Hospital Update

Each medical ward (male and female) at Princess Marina is divided into 3 firms: green, blue and pink. I’m on the male green team. Yesterday we were admitting patients, which means that any patient that arrives between 7am and 4pm gets accepted by our team. There are other people on call in the evening and overnight to do admissions, and then we get all those patients as well. The exception is for people who have previously been seen by one of the firms - they always go back to the same firm. So, you can get a patient any day, but you get more on days you admit. This week we admitted on Tuesday and Thursday, next week just Monday, and then the week after on Wednesday and Friday.

So anyway, yesterday we were admitting, which meant I got to spend some time in the A&E (Accident and Emergency) department, the equivalent of the ED in the US. A&E is actually a bit better equipped than much of the hospital. Most sick patients get private curtained areas (although overflow goes to the hallways, just like at home) each of which has a monitor, oxygen and basic supplies.

The first patient I helped admit yesterday was a 58 year old, HIV-positive man coming in with a couple weeks of cough, weight loss, and fatigue. When we saw him, he was febrile, hypotensive, tachypnic and in clear respiratory distress. In the US, we would have put in a central line, probably intubated him, and sent him to the ICU. Here we started fluids, gave him an antibiotic, and admitted him to the floor. He died overnight. Frankly, the outcome might not have been different at home, but we probably would have felt better because we would have done a lot more.

I went back to A&E later in the afternoon. We admitted two more to our team - a probable stroke, and a likely meningitis. I tapped the second patient with an 18g angiocath because they were out of LP needles. My medical officer asked me to stay afterwards and help out because A&E was so busy. I got to work up a couple patients who ultimately got sent home. It was nice to see a bit of how emergency medicine is done here, and it was definitely a good break from the floor.

Thankfully we didn’t get too many patients overnight (unlike the female team - I’m not sure when Susan will get to leave the hospital today). I was able to leave early and relax a bit this afternoon. This weekend we go to a game preserve in South Africa, and then next weekend to a rhinoceros sanctuary north of Gaborone. There will definitely be photos coming soon…