Sunday Rounds

Since today was Sunday, rounding started a little later today. While we were waiting for D.r Peduche to arrive I had a chance to chat a little more with the clinical officer students (physician assistants). Their training is pretty rigorous and similar to medical student training except they don’t get into as much basic science detail as we do. But they do rotations in everything from pediatrics and OB-GYN to dentistry and ophthalmology. They know their pharm pretty well and they can even do minor surgeries. They exist due to the shortage of physicians in Zambia.

So rounding was pretty similar to what you would see in the States except we rounded on all of the services (medicine, peds, obgyn, surgery). Surprisingly, unmarried teen pregnancies are common here also, as I saw while rounding on OB. Many of the patients also require C-sections here. Although the conditions here are not all that great, I do like the face that they keep all the windows open so that fresh air can come in. I feel that our American hospitals could benefit by following his example. Using the bell of my stethoscope I was able to listen to the fetal heart beat of a pregnant mom. In preparation for the C-section on the 19 year old patient we gave her oxytocin. Next we went to the female medicine and surgery ward. On a patient that was recovering from TB, I leaned how to tell her to breath (pemani) in Nyanja as I listened to her lungs.

In the male ward we had an elderly man who had a blood urea nitrogen (BUN) of 15.5 (not good, and probably indicated renal insufficiency. ) We had him on diuretics and he had barely urinated all day and all night and he had been complaining of his urine dribbling out, so we suspected BPH. In order to confirm this, he needed a rectal exam (to palpate the prostate). The clinical officers were trying to make each other do it and I decided to volunteer since I had never done it. Since all they had was a size 7 1/2 glove I was praying that my size 8 1/2 hands didn’t pop the glove. I felt what I could feel and it seemed normal for my first try. By the time one of the clinical officers tried, the old man just collapsed in exhaustion from being poked and prodded. I felt so bad for putting him though that but it was necessary.

We moved on to our next patient who reminded me of many of our American patients. He was a middle aged man who had a history of smoking and drinking. At the hospital he presented with hypertension (this was news to his wife since he never got is blood pressure taken before) and right sided weakness. He had obviously had some kind of stroke. In the States we would start him on a blood thinner like Coumadin or Heparin; we might also evaluate his clotting process by checking his PT or PTT. At most rural hospitals this is just not possible. You see, all of the drugs and reagents are supplied by the Ministry of Health in Zambia. If they don’t offer a drug, you probably won’t get it. I realized that they could not even do an EKG or check the cardiac enzymes of a patient to see if they had a heart attack. Now of course if you have an abundance of money (which only tends to include the whites running the NGOs, the Muslims and Indians running the businesses, and the corrupt African politicians) then you can pay to send your blood work to private labs. Most Africans will not have these opportunities; s with our patient who really needed an MRI and Coumadin, we just had to give him Aspirin.

There are so many things I am seeing that it is hard sometimes to remember. Many problems I see are simply due to the patient coming in too late or seeking our medicine after other methods. For example, this one patient in this picture:  decided not to come into the hospital when there was clearly a problem with the birth. By the time she came in, the baby was dead, and we just had to take it out. Also there was another patient who had AIDS and an odd protrusion of his spine and severe abdominal distention. As you can see from the picture:     he had waited awhile to come and see us. You can tell this because the cuts on his stomach and chest indicate that he went to a traditional healer (AKA a witch doctor) to be treated first. Then other sad stories include his patient who’s hand was destroyed in a grinding mill accident:     . There is so much need here.  I hope that I am up to the task which God has called me to.

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