Princess Marina Hospital Adventures

The morning began with the usual nurses' songfest around the nurses' station. The place was packed with patients...people on mattresses spread on the floor adjacent to the entrance to each of the 5 "cubicles" of 10 beds. I was asked to do a consult on a 57 year-old diabetic woman with profound heart failure. I went by to see her yesterday afternoon but couldn't intrude on the circle of relatives surrounding her mattress fervently praying for her recovery. She had evidence of a hypertensive and ischemic cardiomyopathy and I encouraged her and the housestaff that she likely would be easily treatable and I would expect her to recover with time.
I did an echo study on an unfortunate 21 year-old man in terminal heart failure 3 years following valve repair in South Africa. His findings on echo were so severe that I forwarded the images to the echo lab at Maine Medical Center for presentation at clinical conference.
This was the 2nd transmission of this sort in 2 days.
Yesterday a 20 year-old girl who had undergone a right above-knee amputation for osteosarcoma in 2007 had evidence of pulmonary congestion and on echo showed a very dramatic probable intracardiac metastasis emerging from the posterior wall of her left atrium.
As I have mentioned before, the dramatic findings I am uncovering here are astounding!
I supervised the residents who performed their first electrical cardioversion, and they were thrilled to be instructed in the synchronized use of the defibrillator for elective procedures.
The steps required to obtain the appropriate IV sedative were frustratingly baroque, and the nurses (see the chain of command chart) are organized in a way that de-emphasizes teamwork and makes obtaining quick and effective assistance difficult. This characteristic is typical of Botswana culture and often leads to buck-passing on even the most elementary decisions.

Barbara speaks -
I am very close to finishing a lengthy Muskie report and am delighted about the prospect of delving into subjects of more local interest. Tomorrow I hope to go to a district court which is hearing the case of a non-compliant TB patient - a perfect public health law case. Our flatmate, Rob McGregor has been involved in TB treatment here in Botswana for the last 8-10 years and is full of lots of great stories. Stay tuned for a new series, Gabs Law!