitely going to miss that. 

 I'll have to see if I can get a picture of our maid, Doris. She's incredibly nice.

This is the hospital where I am working, Princess Marina Hospital. Well, the sign anyway. The hospital itself is a sprawling complex of single floored straight hall-way "wards" that are connected by covered or uncovered walkways. It reminds me of a Southern California high school.

In the parking lot are reserved spots for the Head of each department. Please note that the Head of Orthopaedics drives a VW in Botswana.

It's difficult to tell by the angle of this phot but if you look closely you can see that, unsurprisingly, the Head of surgery drives a BMW. As it was and ever shall be. There are just some immutable laws of nature. 

 There is another sign at the entrance to the hospital which proudly proclaims all of the services that Princess Marina Hospital provides to their beloved patients. Please note how prominently Dermatology is displayed.

On my last day I might have to go write it in at the bottom with a sharpie. As I've always said, if you want to be envied but not respected, go into Dermatology. 

Well, that's all for now. I will be starting my clinics soon so I'm sure will have lots more to talk about. 

Signing off from Gabarone. 

Arrival in Joberg

14-hour flights have a way of completely destroying my sense of well-being. I've always had trouble sleeping on airplanes and I can usually get away with it, but 14 hours is a long time to sit in a state of half-delirium and neck-ache. So I've been shuffling around the O.R. Tambo (no, autocorrect, not "Rambo", though that would be cool) like a zombie in the world of the living. Signs and speech are difficult to understand and I'm completely perplexed by escalators. If I ever need to zombie-proof my home, I'm going with escalators. So far I've managed to pass myself off among the living, but the other walking dead clearly recognize one of their own. You can find us standing in front of departure boards and staring at the information for far longer than necessary and occasionally looking around, as if about to enlist the help of the other slack-jawed zombie travelers. Occasionally you will see their mouths open as if to form speech, maybe a hesitant finger going up, to attract attention, but that's as far as it goes... because zombies can't communicate.

Posted with Blogsy

Picture test

This is a 12 year old African male with extensive scarring and actinic damage and an apparent left-sided facial palsy s/p trauma. He presents as a consult for Alopecia of 1 year duration. 

 

He has no other concerns. 

Test post

This is my blog for posting updates about my trip to Botswana.