Procedure Day and Setswana Lessons

Busy day, medical-wise. Morning report stimulated a spirited discussion about the inability to obtain desired radiographic studies (contrast CT) on patients admitted from A&E (the ER) with neurologic presentations. The passion of the house-officers was reassuring, and the understanding that testing needs to be considered in the context of clinical assessment essential to their development.
Medically, the day was eventful.
I consulted on a young 15 yo student with dramatic episodes of chest pain and fainting. She had a case of pseudo-syncope, in my opinion, and I urged reassurance and opposed sending her on to RSA for EP studies and possible pacemaker!
A 30 y.o. male patient with AIDs and TB was admitted with severe shortness of breath and weakness. His chest xray showed a massively enlarged cardiac sillouette, and he almost certainly had TB pericarditis. I did an echo, confirmed a huge pericardial effusion (5 cm in depth!) and arranged to do an echo-guided pericardiocentesis in the afternoon after my Chest Pain lecture to the interns. We drained over 500 ml of fluid, and I left the catheter in overnight to see if more would drain. I had obtained a sterile procedure tray from the OR and did the procedure aseptically, in part to demonstrate how this could be done even in the ward procedure room. The echo machines I have been using have been an immeasurable benefit, and I am grateful for all the patient mentoring given me by the echo techs at MMC while I prepared for this experience.

Barbara's Turn:
Thanks to the patient mentoring of Alima, who works here at the house on Pilane Court, I have been working on my Setswana. We have moved on from the dumela mma, rra greetings to goodbyes (different if you are the one leaving or staying behind) and now I am being drilled on how to say things like "I want to go to the store" or ke botta goya ko di shopong. All g's sound like back of the throat "H"s and there are frequently this "ng" which has a kind of n and click. They laugh hilariously at my efforts but it is fun and I hope to be able to talk maybe like a 2 y.o. by the time I leave.

While Setswana is spoken by everyone, there are also tribal languages which are the first language for many people and are completely different from Setswana, which means a lot of people are fluent in 3 languages here. English is taught in the school so everyone speaks it, but it is sometimes difficult to make out all the words.

Off to RSA tomorrow. More about that later.