We were back at
the hospital today for our second to last day of clinical and academics at
Kitona. Like Saturday, we physicians rotated physicians to work with. I took
the pediatrician, Dr. Lesho worked with the triage doctor who doesn’t like
anyone, and Dr. Mann (the pediatrician) went to internal medicine.
Pediatrics clinic
was slow today, so we ended up going up to the pediatrics ward for rounds. Most
of the cases were simple malaria (well, simple for them), but there was one boy
who’s pretty sick. He’s had swollen lymph nodes, a cough, lack of appetite, and
swollen legs for about a month. I’m thinking it might be TB, but with three
primary sites (lymph nodes, lungs, and possibly kidneys), which would be
unusual, unless he has HIV, and the mother won’t consent to an HIV test. Dr.
Mann thinks it might be Burkitt’s lymphoma, a cancer caused by EBV, the same
virus that causes mono.
The issue about
HIV testing came up in academics this afternoon as well. In DRC, you have to
“opt in” for testing, which means that a doctor can recommend that you go for
counseling and testing, but can’t order the test for you. This is the system
that the US used to have, before we went to “opt out”, which means that a doctor
can order an HIV test for you, unless you specifically state that you don’t
want it done. The problem (especially in Africa), is that if you have an opt in
program, people can chose not to opt in (and usually they chose this because
they’re afraid it will be positive), and then continue living life as if
they’re negative, continuing to spread HIV. You’re not going to be able to
fight HIV until you have the ability to get people who are HIV+ the education
and treatment they need.
We also had a
lecture on antibiotic stewardship by Dr. Lesho, who works in the wound
infection division at WRAIR. The lecture was a bit too technical, especially
when working through a translator who doesn’t know medical terminology, but the
point was sound. Since they can’t do culture and test for which antibiotics a
bacteria is susceptible to, the doctors in Kitona tend to prescribe anything
and everything for any complaint, and often for longer treatment courses than
necessary. For example, every patient (outpatient, inpatient, etc) gets a
urinalysis, even if they don’t have any urinary symptoms (which they usually
don’t). Because hygiene is an issue, and I doubt they know how to do
clean-catch urine collections, there’s a lot of background bacteria. In the
U.S., you don’t treat bacteria in the urine if there are no symptoms, unless
it’s in a pregnant woman. Here, however, if they find evidence of bacteria,
they’ll treat with 7 days of ciprofloxacin (an antibiotic). In the States, that
would be a 3 day course of antibiotics. This kind of over treatment and
over-lengthened treatment increases antibiotic resistant bacteria, which is a
huge problem everywhere.
Tomorrow is going
to be our last day of clinicals and academics. It’s also a surgery day, so
there probably won’t be much going on clinically. I might watch a surgery or
two. The academics will be long; we’ll finish up the HIV lectures, and then we
have a presentation of certificates to the DRC participants, and then we have
an after-action report. It should be interesting.
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| Random picture of the group from cultural day |
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