Lobatse

This morning I walked over to the UPenn office at 0630h to meet Mike Pendleton, MD, a FP from Oregon who, like me, grew to detest night call and came to Botswana to help teach in the Botswana-UPenn Partnership. Mike primarily performs medical outreach. The primary sites are Mochudi (where I went last week), Lobatse, and Kanye. Today was Lobatse, a town about 40 km southeast of Goborone. We arrived at the Althone Hospital (the oldest in Botswana, built around 1922), used initally as military barracks. We attended morning meeting, which began with a prayer (recited in quick-time English by someone in the back row). There was no song, much to my disappointment. Patients were presented by the nursing matron sitting at the front. The doctors took little part in the discussion, and the scrubs-clad woman next to me seemed more intent on working through her cell phone messages. Curiously, there was a land-line phone on the main desk, which rang several times during report. The phone was answered, and a discussion ensued which rivaled (and obscured) the simultaneously occuring medical discussion in the same room!
Thereafter I was directed to the male medical ward, where several patients with cardiologic issues were housed, 8 to a cubicle. There were some interesting questions (rhythm, heart failure, and physical findings) in a few patients, among several patients without heart disease. I was even asked to look at the right thigh of a 27 year old HIV and TB-infected man who had moderate sized papules (somewhat pustular) and its anterior aspect, with firm lymph nodes in the groin on the same side. I thought it likely was extrapulmonary TB, and encouraged aspirational samples from both the papules and the groin nodes. For a cardiologist with little TB or HIV experience, I was gratified when the other physicians agreed with my assessment.
I spent the rest of the time with Dr. Pedro, a general internist from Cuba in his mid-late 50s, on a 2 year contract with the country held by the Cuban government. Cuba won't allow family members to travel, so he, like the Cubans in Gaborone at PMH, must leave their spouses at home. This would not work for Barbara or me. Dr. Pedro had collected a number of consults for me to see in his office, one of whom will see me Tuesday at PMH for an echo.
Today is the intern match day, and the students here are anxious, despite already knowing that they all were matched somewhere. We find out specifics tonight, and will be helping to host a cookout for the students and residents tonight, also partially hosted by UPenn faculty. I'm certain there will be no long faces among the prospective house officers. Plenty of beer will be available for anesthesia.
Tomorrow, we're headed back to Maun, to be transported by bush plane to Pom Pom Camps in the Okavango Delta. We'll have plenty of details after the weekend.