Mochudi

This week I’ve been out at the district hospital in Mochudi, which is about 50km from Gaborone. Each morning (unless I can finagle a ride), I walk to the Gabs bus rank and take an hour bus ride out there. There really is a marked difference between the district hospital and Princess Marina. First of all, everything is much smaller. The hospital itself is a series of distinct buildings arranged on the side of a hill.

Each ward - male and female medical, surgical, pediatric and maternity - is its own building and there are additional buildings for administration, nurses training, outpatient, laboratory, etc. Like at Marina, the day starts with morning meeting, but because of the smaller size the whole hospital is represented instead of just medicine. All ten doctors are there, along with about twice as many nurses, representing the various departments. Meeting starts with singing by the nurses, followed by a prayer, and then an update on all the admissions overnight. I feel like the smaller size really facilitates better communication between the doctors and nurses and makes it so everyone knows what is going on throughout the entire hospital every day.

Two of the doctors are from Cuba and are residency trained - one in internal medicine, the other in pediatrics. The rest are medical officers from throughout Africa, although at the moment none are Batswana. The MOs rotate through the various departments, so one month they could be in outpatient clinic, the next on a medical ward, and the next performing C-sections (or “Caesars” as they call them here) on maternity.

I spent the week on the female medical ward with Dr. Carlos, a Cuban physician who is 8 months into a 2 year appointment here. He receives his living expenses here, while his family is at home in Cuba getting his salary and a $50 per month bonus to make up for him being away. Each day Carlos and I round with all the nurses from the ward, another difference from Marina. Doing it this way means the plan for each patient is clearly communicated, and things seem to get done a bit more efficiently. Of course, there are only between 10 and 15 patients admitted any given day, which makes working this way possible.

I’ve actually been surprised at how different the patient mix at Mochudi has been compared to my time at Marina. In Gabs I saw a lot of stroke, CCF (what we would call CHF), DVT and diabetes, with smaller proportion of TB and HIV than I initially expected. At Mochudi nearly all the patients are HIV positive and are in the hospital for some direct complication of their HIV status. I’ve seen several opportunistic infections, HIV encephalopathy, wasting syndrome, etc. They do a lot of HIV care directly in the district hospital, although the severe cases do get referred to Marina. We had an HIV-positive woman who was 32 weeks pregnant who presented with fever and confusion. I did the lumbar puncture and the opening pressure was so high I could barely remove the manometer before the CSF spilled over the top. She improved somewhat after we removed 30cc of fluid, but worsed again and clearly needed another tap the next day. She was sent to Marina for management, which was the right decision, as she later lost the baby and is currently in the ICU, which is definitely not available at Mochudi.

That example aside, it’s clear that a lot of good medicine gets done in the districts without any need to send anyone to Gabs. The resources are a bit more limited - not only is there no CT scan or many options for ultrasound, but soap is scarce, and Purell is nowhere to be found. It seems that the system works well though, and many many patients get excellent care here. I’ve had a great time at Mochudi, and I’m feeling like I’m actually seeing a more typical picture of how medicine is practiced in Botswana.

More Mochudi pictures on Flickr.

This weekend we go on vacation again, this time to the Chobe River and Victoria Falls. Then only two weeks left on the wards - the time here has been flying by.