Dinner with the big wigs

So intake this morning was a little surprising – my team had 3 patients die over the weekend – one 77 year-old with metastatic adenocarcinoma, which wasn’t too surprising. But the other two were young, 30 and 42, with mental status changes, that I thought were going to live! It was a little difficult to take – I was not expecting it, and I had poured so much work into them to try and make them better. Some of these patients you know are going to die, so it’s not worth 3 hours of your time to try and diagnose or treat them. But these two I thought were going to make it. I guess that’s the way it is here… Nothing much happened today though. I thought we might pick up a huge number of patients since Boipelo was on call Saturday, but we only picked up 3 or 4.

Tonight we went out for dinner again, this time at Tendani’s house – she used to be an MO, and was leaps and bounds better than the other MO’s, so got recruited to run IDCC, which is the Infection Disease Clinic at Princess Marina Hospital – it mostly takes care of patients with HIV and AIDS. However, she is rarely ever there anymore as she now is very involved in PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief). Her dad is the Minister of Finance in Botswana, arguably the 3^rd most important person in Botswana, so she comes from what seems like a line of administrators. Interestingly, her husband is an artist, and seemed to be a very cool guy – although I didn’t really get to talk to him.

There were some very interesting people at the dinner. The entire Penn team had been invited, and she had invited a lot of PEPFAR people as well. I had very interesting conversations with a few different people – one was the son of a prior president and he told us a lot of stuff about Botswana politics. I met a few PEPFAR people too, and they explained to me what PEPFAR does – it helps set up HIV/AIDS clinics in small towns in Botswana so that eventually, hopefully all citizens will be able to receive treatment. HIV is such a huge problem here – I would say that 75% of my patients come in knowing they are HIV positive. And who knows how many of the other 25% are HIV positive. We offer the testing to everyone, but not everybody wants it. Boipelo says it’s because most of them are in denial or are afraid, but they have really good accessible treatment now, so it’s starting to become a little more openly talked about.

Decompressing

It was a busy day today and we barely had time for lunch because we had 10-11 admissions overnight that were done for us by the MO on call. There were 3 of us working though, so we made it through but were running around all day.

We needed to decompress, so a few of us (Sarah, Amy, Joanne, Jeremy and I) went to the Bull N Bush for dinner, which is a nice chain. It’s a pretty busy bar and club too on Friday nights, but I never went when it was really active. I had a great burger with mushroom sauce here, and we took these funny pictures with a cross-dressing cow statue. In general, I think I’m starting to get tired and worn down a bit – when we got home, Jeremy and I started Skyping each other even though we were in the same room and I thought it was the most hilarious thing ever. And we only had one beer at dinner! :)

My team at PMH

We were on call tonight and got a lot of patients. We have a new MO – Mpho Mpape. She’s not very good. But she’s pretty good at doing scut. She disappeared for like 3 hours in the middle of the day. But I guess then she stayed late (only until about 5) doing stuff.

There was a little tiff at the end of the night – Boipelo came on for call at 9pm and found a chart on the female side that said the patient was in the ward at 7:30pm and she got all mad because she had not been admitted yet. She got upset at Amy, the resident who was on call on the female side, and also at Shabnam, the Indian MO who is on call until 9pm. But both of them said they had not seen any new admissions! It’s interesting – the MO’s are very strict when it comes to whom new admissions are clocked by and which team new patients are assigned to. It makes sense – they don’t want to do any more work than absolutely necessary. In this case it turns out that Amy had already clocked this new admission but the nurses lost the admission note and so put the file back into the new patient box. So Amy was able to find the lost admission note and put it back in, but people were still aggravated at each other.

In general, I think my team is great, even though it’s the smallest one. We have as much work as every other team, but for some reason we don't get any new students, residents, or interns! At least so far it has been manageable. Boipelo (our MO) has always been there, although she’s taking the next two weeks off for vacation, starting Monday, and is being replaced by Mpape. She’s actually on call tonight. Not all the MO’s are that good, but she’s pretty good, even though she definitely has an attitude and is pretty cynical. She also works pretty hard. The work ethic is pretty interesting around here. Most of the Motswana MO’s and some of the doctors work relatively slowly, compared to the doctors in the U.S. It’s just a different pace – they tend to take 1 hour lunches (at least) and they don’t rush to try to get everything done. If by 4:00 pm there are some things that are left to do, they just leave anyways. They just try to get to the most important stuff early in the day. This I understand, but not necessarily agree with. There is just so much to do that sometimes one person just can’t get to it all. I do get frustrated on occasion, because there doesn’t seem to be a need for 1-2 hour lunches when you can be working on patients!

I think especially on the teams that have Penn people, the MO’s have a lot less work to do because the Penn people are “extra”. And on call nights when Penn people are on call, the MO’s tend to take off early or disappear, because we are also “extra” help on those nights. It can be really frustrating – often, an MO will just disappear for hours at a time because they feel there’s someone else there to do the work! Some of them are really starting to take advantage of us, and the MO’s are starting to fight to be on teams that have Penn people so they don’t have to work so hard. It’s annoying, because although we are there for patient care, Penn people rotate in and out, and we don’t always know the correct way to do something, or what resources are available to us. And more importantly, we can’t speak Setswana, so we need those Motswana doctors and MO’s to help us translate! It’ll be interesting to see how this plays out in the future because I don’t see it getting better unless there’s some kind of intervention.

Each team also has a specialist, who is equivalent to an attending in the states – they make the big decisions and do a lot of teaching. For my team, the specialist keeps on changing. The first two weeks it was Dr. Stefanski, the next two weeks it was Sarah, and now it’s Shanthi. They all do quite a bit of teaching, and are all very good (not all the specialists are good) but I think I liked Sarah the best because she knows how the hospital works and helps us out with the work after rounding. Shanthi will probably be like that too, but she’s relatively new, and is still learning the system.

Below is a picture of my most recent team – it’s Boipelo, Sarah, and I.

The first day at the Princess Marina Hospital

This was the first day of work! I started my first day on call on the pink male ward (there are female/male pink/green/blue wards). Kiona and Kristy are on blue female. Philip is on pink female, so we are on call the same nights. The good thing about being on call Monday is that the rest of the week is free! However, I only got 4 hours of sleep the night before. So the morning was rough. Every day starts out with intake at 7:30 am, where we go over the previous day’s admissions. Monday intake is super long because it includes all the weekend’s admissions in addition to Friday’s admissions. Then I rounded with Boipelo Lecoge (an MO, or medical officer, which means she’s finished internship at some point and may be working or in transition to residency) and Dr. Stefanski, a specialist (what they call attendings) from Australia. The residents act as specialists here, so Sarah would have been my specialist, but she left yesterday for 2 weeks to go back to the US to take boards. So Dr. Stefanski is covering for her. Mike Chattergoon is also a resident from HUP who is a specialist here, and he is on blue male, so he can be a resource for me when I’m looking for help with procedures or other things.

It wasn’t too crazy of a day, but I ended up admitting 3 patients all by myself – Dr. Lecoge did all the ongoing patient work while I was going to lecture and admitting. She had to go home at 4pm and came back at 9pm because she was on call. Mike left early because he got sick, so I didn’t really have him to help me out either. All the other students are on the female side so I don't really have their support either. Meanwhile this other MO Suna was the covering MO for both the female and male wards and she was awful. She kept disappearing for an hour at a time and she didn’t really want to help me out until Dr. Stefanski made a point to ask her to help me out. All in all it was an okay day. It will definitely take a while for us to adjust to this new hospital and figure out how everything gets done.