Day 4 - Meeting Dr Jan

So today was the first day of our rotation. We set out to find Joy Hospice and our attending , Dr Jan.
http://www.mbalehospice.org.uk/
Read through the website, it's pretty amazing stuff.
So of course we got lost en route. We tried to cut through the regional hospital as opposed to turning right at the little clock / turnaround .

* will include day 4/5 stuff *

Joy Hospice is a special kind of place . It's a mixture of a mini hospital with ten "ward beds " and outpatient clinic . The kinds of patients I've seen in clinic this far :

Ward

Infant with diarrhea illness treated with ORS and zinc 

Older lady with spondylosis and uncontrolled htn 

Young gentleman with wasting / fatigue found to have AIDS, cd4 count in 100s. He's been having some hypotension . He's also complaining of nausea and weakness  . My theory was that he could have an element of adrenal insufficiency but without a Chemistry / cosyntropin/ cortisol level, it's hard to prove . My c.o. Was amenable to trying steroids though :) labs cost money to patients in clinic   . HIV testing is free when available but we have to pick the best test for the money so this far he's only had a cd4 count .

2 different ladies wi asthma exacerbations. One lady came in with hypoxia and severe distress , was given steroids and only two salmuterol treatments which ....blows my mind. Needless to say I requested at least q4 treatments , with Ashley and Courtney in agreement .

Outpatient 

Young girl with fever / abdominal pain = typhoid and uti ( cipro for both)

Older gentleman with tendon pain and early satiety = hpylori positive / pud and partially torn tendon ( a good find on me and Ashley's behalf with a bunched up tendon and obvious deformities when patient lay prone comparing the two tendons 

Young girl with follow up , she had previously presented with significant weight loss / night sweats / nocturnal fevers  / anorexia and had been treated several times for "malaria " without improvement . The person at joy hospice took a thorough history and realized there was a sister with newly dx tb and patients afb came back +++ = newly dx tb. On follow up , two weeks into treatment she looked happy and alert . She thanked the clinical officer for saving her life :) 

So that was clinic so far . I feel very fortunate to be helping and learning . People are referred to joy hospice in times of desperation when other doctors can't help them.  I feel very fortunate to help in my little way and learn from the Ugandan people and our fellow healthcare workers.

I will blog about our clinic staff and dr jan later, since there is so much to share.