July 16th, 2018 by edwardchristiansen

A few days passed and I began to get the hang of/rhythm of everything. The hospital is located in the town of Mseleni (perhaps why there were many signs on the confusing directions here the other day!). It’s rather rural. Cows and goats commonly cross in front of cars without regard or care. Chickens are free range and commonly jolt across a roadway narrowly missing an oncoming car. I have mainly been living off of items I brought along in my bag. This is inclusive of pistachios, coca-cola, dried cranberries, and twizzlers. My bravery, combined with the likely necessity of running low on supplies, compelled me to venture out passed the gates after 2 days. I passed a small grocery store, herein known as a “tuck shop,” and continued about a mile. Locals passed and said “hello.” The houses are mainly concrete and brick, as well as small in nature. However, they are a definitive step above the thatched homes I was expecting and had noted aside the long highway ride in. Walked about a mile before turning around and heading back. Of note, I did stop in the tuck shop and purchased a 2L of sprite, a few canned goods, bread, and peanut butter. That night, I would eat like a king!

Cracks me up everytime…clearly everything is straight ahead!

Mseleni Hospital is unassuming in nature. Spread out over what must be a few acres, the hospital is at the top of the mountain/hill. The wards are all open air. They are divided in the following manner:

• male ward (composed of surgical step-down, TB ward, medical step-down, and triage)
• female ward
• high care (ICU)
• maternity and neonatal (post-op, post-partum, healthy neonate, neonate high-care, and ill antepartum)
• pediatrics
• OPD (out-patient department-essentially urgent care/ER)

There are 2 OR’s and patients line their corridors ready for a procedure. The schedule in the morning is usually to do a group rounds (ward rounds) and then go off to round on ones respective ward until lunch. At this time, people either go to an outlying clinic or OPD to see patients. Those who know me know my love of flowers and plants. My favorite thus far seems to be right outside the main doors of the hospital. In many ways, it is a perfect metaphor for this landscape.

The perfect metaphor

This morning in particular I was on male ward and following with a rather haggard physician. She’s lovely but had just had a horrible night call and was itching to go home to sleep. She asked if I would feel comfortable rounding on one ward while she did the other. We would then reconvene, and discuss prior to her leaving. I agreed. Luckily, I found the nurse whom I had the previous day and she patiently/graciously guided me through my patients; interpreting, answering questions about protocol, and even telling me what medications are on the formulary. Please note, I realize the audience of this blog is not necessarily medically inclined. For this reason, I will attempt to be as general and non-medical as possible while still allowing for the acuity to be noted by my colleagues in the medical community. Also of note, hence forward RVD (retroviral disease) shall be used in place of HIV. This is because of the social stigma that remains in this community. My patient’s were as follows:

• 2 schizophreniform’s now stable and on risperidone
• 1 transfer from high-care with a questionable past medical history from the record. Clearly has systolic heart failure, ESLD, who commonly presents for hospitalization with recurrent pneumonias.
• 1 RVD with PCP, EF 20%, b/l pleural effusions on xray, and a large heart on xray.
• 1 severe headache with meningitis ruled out
• 1 post-op day #2 s/p pleural effusion drainage
• 1 catatonic schizophrenic
• 1 amebic liver abscess with erosion into the thoracic cavity status post drain placement

I made some med changes to all the patients, ordered labs, and ordered an ultrasound on the PCP pneumonia with O2 requirement looking for a pericardial effusion to possibly drain. All in all an interesting morning.

Walking back to my room, I ran into a fellow physician who asked if I’d like to help with a “ceaser?” Phonetically see-zur, I found out this is a cesarean section! I jumped at the chance and assisted. Here, one physician runs anesthesia while the other operates. Usually performed under spinal/local injection, they also do “crash csections” under ketamine! Yikes. Most incisions are vertical incisions on the skin. This leaves a rather large scar and is not what I am used to seeing. The csection was a success and I left to return to my room for my peanut butter and sprite feast.