Taking Tea

Dr. Windus, Hannah, Henish and myself were up late last night talking about Eritrea and the medicine. Because I was up past my "bedtime" and because I slept horribly, I felt like I had been hit by a truck this morning when I woke up. Being a light sleeper is tough in a foreign place. One positive though was that I have decided to start turning on my water heater at night instead of some random time in the night when I wake up. The hotel requests that we turn it on 30 minutes before, but when the shower is the first event of the night, that really is difficult to do. No more lukewarm showers for me.

We all walked to the hospital today together. Dr. Windus showed us a new way that isn't really a whole lot faster, but it sure is nicer. Most of cars here are all old, probably from the 80s and early 90s, and its not like they have emissions testing here, so they all spue out exhaust. That has made our route on one of the main roads to the hospital somewhat unpleasant in the mornings. The buses here which provide a large part of the transporation for people are the worst. They seriously need some new vehicles. Or some better mechanics. So our new route bypasses the main road and is much cleaner and quieter. The main drawback is that we miss out on seeing all of the little children all dressed in their respective uniforms walking to school. If I haven't mentioned it, all of the kids here either go to school from 8 to 12 or from 2 to 6. They all wear uniforms that is determined by their grade. The youngest wear these long blue shirts that look almost like dresses with collars and black pants. They are adorable. I have a lot of pictures of random kids on the streets.

So we went to morning report this morning as per usual, but this time with the company of Dr. Windus and Henish. The case this morning was one of a 37 year old male with a 3 days history of anuric acute renal failure who was admitted with mental status changes and suddenly developed large volume hemoptysis overnight. On admission he was started on dialysis using the only dialysis machine they have at the whole hospital. He was essentially unconscious on admission and there wasn't any obvious explanation nor was there an investigation as to why. Then with the development of hemoptysis, he was intubated but there was no chest x-ray. I'm not going to keep on about this case, but it demonstrated the difficulty with very complex cases that are seen here. It was nice during this case to get the input from Dr. Windus and Henish.

So, after report, I started rounding on my own even without the intern. I feel like I am understanding better what is going on with my patients, but the problem is that it just takes soooooooooooooooooo long for anything to happen. After lunch today, for example, I spoke with my nurses about some chest x-rays that were supposed to be done, but they had not been doing even with having ordered them 2 days ago. A patient with an aleged sodium of 177 (I think this is lab error) was supposed to have labs drawn last week, but I learned they were never drawn. There is just so much more to stay on top of here with these patients that it makes it difficult and its not like there is a computer on which we can keep a list.

So, today I was able to do the first procedures that I have done since I have been here. I did a diagnostic paracentesis on a 23 year old female with type 1 diabetes and anasarca likely related to diabetic nephropathy. I also did a diagnostic and therapeutic thoracentesis on a 67 year old female with a history of weight loss, night sweats, fevers, shortness of breath, left sided chest pain and a whopping pleural effusion on the left filling up the entire left lung. During both of these procedures, I essentially used an 18 gauge IV line to do them with and Hannah and I both found this method to be infinitely easier than using the kits that are provided for us in the US. With this method, there is no need for any lidocaine because the needles are so small and go in so easily. I think that we should consider this method in the US.

After my procedures, I came out of the rooms intending to get some work done---like writing progress notes that don't get written very often. But, alas, my attending wanted to go have tea, so at 11:15am I took a tea break. After tea, I went to lunch. Oh, how difficult life is. ;) On our tea break I learned that my attending did his undergraduate training in Addis Ababa in Ethiopia, and then he did all of his medical training in Italy. He was initially trained for 5 years as a general internist and then he underwent training for treatment of solid tumors. He came back to Eritrea because this is where his family is and because they are constructing an oncology hospital which he will essentially be the one physician for. Currently, in this country, there is no such thing as chemotherapy at all. You have cancer, you either go to another country to get treatment or you die. I was thinking about having this cancer hospital, and I just don't know yet if I think it is a good use of resources for this particular country considering everything else they need (faster labs, better radiology facilities, books for the medical students, etc).

On our lunch break, Hannah and I returned to our hotel where we ate lunch and then took a quick nap. As per usual, we returned to work at about 2:30. We did bring a large delivery of books to the library as a donation. It was nice to get rid of them because of the weight they added in shipping them with our luggage. Because we will have essentially one free suitcase each, we should be able to do quit a bit of souvenier shopping to fill them back up. We still haven't really found anything that we want to buy though.

My afternoon went quickly, but Hannah had a new admission, which was quite interesting. 58 year old lady presented with a 1 year history of lower extremity paralysis and pack pain, chronic watery diarrhea for 6 months, and today she just became unconscious. Cord compression anyone? Oh, and there is not an MRI machine in the whole country and as far as I can tell the CT scans are all done without contrast.

Tonight we went to dinner with Melles and his wife at a restaurant where his sister in law works. The food was specially made for us and included a mix of Eritrean and Sudanese food. The menu included vegetables, spinach, two types of delicious fish, some sort of toasted corn thing, some eggplant dish, some lentil dish, broccoli, and bread. By far, I thought it was the best food that we have had since we arrived in Eritrea.

I have a lot to say, but alas, we stayed up late again talking. I guess I'll have to save it for another night.