I wrote this blog entry and attempted to post it last week, but somehow everything except the pictures got deleted. I was pretty frustrated about it for a few days, which deterred me from blogging. But I figure I really should rewrite it and get on with other posts.
Last Tuesday I went on Outreach to Hukuntsi. It's a village about an hour flight by prop plane west of Gabs, pretty much in the middle of bush/desert. The idea behind outreach is to bring specialists to smaller hospitals to provide care for complicated patients. The government arranges for a private flight to take physicians and other providers from Gabs to the rural site for a day, and the team visits each of around 12 sites monthly. Our team consisted of a pediatrician (Peter, from BIPAI, who was leading a training session is a town about 100 km away, and met us there), an internal med doc employed by Penn, a peds resident, a physical therapist, two medical students from the University of Botswana, the BIPAI outreach coordinator, and me. We also brought around 10 boxes of antiretroviral medications to supply the hospital. The services provided each week varied depending on the team, but every team provides specialty care in adult HIV, peds HIV, and general pediatrics (pediatricians are considered specialists in Botswana, and there are fewer than 5 residing in the country--though there will soon be Botswana-trained pediatricians graduating from the new peds residency program).
We were met at the tiny airport (i.e. a shack, a windsock, and a gravel runway) and driven about 5 minutes through town to the hospital. Although small, the hospital was the only medical center in the region, and some of our patients traveled 100 km or more to receive care. As we learned when we were asked to consult on a child who was being treated as an inpatient, the diagnostic technology available at the hospital was very limited. They were able to do x-rays, ultrasounds, and very basic blood work. They were not able to perform an echocardiogram, a CT, or a blood smear. Any patient requiring more extensive testing, including the HIV negative 15 year old with severe growth retardation, hepatosplenomegaly, and a hemoglobin on admission of 2.9 for whom we were consulted, required transfer to Princess Marina or another hospital in Gabs.
In addition to inpatient care, the hospital provides ambulatory care for patients in the region. We saw patients in the HIV clinic--a single exam room where patients are seen every Tuesday. The patients we saw at the pediatric HIV clinic were referred to us for a variety of reasons. The most common reason was virologic failure, which, in the majority of cases, is due to poor adherence. So, as in the clinic in Gabs, much of our work revolved around adherence training. We also saw patients who were being transitioned between medications (the government is currently phasing out stavudine due to its side effect profile--except in extreme circumstances, all patients are supposed to transition this month), patients with side effects (e.g. gynecomastia in a 14 year old boy from efaverenz or anemia), and, one girl with Kaposi Sarcoma, whose disease was worsening despite two rounds of chemotherapy.
Overall, the clinic was fairly similar to our clinic in Gabs, but there seemed to be a somewhat higher use of traditional medicine. One patient had recurrent viremia followed by periods of good control because his father did not believe in western medicine. His mother--who appeared ethnically San and wore a satchel like the medicine bag displayed on my parents wall along with western clothing--administered his antiretrovirals when she was in town. However, during her frequent trips out of town, the child's father withheld medication. The team decided to try to contact the father to ask him to attend the next visit. A less tragic example was the 9 year old girl with Kaposi Sarcoma. Hers was the first physical exam on which I have seen marks from traditional medicine. However, her mother followed all medical advice from physicians and diligently administered antiretrovirals and took the child for chemotherapy and follow up oncology appointments.
After seeing the HIV clinic patients and the consult on the peds ward, we returned to the airport for the flight back to Gaborone. We arrived back around sunset after a fascinating day.
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Our prop plane |
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The team during the flight to Hukuntsi |
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Hukuntsi Hospital |
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The hospital "lobby" from which the wings opened. Like Princess Marina, the connecting spaces are covered walkways outside. |
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The medicine ward where we saw the peds consult, from the "lobby." More on the open doors to wards in my next post. |
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The guardhouse and ambulance in front of the hospital |
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A house of the drive back to the airport |
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The airport, complete with shack and gravel runway |
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Our plane at sunset, back in Gaborone |
2 Comments:
Robtswana update.
this is the normal view of local place. DTW Airport Taxi is always ready to serve Metro airport taxi service in Detroit city.
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