Back in the Saddle

After returning from our safari weekend, we returned to Gaborone and hospital routine. The director of the Botswana-UPenn Partnership, Harvey Friedman, MD, the chief of Infectious Disease at the U. of P. hospital and research ID doctor has come for the week and we have had the opportunity to share space, memories, and philosophies over dinner and wine.
The work in the hospital has changed, in that my presence is no longer an anomaly, but I am depended upon to help refine diagnoses, direct management, and objectify with echo cardiologic issues and emergencies. In the past day I have sent a patient with an ST-elevation MI to Johannesburg for invasive management (this was in the absence of 2B3A infusions, IV heparin, IV nitroglycerin, clopidogrel, etc), diagnosed apical mural thrombi in an elderly woman with embolic infarction of a foot, and ruled out cardioembolic source in a young patient with a stroke. Once I am no longer here, these services are in danger of lapsing. I have 2 ideas to allow them to continue. One is to have the device providers underwrite the training of an Xray technician to become an echocardiography technician. He/she could return to PMH, establish an echo lab, using the GE machine (Vivid S6) and/or the Philips HD11 (if the company would sell it to the hospital for a good price). The doctors here could be trained through CME to learn to read studies provided by a competent echo technician. The second is to encourage 2nd or 3rd year cardiology fellows to come here for 6 week rotations; this would be especially beneficial for the noninvasive fellows. They would be busy and stimulated by the breadth and depth of the CV problems here. I would encourage either UPenn to sponsor this endeavor, or perhaps the American College of Cardiology to fund it, similar to the program created by the American Academy of Dermatology, who sends a fellow here every 6 weeks. I am waiting to hear back from the vendors with respect to my first idea. It could make a huge difference here.