Happy Labor Day!

It may be a nice day off today in the states, but here in Africa, it was just a typical Monday. We rounded on our respective wards again and went to clinic in the afternoon. One of the things that keeps striking us is timing. At Geisinger, we can order lab tests, xrays, even MRIs and they will be done pretty quickly. We can even view the imaging studies minutes after they are completed. This is not the case here in Namibia. Lab tests are ordered on rounds, then the intern draws the blood after rounds and it is sent to the lab. The lab (or Namibian Institute of Pathology) completes the labs within 1-2 days. Usually, we have to call the lab to get them to hurry tests along. Imaging studies take even longer. All of the larger machines (MRI, CT scan, echo, ultrasound) are located at Central Hospital. It is a few miles from Katatura State Hospital. So, anyone who needs any of these tests has to wait until the days that the techs are at Central to do the tests. We have several kids waiting for echocardiograms that will not get them until October. Stacey has a 13 year old patient who came in because she couldn't see. It took over a week to get the CT done and even longer to read it (actually it isn't even officially read yet.) The CT showed a large ring enhancing lesion. So now they are waiting for neurosurgery to come see her and decide what to do next (the neurosurgeon is on vacation.)

All of this waiting can be very frustrating. It is making us rely more on our clinical judgement. We only order tests that are absolutly necessary. In clinic today, we saw a 6 day old infant who was jaundiced. If we had been at Knapper, we would have ordered a stat bilirubin, waited an hour for the results and then either admited her or sent her home on a wallaby. This baby was a preterm infant and she was jaundiced down to her toes, so we knew that she would need phototherapy (and they don't have wallabys here.) Rather than waste 3+ hours waiting for her bilirubin level, we decided to admit her and start the phototherapy right away.