Nyangao

I'm spending the first week in "orientation" to become more familiar with St. Benedict's Hospital. Each day during orientation I have to round with the doctor or medical assistant in two different wards.
This morning I started in the medical outpatient department.
I introduced myself to Lillian, the medical assistant covering the MOPD (medical outpatient department) and sat in her office while she saw a few of the patients. By the third or fourth patient, she handed me the chart and wanted to me to start seeing the patients. There was some misunderstanding because in my Swahili I tried to explain that I would just be observing her. But she insisted that I see the patients and I didn't mind so I prepared. Luckily all of the charting is in English but of course none of the patients speak English. I tried hard to take a history in Kiswahili, and for the most part, patients understand me, but I still have difficulties understanding the spoken language. I had two interpreters with me......A few of the first patients had multiple problems, diabetes, hypertension and just came for medication refills. The next patient was a four year old boy who was carried into the room by his mother. His eyes were closed, he looked very weak and sick. His mother gave the history - fevers, abdominal pain, sore throat, nausea and vomiting for two days. The nurses took vital signs and I did a physical exam.....I spoke briefly to the medical assistant to discuss my differential diagnosis and possible work up, but she didn't hesitate to say that he has Malaria. I asked if we would get blood tests or do any other type of work up. She said no.... so I admitted him to the peds ward with medication to treat presumptive Malaria.
By ten am, I had to leave to accompany other hospital employees to drive to Nyangao, a sister hospital in the village of Nyangao about an hour east of Ndanda. Nyangao Hospital was host to today's monthly medical conference so about 50 health care workers from 4 regional hospitals met to hear lectures by 3 doctors. Coincidently the lectures today were OB related. A general surgeon gave a talk on wound healing, a gynecologist at Lindi hospital talked on management of normal and abnormal labor, as well as complications in C-sections, finally one of the medical assistants gave a lecture on post op c-section wound infections at Nyangao hospital. Very interesting to hear the perspective and management. There are many differences b/w practices in US hospitals compared to Africa (obviously). Some very basic medications are not available, and as a result there are higher numbers of c-sections and complications. Even pitocin, one of the most commonly used medications on a L&D ward to augment labor is sometimes not used, because it is not available!
By the time I returned to Ndanda it was late afternoon. The hospital administrator and other volunteers living next to me had already left for Mtwara for the weekend. I spent the afternoon walking around the town. The butcher was closed so I went to the monastery kitchen and bought some milk, eggs, bread and some sausage - enough for dinner tonight! Hint - please send recipes and/or the Idiots Guide to Cooking! I don't know how long I will last on scrambled eggs and sausage!