Back in the swing:

The CO school is full of resolute students that, on graduation, will either return to their home villages to carry on or staff what will soon be 19 out lying clinics in the system. All health care here is administered by the Ministry of Health for the region, ungoverned, as understand it, by either Khartoum or Juba. They are supported by Mother of Mercy, the organization that supports the hospital. When I am here, I represent Catholic Medical Mission Board, an excellent NGO based in NYC that supports maternal-child health. I’m neither Catholic nor a practicing Christian but they are happy to have me represent them and they fund my travel to and from Gidel. So, I travel from homeàPDXàNYCàDohaàNairobiàJubaàYidaàEnd of the roadàGidelàthen a 2 km walk into the bush to the CO school. I am tasked primarily with teaching but am also managing the male ward, so I find myself walking quite a bit and when not sitting in front of my laptop writing discussions. BUT this time I’m not limping as I am in possession of two new hips!

The school is on the only flat plain around, hence its placement. I will give my first talk tomorrow on the physical exam. I dislike the word “lecture” as it seems too much like “eat your damn broccoli.” I really dislike that style, preferring the Socratic approach. In med school, lectures were occasions for a brief nap. Nowadays med school lectures are recorded such that the students don’t need to attend class, can play the video at 1.5-2x speed, and maximize their free time. The curmudgeon in me feels that, absent the discourse, something is lost.

I enjoyed dinner (called supper throughout the Nuba) with some missionary expats last night. At its conclusion one brought out some Makers Mark 101 proof. We’ll just say that I didn’t learn from the last time, and I didn’t “respect the proof”. Again another “walk” weaving my way back to my room. Too old (read stupid) for this.

Case of the week:

Yesterday a CO admitted a 90y/o man with “dehydration and urinary retention” The history and physical was one of classic outcomes bias, something for which I plead guilty on rare(er) occasion. He has loose skin, so the tent test is positive. He was having diarrhea, but had one formed stool within the last day, hadn’t vomited, and passed lots of urine, so he was wasted, just not dehydrated. His wife said that every time he ate, he had severe pain of the epigastric area which on exam was very tender. It would seem that he stopped eating to avoid the pain and lost considerable weight. He might have an undeclared cancer and we can’t investigate that with imaging or endoscopy. Also, his temp was quite low, BP also quite low, pulse was rapid and thready. He is septic from what remains to be seen assuming he hangs in there long enough. So, like so much in medicine, a moribund patient but a good teaching case.

After 3 full days, I find myself back in the groove and anticipate that things are going to get “real” tomorrow. Jet lag still presses down on me so time for nap #2. Cheers