“You have a tree?”

26-28 Nov 2008:

And now for a quick summary of the rest of the week. Wednesday we started the day at Greys Hospital to attend the weekly grand rounds, a seminar for the registrars (residents) and more senior faculty. Two thirty-minute presentations, neither particularly inspiring. I joined rounds at Edendale upon my return and found that we have a new registrar on the male ward, Dr Madlala. She was kind enough to engage me in discussion about all of the patients she saw, which is still the way I feel I am able to make the most contribution to care (it is still somewhat bewildering to navigate the systems issues here in order to get things done; the interns are much better at this than I am). Dr Thambela came by for attending rounds after that to round out the morning.

In the afternoon, Rachel and I led a teaching session for the interns. We weren’t sure what sort of turnout to expect, but it was very well attended, in part because of the promise of teaching (a rarity for them) but undoubtedly in part due to the pizza provided. Rachel led off with a presentation on aortic dissection and I followed with a workshop on reading EKGs, which they apparently never get trained to do. They were very engaged (including the registrars and even some attendings, who also had seemed to have little in the way of a formal approach to EKGs) and asked if we could do this sort of thing again. We agreed to lead another teaching session next week.

Thursday (Thanksgiving! I almost forgot) was a normal day at the hospital for me. Rachel went on another community service trip with Dr Caldwell, and I went to Edendale. Saw some interesting cases with the new registrar, and a new medical student who just arrived from Jo’burg joined us as well. We saw a textbook case of miliary TB (a particularly widespread lung infection more common in immunocompromised patients), and an elderly patient with innumerable lung abscesses, likely a complication of prior TB infection. We put both on TB treatment and the latter on antibiotics as well, but the elderly man has a terrible prognosis, unfortunately.

In the evening, Rachel, Gugu, myself, and more of the iTEACH crowd gathered at the home of Krista Dong, the ID doctor who leads the iTEACH program, for Thanksgiving dinner. Sadly (as a person indifferent to turkey), it was traditional turkey, stuffing, gravy, and such. One of the iTEACH crowd brought her daughters, one of whom is an engaging 11 year old named Snenhlanhla (Zulu for “I have luck”). Try as I might to say her full name (which she abbreviates Sne for Americans), the best I could do with those consecutive lispy sounds was “Snehlahla” (like Hluhluwe, the game reserve we went to). I said this and she gave me a sideways look and asked incredulously, “Mm-hmm, you have a tree?” (the direct translation of what I pronounced).

Friday Rachel and I drove with Dr Caldwell out to Emmaus hospital in the foothills of the central Drakensbergs for another outreach trip. Again, it was a success; the housestaff were more or less engaged in the morning seminar (Rachel and I reprised our sepsis talk), and during rounds, one of the medical officers told us about the many patients they had questions on. As before on these trips, we puzzled through the cases with them and offered our best advice on how to proceed with diagnosis and treatment. As before, some of our suggestions included hospital transfer for such things as CT scans or specialist evaluation or treatment.

I also found a paper in the Lancet (e-publication) on mathematical modeling of comprehensive efforts in identifying and treating of ALL HIV positive patients in the world. The authors claim that with a massive up-front investment, this strategy would be able to effectively eliminate the HIV epidemic within 20 years and would be cost-saving by 2050. Color me skeptical, but I will present this paper as my exit talk next Friday.