Shalom Shalom

2011-08-25T19:24:00.001-07:00

I haven't posted in a while. But today something happened that surprised me enough that I wanted to write about it. So here it is.

A few months ago a cop stopped me at a busy intersection here in Montreal and gave me a ticket for having run a red light. I was turning right at the intersection and I agree, it was close. But I didn't think I ran the red light. So I fought the ticket, partially for the principle, but mostly for the demerit points it would have put on my license. I pled not guilty. The city sent me a second notice, urging me to plead guilty to avoid further expenses. No thanks.

So then I got a notice with my court date, which was today. In the leadup to this, I tried to research ways to plea-bargain - I knew I could lose the case, so I would have been OK paying a fine and avoiding the demerit points. I couldn't find a way to do this very easily, so I went to court today.

I showed up before my time, they opened the room. I talked to the city lawyer there after he showed me his evidence, which consisted of the cop's written testimony that I crossed the line after the light on his side of the street, ninety degrees from mine, had turned green. I asked the city lawyer if I could plea-bargain. He said that given the testimony of the cop, no, the best thing I could do was plead guilty now, and avoid the charges that go with having my case go before the judge. Again, no thanks.

So the judge comes in, my case is first. I raise my right hand, swear I'm me, that I live where I do, that I was born when I was, and that I'll tell the truth. They didn't even give me a Koran to swear on or anything.

The judge asked for my version of events after the city lawyer gave him the deposition from the cop. Let me tell you, I was kinda nervous. Actually, pretty nervous. Very nervous? OK. I mean, I'd never been in court before, here I was by myself, defending myself, with no clue what I was doing. In French.

After trying various ways of saying it, I finally communicated to the judge that the light had turned yellow, that I didn't think I could stop in time, and that the light had turned red after I had crossed the stop line, so I continued my turn. He asked several questions about when the light changed etc. Then he said my version of events seemed plausible, and that it is the right course of action to continue if one can't stop in time, and then he pounded his gavel and acquitted me.

I was sorta dumbfounded. I mean, it's not like I was acquitted of a crime for which I would have to serve time or the death penalty. But hey, I won! No fine for me...

Anyway, I wanted to post this because I was surprised that in some municipal traffic court, on a regular weekday, a judge actually listened and thought about what I said. And believed me. Weird. But inspiring. At least to me. I mean, this might be a boring and inane story. But I had a pretty good day after that.

I hate the emergency room

2009-05-27T15:54:00.000-07:00

I know, most people hate the emergency room. But not like me. See, they come in, wait several hours, and then get substandard care. So they hate it. Me, I'm the one who makes them wait several hours. I don't think I give substandard care, but that's not for me to judge.

But how many fevers can one person see in a night before he gets jaded? Kids get fevers. It's what they do. You give them a cold, and instead of the sniffles, they get a fever. But parents get scared and bring their kids in at 11 pm. At which time there are no rooms in the ER to see kids, since the place is packed with adults with various equally unsatisfying complaints, like back pain. It may sound callous to some, but I just get fed up with counseling parents about their child's viral illness. Keep fever down, make sure he/she is drinking ok, it's ok not to eat when they're sick, make sure he/she pees once in a while. Call if he/she still has a fever in 3 days. At which time I'll give you the same advice again.

So in 1 month, I'm going to be in the ICU for good, and I won't have to deal with any viruses, except maybe my own kids' one day. I can guarantee I won't show up in the ER with my kid at 11 at night.

Sick of SF weather

2009-05-25T14:49:00.001-07:00

So I'm no longer sick, as I was last week. It was neither swine flu nor malaria, so that's boring. But I am sick of the weather here. It was teasingly warm for one weekend, and then back to regular - highs in the mid-teens (Celsius), lows around 10, maybe some sun sometimes, otherwise foggy. It's just so boring. AMT blogged about weather in Edmonton, and I can see her getting sick of that too (snow in May - well, it's not as bad as snow in June. Or July), but at least it's weather. We lack that here. So in 38 (!!!) days I'm going to a place where it cannot be argued there's no weather. And hopefully I won't do anything bad to my patients there. But they scare me.

Sick

2009-05-18T16:02:00.000-07:00

OK, so it's not so much fun to be sick. I've been sick for a week now, and every day, it gets less fun. Except for that one day when I thought I wasn't sick any more, that was pretty good. On that day (Sunday) I felt so good I went to the gym. Hey, I was even able to lift pretty decent weight for a while. But then I started noticing that whenever I stood up, I got a bit of a headache, which died down. Then I noticed that whenever I changed position, I got a bit of a headache, and when I stood up, I got a bit more of a headache. And then I started feeling tired. So, being smart, I left.

Being smart, but not that smart, I didn't go home, but I went biking and shopping. Then I went home, really not feeling so hot. Er, good. And as the afternoon wore on, I got a headache the likes of which I cannot recall. Ever. Both my temples pulsing with pain, a band over my head between them made of throbbing... lighting. I don't know. Something big and destructive. And every time I moved, the throbbing went up. It was unbelievable. And it took 2 hours of this (during which I refused to take anything because I needed to see if I would still get a fever) before I finally got a fever. Then I took Tylenol, then ibuprofen, then felt somewhat better. I even slept OK.

