The Wards (May 3)

My first day in the hospital was Thursday.  I walked with Eli and Sarah to 7:30am morning report.  We discussed a patient admitted to the medical wards overnight who had a late presentation of cryptococcal meningitis (an uncommon diagnosis in the US, but not in Botswana which has one of the highest rates of HIV in the world).  The patient received excellent care overnight and received an emergent lumbar puncture to make the diagnosis.  I was impressed.  The morning so far had been almost indistinguishable from my own residency; a sense of relief came over me that perhaps I had misjudged my experience again .  As the case report ended, however, we were informed the hospital had run out of the life-saving and possibly vision-saving medication needed to treat the patient.  My jaw dropped.  Even if medications were in stock, I soon learned they were sometimes not given though ordered, or sometimes incorrectly charted as being given.  Blood vials that had been collected were lost and results routinely took days to come back (or never did).  Patients receiving intravenous medications had no IV in their arms.

The differences in care are striking and somewhat ironic.  In an ICU back home, an extraordinary abundance of resources are directed to prolonging the life of elderly or institutionalized patients in the final few days to weeks of their lives, patients with little to no hope for a meaningful recovery.  Yet here there are countless patients in their 20's and 30's who are dying every day from medically treatable conditions like heart failure, meningitis, HIV/AIDS, or TB, simply because of the lack of resources.  In fact, such deaths seem almost commonplace here.  At the start of ward rounds on my second day, we arrived to find our young postpartum female patient laying in her bed in rigor mortis (a stiffness of the body that occurs well after a patient had already passed), but rounds continued on to the next patient without a faintly palpable interruption.  And the irony is that all Batswana (plural for more than one person here) have something that Americans do not - free and universal education and healthcare. 

By the middle of my second day, I could feel a sense of hopelessness creeping upon me.  I came here to make a difference.  Back home, there were so many people involved in the care of my patients that I often felt disconnected; it was frustrating.  I hoped perhaps here my medical experience would be more valuable.  At the end of my second day in the hospital, Eli (a medical student with me) and I performed a therapeutic lumbar puncture on our patient with meningitis who was not receiving his medication. This procedure was done in an effort to remove fluid from his spinal cord and relieve the pressure that had been building up from his infection and causing him to have severe nausea and headaches.  He instantly felt better and so did I.  While it will take time for me to recognize and make sense of the bigger issues and challenges of healthcare in Botswana, I find satisfaction in knowing I can still make a significant difference here.