Weekend update

This weekend we moved down to exempla house. It is a great location with a lot more exploring to do in the yard for Charlie and more comfortable surroundings. We have passion fruit, bananas and avacado trees around the yard that are producing right now. Our housekeeper also brought a ton of mangoes in today!

These first pics are from Saturday afternoon. It is Charlie's first shin scrape! He was playing soccer in his rubber golloshes the gravel driveway and fell down. He barely cried though, and went on playing. The reason for the boots is the army of biting ants currently moving through our yard. He got bit a few times in his sandals and refused to go out without his boots. The reason for playing in the gravel driveway is he was scared of the biting ants. He's fallen a few more times but the ants have migrated to more peripheral areas, so he roams the grass more confidently now.

Since the migration, Charlie has ventured around the yard and found the two long term residents of exempla house: turtles! He loves following them and watching them walk/eat grass/retract into their shells. He currently calls them "doggie", but we hope to have him to turtle before he leaves...

He spent Sunday morning before church getting very muddy in the small stream that runs through the yard. He threw rocks into the mud for about an hour and then sat right down and smeared it all over for a finale. Tonight we forgot to give him malarone (anti-malaria meds), so we woke him up with the standard crushed malarone in Nutella- he successfully took down the chocolate easily while remaining asleep.

Today I moved from pediatrics to hospice/adult medicine. Hospice seems to move with spurts of activity so I anticipate a good mix of both. Until noon I basically rounded with the team on the female ward. More frustrations with the health system here as many of the basics are lacking: we had a patient with an acute abdomen who could have a stomach ulcer, or possibly pancreatitis. But they don't do the labs that could diagnose pancreatitis so it is a guessing game. There is also the woman who ingested the unknown pills. Apparently they were Flagyl (a fairly harmless med) and 8 other unknown pills. The problem here is she has depression, but there is no Prozac to give her. That is a safe and cheap antidepressant. There is an alternative, but it has side effects we like to avoid and some dangerous elements for a person who attempts suicide by pills.

On the flip side, this hospital is one of THE best in the country. For all my frustrations with it, it remains one of the best options for care here. So please don't misconstrue my frustrations as directed at the hospital itself, just the situation the health care system is in! It is a sad fact that a great deal better care is possible, as our system and many others have proven, but these people do not have access to it.

One patient that stuck with me today was a 68 year old woman who appears well into her 80's by first look. She is extremely cachectic (emaciated/thin), to the point that I can easily make out the bony landmarks of her skull and skeleton. On abdominal exam there is a large right sided mass about the size of a tennis ball, and it is tender. We are waiting for a diagnosis, but it is likely an intestinal tumor. Why did she wait so long for care? How could she have gotten so far along before seeking medical help? To end today on a positive note I correctly differentiated a fixed vs physiologic splitting of heart sounds! A fixed split is not a good thing, means you have a hole in your heart where there shouldn't be one. A physiologic split is just a ramification on your heart beat when you take a deep breath, which everyone has. A good difference to distinguish and it made me very happy.

To end the day, Mat and I had a very nice mountain biking experience. I would have had a picture too, but the watotos (kids) who asked for a picture ran away screaming when I U-Turned to oblige them! We hit some fairly steep grades and crossed some awesome streams. We left the main "road" for walking paths that are perfect for biking. There appear to be 3-4 road types: one a car could take, one for push carts, one for walking, and the dangerous small ones that get us lost! My bike is not exactly perfect- poor gear shifting and soft breaking which I can easily fix myself. But with that and no helmet it was an experience today. The brakes squeak horribly, so it was funny to come barreling down a hill into somebodies backyard that dead ends into their field. They would come out to see the cause of the noise and find two sweating Wazungus (white people)! We would be chased by several kids and met a lot of friendly people. The great aspect is you leave the population used to seeing wazungu and enter a region where our presence is a novelty and not one where we are constantly asked for money or some such silliness. It was a beautiful countryside and nice to know I can easily get away from the hectic streets into the countryside. As it approached dark on our return, we passed a church holding choir practice, and it was a peaceful moment to hear the songs reverberate as we went by.

The nightly neighborhood dog fight has begun, which means it is time for bed.

Cheers!
Eric