So this am I went to the doctor (urgent care at UCSF, not my useless GP here), where they ran some tests. Everything so far is negative. My white blood cell count is as normal as possible, I'm not anemic, my kidneys seem to work, my liver is OK. Even my malaria smear (so far) is normal. Stupid lab tests. What do they know?

Flying

2009-05-12T18:10:00.001-07:00

It seems airports are my favourite, or maybe only, places to blog. In any case, I've been getting sick for several hours after Stephanie came down with something and left already, and it's getting worse. Fevers, chills, aches and pains. Hopefully they won't quarantine me. Anyway, a few advil did the trick, and things are looking up. I hope I can sleep on this plane, 'cause I feel like shit.

Israel

2009-05-11T06:17:00.000-07:00

I've been in Israel for over a week now, just so you know in case you haven't been able to find me. As far as I'm concerned, there isn't a better vacation place. Although it appears the pope has just landed here, so that might put a damper on things. But never mind that, I still love it. The beaches are fantastic, the water is still cool in May instead of the pee-temperature (and probably pee-filled) water in the summer, the food is still amazing. I don't know why people eat anything else. Except maybe the occasional French or Italian meal. Maybe Thai and Indian occasionally. OK, there's other good food out there, but seriously, I prefer this. Vegetables as tasty as you can imagine, hummus and falafel that's mouth-watering, fresh-squeezed juice at the beach... Sigh.

But I'm leaving tomorrow, back to San Francisco for my last six weeks of residency. And then on to Montreal. Love it! But first, I think I need more hummus.

Last blog from Kenya

2009-05-10T07:55:00.000-07:00

01/05/09

Jomo Kenyatta

I’m typing this at the airport, having arrived at Nairobi (Jomo Kenyatta) airport a while ago from Kisumu. I still have 5 hours until my flight to Istanbul, and then 8 hours or so there before I go to Israel. So I have time to blog. Or at least to type, since I can’t connect to the internet here.
Que dire? I spent a month in Kenya, going on safari, treating HIV, seeing kids on the inpatient side with tuberculosis, malaria, cholera, typhoid, marasmus, kwashiorkor – diseases that, in my world, only exist in books. Diseases that should exist only in books. All of them, except maybe HIV, can be easily prevented. When caught in time, they also can be fairly easily treated. But so many forces here have conspired to allow these diseases to flourish.
Poverty is of course chief among them. But the poverty is complex, and I’d need to spend much more time in Kenya figuring it out. The legacy of colonialism is, to me, strongly felt. Hundreds of years of oppression, followed by rapid independence based on map lines that have, or had at the time, nothing to do with Kenyans’ (if we can call them that) lives. And then somehow we expect them to have a flourishing democracy. Just like Iraq has.
I also think centuries of white oppression has divorced people from their culture, and therefore from their land. Not only do people not have the means to feed their children, they don’t know how. I am sure, before colonialism, there was no such hunger and malnutrition. People farmed, hunted, fished to eat, and though there were general problems (wars, floods, famines, etc), there was local knowledge and wisdom about how to farm without raping the land, about what constitutes a good diet. Now all people have is Ugali, which has the texture and likely the nutritional value of wet sawdust. I don’t think I’m romanticizing here. Whatever was here before white people was better than what is here now. “Progress” has only made the majority of people poorer, unable to feed themselves and their families.
Incompetent government is easily seen in the papers here every day. I thought Stevie was something, but we’re talking orders of magnitude here. And the corruption the incompetence engenders is also palpable. Government money simply disappears. As if there was enough to begin with, the government spirits it away. Much of the population has nothing to eat but maize, and the MP’s are raking it in. Families lose half their children to malnutrition and related diseases, but the government is more interested in power-grabbing than in solving socio-economic problems. Recently the Ugandans planted a flag on a small island in Lake Victoria that is also claimed by Kenya. Luckily the Kenyan government decided not to go to war over this, but the amount of energy devoted to this in politics and on the streets is unbelievable. As if a tiny fishing island has any effect on the majority of the population.
But similarly what they do with their free time. In general, men here are obsessed with one thing, and that’s Champions League Football. In Kenya, you’re either a Man United fan or an Arsenal fan. As if some game played on another continent has any bearing on anything here. But it does, because that’s where people’s emotions are invested. Which I find difficult to swallow. I do understand the wish to escape from the daily life, but this is crazy. In Sindo, for example, which goes without power for much of the day and night, some people have their own gasoline generators. And what do they do with the gas they buy? They watch TV, of course, and mostly it’s football.
Kenya is an economic success in sub-Saharan Africa. I can’t imagine what countries like Angola look like, let alone Zimbabwe. One reason people at the clinic were sad to see me go was that they could see how a paediatrician was so important. And they don’t usually have access to one. As they said, my services are more needed here. And they’re right. There is an abundance of people to take care of the preemies at UCSF for the next month. But for the rural population of Suba, there is no paediatrician.
So I’ll be back. Maybe not exactly here, but somewhere where they need me more than at tertiary-care centres in the developed world. I’ll probably come as part of something organized rather than on my own. I’m not sure what form that will take. Maybe as part of the MCH’s cardiac team, but that’s not what I feel is really needed. What’s needed is fairly basic care. Not like kids with cardiac disease don’t deserve to live, but the resources that need to be invested in them are huge, and with that money, you could make Sindo District Hospital into a place that could actually be conducive to healing, rather than death.
OK. That’s a downer. And this is long again. Not blog-like. I’m sure I’ll soon find good things to write about. Like this mosquito I’m hunting right now…

