Wednesday, January 16, 2008

Finishing at QE2 and The 6th Trip to Mokhotlong

QE2 Winds Down

The last 5 days at the Queen Elizabeth 2 (QE2) Children’s Medical Ward (CMW) were, unsurprisingly, not easy. My patient load was certainly manageable. Unfortunately, this was due to both discharged patients (yay!) and children that had died. Looking back, I certainly worked harder during most of residency rotations. The reason that I was so burned out after only 2 weeks of QE2 (which doesn’t even involve being on-call) was due mostly to a combination of preventable deaths, lack of supplies and an apathetic staff. I passed off the baton to Anu, my roommate who helped me during my rotation at QE2 both by giving advice on how to manage the patients and offering moral support. I felt bad passing the work to him, as he had already, in a way, gone through the rotation with me. It was interesting to see him react similarly to me as his time at QE2 progressed. The frustration settles in, you begin to question your skills as a doctor, and you start to feel like Death himself, roaming the ward in a black cloak holding his scythe.

Whew. That was a bit dark. Glad that’s over. I’ll probably do one more rotation on the CMW closer to August.


After a great weekend of sleeping in (and not having to go in to QE2), I drove out to Mokhotlong, along with Ntate Thuso, a local counselor, seen in the pic (I'm on the right). Though the work in outreach is always exhausting, I felt great to get out into the countryside and travel among the sheep under the open sky. The routine was the same: mentor docs and nurses both in the hospital and the more rural health centers, distribute medications, and see a few patients on my own. Probably my favorite encounter of the trip was diagnosing a woman as pregnant, about half a year after her tubal ligation surgery. I was able to show the local physician how to do an early pregnancy ultrasound (thanks to many days in OB intake and on therapeutic abortion rotations) and prove that it wasn’t an ectopic pregnancy. Overall, I felt that things in Mokhotlong were slowly moving in the right direction. The health centers seem to be on the verge of getting their own supply of meds, the nurses are getting more adept at seeing HIV positive patients, and Riders for Health ( are supplying some motorcycles to be used by the health system, to name a few advancements.


Back at home base, we celebrated by watching the entire Lord Of The Rings trilogy over Friday, Saturday, and Sunday. Anu gets the prize for Most Dedicated Hobbit by lasting the entire extended version of the Two Towers (until 3:45AM) and then going in the next morning to QE2 to round on the entire ward. Work this week at the clinic has been steady and routine. I’m seeing a mixture of healthy HIV positive pregnant women, children on long term anti HIV therapy, newly diagnosed HIV positive adults, and some really, really sick kids (most of which were recently diagnosed with HIV). Most of these sick kids we try not to admit, since the conditions at QE2 are so atrocious and what can be done for the patients therapeutically is so limited. Today I admitted another child to QE2 with vomiting, diarrhea, malnutrition, and possible sepsis. Yesterday the child looked relatively healthy, with what I though was just going to be a case of viral gastroenteritis. Some of these kids can get sick so quickly. I don’t think the child will survive. Today, I’m kicking myself for not admitting the child yesterday. You just never know. In similar fashion, I’m managing a severely malnourished child with possible meningitis as an outpatient! This would never happen in the States. Medicine is very different here.


Friday Anu and I’ll be flying out to Tanzania for two weeks of glorious vacation. The plan is to go on safari in the Serengeti, see famed Ngorongoro crater, climb Mt. Kilimanjaro, then relax on the beaches of Zanzibar. And while it might seem to my friends (Dolan, et al) that I’m not actually working but only vacationing in Africa, I must remind them that I blog mostly about my vacations while sparing you most of the details of the day to day work life here, therefore causing the aforementioned confusion.

Your's truly,

1 comment:

david santos said...

Hi Jefe
A beautiful place here!
Excellent post! You are Master.
Thank you.
have a good day