This morning, we helped Dr. Kaaya put on a very condensed NRP course for the interns. She took the whole course and shortened it to under 2 hours. After that, we had daily rounds and then set off for the OPD again. Stacey and I were allowed to see patients on our own today, but we had to ask Dr. Kaaya for advice several times. We also needed several interpreters. There are at least 11 languages spoken in Namibia, and most people speak at least 2, so we were always able to find somebody who could translate. My first patient ended up being very interesting (and sad) and I had to admit him. I'm not going to tell the story, because I'll probably use him for a morning report.
The most difficult thing about clinic was not the language barriers, but the yellow passports the kids carried with them. Its basically their medical record from birth. They carry them around and doctors write in them anytime they were seen. They were so confusing! I couldn't read most of the handwriting or understand why they were given certain medicines. An 18 month old boy came in with a cough for 2 days and "oh by the way, he was diagnosed with TB in June but never treated and opps, we lost his passport." I was so confused! I think he just had a cold and not TB, but we did a ppd and a cxr anyway. After today, both of us are very thankful for EPIC.
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Dear GSE crew:
ReplyDeleteYour comments raise issues for me of what skills are important to learn in that setting. Do general doctors do some of the bedside lab tests that were done by physicians 2 and 3 decades ago? microscopic exams, Hematocrits, sedimentation rates? Your words cause me to wonder why not consider general physician instruction in ultrasound as is done in our emergency medicine programs?
In between your words I am reading that you must rely on your clinical diagnostic skills and judgement, since history and records are sparse. I have confidence in you!
Stay Well, DrF
My mom and I enjoy following your adventures! She just got 2 CT scans in a matter of hours. Can't imagine waiting weeks. I'm sure you're doing a great job!
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