Rain and Shine

The rainy season can produce prodigious thunderstorms and high-volume downpours. Yesterday evening, we went out for dinner at the local Chinese restaurant, "China Restaurant" at a nearby mini-mall. The restaurant had one other table of diners (a couple eating "Hot Pot" that began before our arrival and was still going strong when we left). There was a large group of maurauding 5 year-old children who treated the nearly empty dining room as their gym. Two secluded rooms on the side were set for dinner and when we left, we saw the large assembled Chinese family of the owners enjoying their meal.
The rain was pouring and the thunder and lightning powerful when we exited the restaurant. The parking lot was flooded with what appeared to be ankle-deep water. We swallowed hard and took steps into the deep puddle toward the car. Suddenly, Barbara was into water thigh-deep! She had inadvertantly stepped into either a giant pothole or a drain-pipe. Fortunately, the damage appeared to be limited to a mild foot-sprain, but the surprise, the mess, the wet, and the concern about worse injury made the entire event frightening. A warm bath, ibuprofen, neomycin ointment, icing, and sleep helped diffuse the potential injury a great deal, and Barbara is back to normal 24 hours later. We were glad we updated our tetanus vaccinations!
Today at the hospital was another productive experience. Among the cases I was asked to see was a 26 yr-old woman referred by a local "cardiologist" for a pericardial effusion, found on his echo exam. She indeed had a 4 cm effusion, likely due to TB, which I will tap tomorrow. However, he totally missed the fact that she had an enormous intraventricular septum with evidence of dynamic LV outflow obstruction, a condition called Hypertrophic Obstructive Cardiomyopathy. This is a major finding and will significantly affect our management strategies for her. Other studies ruled out myocardial scarring in a 60 year-old diabetic woman with an abnormal ECG, and helped forstall aortic valve replacement in South Africa in a 63 year-old man who had only moderate AS/AR and LV systolic dysfunction, who really needed appropriate medical care to reduce his symptoms. Yesterday I echoed the Foreign Minister, who will be happy to extend my greetings to Mrs. Clinton when he next sees her.
This evening, I had the pleasure of meeting Dr. Howard Moffat, the former medical director of Princess Marina Hospital, who shared tea and wanted to know my opinion about how to raise the level of subspecialty care in the country. We had a great discussion, but I suspect that the problems here are complex and have no simple answer.