Clean laundry!

Okay, not the most exciting thing to happen ever, but my clean laundry just got delivered to my room. It cost me an arm and a leg (hotel laundry is expensive regardless of the country the hotel is in), but it's worth it to have some clothes that don't smell like sweat, dirt, and patients.

If you're wondering what happened to yesterday's post, the answer is, the internet. I really can't complain about the quality of the wireless internet when I'm in a country where most people don't own a computer, so I won't. I'll just say it's not at the standards we're accustomed to.

At any rate, yesterday I had my first day in the medicine wards. In some respects, it was very similar to being on the wards back home--large group of doctors and medicines making their way from way patient to the next, talking about him or her as if the patient wasn't there, discussing treatment plans, attendings belittling interns, etc. That's where the similarities ended. Yesterday's round, in the women's ward, was filled with patients with severe anemia, HIV/AIDS, TB, and hypertension. Hypertension is hard to manage in a resource-poor area; people can't really change their lifestyles (how they eat, exercise, etc), and medications cost money that could be used for food. When you don't know where your next meal is coming from, you can't be concerned about getting to the pharmacy to pick up your blood pressure medications. So they come in with heart failure, kidney failure, stroke, and the like.

Today's ward round was in the men's ward, and many of the cases were similar, with fewer severe anemia cases and more hypertension and complications of HIV. There was one patient who is still a mystery to everyone involved, because the clinical officer intern didn't bother to do her job. The patient (a man in his 20's) came in with altered mental status and left-sided weakness, and she decided that it was cerebral malaria. She got a blood smear, which was negative for malaria, but decided that it was still malaria, and began treating with quinine. Just as an aside--cerebral malaria is a very serious complication of malaria, and only occurs when malaria is severe. When malaria is severe, you're not going to get a false negative on the blood smear. So, she was lazy and ended up giving a drug with some pretty serious side effects. When we came to this patient in rounds today, the consultant (attending) went nuts. He said, "I'm sure everyone here has had malaria, and we can all agree it doesn't look like this." He then proceeded to tell the intern that if she couldn't be bothered to do her job, he didn't want her in his ward or in his hospital and she had no business being in medicine. Harsh, but true.

There were a few Australian med students during rounds, so I introduced myself and chatted with them. When it was time to finish with the jiggers patient (and yes, we finally are finished), I invited them to join me, since none of them had ever heard of jiggers (or chiggers), and they helped out in finishing with the patient. Then we went out to lunch at Old Man and the Sea (the place I went for my first lunch in Malindi) and talked about their elective here, our comparative health care and medical school systems, and the like. Good times.

Katana and I have also begun working on plans for a waste incinerator. My job is to figure out how many operators they need and what kind of training they need, so I got on the WHO website and looked up some stuff. Turns out, they don't like waste incinerators, but they do have some guidelines when they can't be avoided. One of the most valuable lessons I learned getting my MTM&H is that if you have questions about how to do something health-care related in the developing world, the WHO website will have answers.

Tomorrow: more medicine rounds, then working with Katana more on the waste incinerator. Should be a pretty low-key day.