Friday, February 10, 2006

Another Day At Work

Well, I can't exactly be considered a veteran of Botswana medicine, but I've now completed my first week (albeit incomplete) of inpatient medicine at Princess Marina Hospital!

Since I arrived here on Tuesday night, I can honestly say that I've been exhausted for just about every waking moment. One of my goals for this weekend (in addition to getting myself familiarized with the city of Gabarone) is to catch up on some zzz's and hopefully reset my sleep-wake cycle to something more reasonable that inexplicably waking up every night at 2 a.m. and staring aimlessly at the ceiling for several hours.

Recall my excitement at helping out with 5 procedures the day previously? 3 spinal taps, 1 thoracentesis, and 1 paracentesis? Well, a very frustrating aspect of Botswana medicine reared its ugly head today when we realized that the lab had completely LOST one of the spinal tap samples and the results of both the para and the thora weren't back despite having been sent to the lab greater than 24 hours earlier. Crazy. Why subjuct a patient to a painful and potentially dangerous procedure if you can't get the results? It made me want to go nuts, but having been previously warned about the pitfalls & frustrations of the health system here (which interestingly enough is considered one of the finest on the African continent) I told myself to remain calm and go with the flow. You have to really base a lot of your decision-making on the physical exam.

I also experienced a very interesting cultural phenomenon today: many Batswana share the belief that if a doctor performs a spinal tap on you, it can cause you to become an invalid or even kill you. Unfortunately, I found this out about 20 minutes after performing a spinal tap on a half-comatose patient and speaking with his distraught brother. (By the way, the spinal tap yielded critical information which led to the diagnosis of cryptococcal meningitis, which is potentially treatable with antifungal therapy and yep, you guessed it, repeat spinal taps).

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