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.