Hospital Issues

This morning started promisingly. I did a consult on one of the nurses' father (a 70 yo man with hypertensive heart disease). She brought him to the hospital with records in hand for me to review and provide input. She even brought Xrays. I examined him, did an echo, and gave her the advice she needed to improve his care. I did 2 other studies with the Philips machine which will be great as long as I get an ECG cable. I'm waiting for it to be shipped.

A 28 yo woman who presented in heart failure (requiring mechanical ventillation) 2 wks after delivery had a classic post-partum cardiomyopathy, with poor systolic function on echo. I made suggestions regarding drug therapy in a breast-feeding patient. I encouraged her to feel optimistic about her ultimate outcome, and counselled the housestaff on safe and effective drug therapy.

I observed a chest tube insertion in a man with a pyogenic pleural effusion. I walked in on the procedure, which was going on for an hour when I arrived. The MO doing the chest tube had gloves on, but, dressed in her white coat, had her hand bag draped over her shoulder while she was trying to insert the tube. We will need to discuss aseptic technique with the housestaff. This, and the unavailability of hand-washing resources, will be a subject for discussion, to be sure.

I walked back to the flat to get into the pool and read a bit. Barbara was off making legal connections (see her input below or later).

For my echo buddies: the 2 machines I have access to, the Philips HD11 and the GE Vivid S6, are both excellent and allow me to make a real contribution based on objective data supplementing clinical observatons. Both machines function very well, and the Philips even has an XCelera report module! I'm still learning the buttons and the controls to help optimize imaging in the "TLS" patients.

Now for Barbara and the legal beat!

Today I spent a few hours at the office of BONELA - an advocacy group dedicated to combating HIV/AID discrimination and advocating human rights policy in Botswana. I met with a very energetic and young group of legal and community staff and will likely volunteer there a few days a week. There is not much in the law that protects people with AIDS from all kinds of discrimination in employment, housing, health care. They were very enthusiastic about my coming in and I hope to be able to contribute to their efforts.

The sun is setting now, and the birds are singing (or sqwacking), and dinner awaits us.