Death

2009-04-30T05:10:00.000-07:00

Today I saw my first dead child here. Just now. Some kids have died while I’ve been here, but I hadn’t seen them after. Only before, even if I knew they were going to die. But this is different. I walked into the urgent care centre here to talk about something with a nurse, and see a child on a table, motionless. He looked 5 or 6 years old. The nurse was listening to the heart, and then stepped away. There were no chest movements. I put on my stethoscope to listen, and heard nothing. Just in case, I also felt for a pulse. Nothing.
I asked another nurse what had happened – he had come in earlier that morning with convulsions, and they had attempted to resuscitate him, but clearly with no success. He had been pulseless for quite some time. Thinking about it, a child coming in, likely in status epilepticus for who knows how long, and now pulseless for an equally poorly defined period.
They have no ventilators, no ability to do any diagnostics in a case like this. I decided not to resuscitate him. It would take too long to figure out what had already been attempted, I had no idea why he might have seizures, and there was likely little left to salvage. I walked away, letting the caregivers here do their work.
Lisa, a former UCSF peds resident, had talked to us at UCSF about how she generally does not code kids in Kenya, mostly because there are no post-resuscitative options. Without any labs, really without many meds, and with no ventilators, there is no possibility to manage this kind of patient.
Saddened, and humbled by my inability to help and my lack of knowledge about how to deal with this in this foreign setting, I went back to the coordinator’s office, where I work.

Kenyan English, and other random observations

2009-04-26T04:04:00.001-07:00

Kenyan English is very interesting, I’ve found. English is one of the two official languages here, along with Kiswahili. Perhaps some of the idiosyncrasies come from translating Kiswahili, I don’t know. But here are some of them that I’ve found interesting.

“Isn’t it”. This phrase is used in Kenya for just about any sentence that needs confirmation. Uses include some that are like ours (e.g. This ball is red, isn’t it?), and most that are not. They’ll say things like: “We have just talked about malnutrition, isn’t it?” Weird.
Odd word usage. Some things are expected, but sometimes it isn’t clear why they use a complicated word when it doesn’t even mean (in my English) what they want. For example, “precise”. They use this word to mean “brief”. This is decidedly odd to me. Something like “Thank you for making your speech precise”. Strange.
Any time the temperature here falls under 25 Celsius, they complain that it’s cold, and start bundling up. They come to work in sweaters when it’s 25 degrees. Clearly they have very different heat capacities than me. Or something.
Rain. The rain here is something. Actually, so is the mud. But first the rain. It’s the wet season, so it rains here in Nyanzaa province daily, mostly in the afternoon and evening. There is no gentle rain here. The clouds build up over the afternoon, and then open up, with amazing lightning and thunderstorms and driving rain. The lightning here is amazing – it can light up the sky for ten, fifteen seconds at a time. Too bad my camera can’t capture that.
Then, the rain generates mud. There is one road through Mbita and Sindo, and it’s a dirt road. Where it crests a hill, it’s mostly OK. But as soon as it gets a bit lower, the water and mud start to build up. There end up being two tire tracks through the mud, with walls of mud on either side maybe 50 cm high. Sometimes a car is stuck in the tracks, and our Land Cruiser goes around it. So that entails climbing that wall of mud, sliding around in the trackless road for a while, and then climbing back into the tracks. Really, you shouldn’t have anything but a Land Cruiser here. Or bare feet. I think those are the only two choices that make any sense.
Kenyan women have large hands. Like, enough for me to remark on it. And Kenyans all have quite small ears.
Buses here are crazy. They stack stuff on top, and tie it down with rope, and then as the bus goes toward its destination (in this case, Kisumu), it stops all the time to load and unload passengers, and Kenyans working on the bus go up and down a ladder on the outside of the bus, taking things up and bringing them down. This makes for a long and entertaining ride. Also, Kenyan buses are generally run privately (some guy owns a bus), and then they name it some crazy name like “The Rasta Rocket” and blast some music or Kenyan TV show at you all the way.

Exploding oven

2009-04-19T11:53:00.000-07:00

I just singed my eyebrows. I've never done that before. I couldn't figure out where the element was on this little oven in my kitchen in Mbita, and I was trying to light it with a match (gas element, of course). It took me a while, sticking matches in various places. I turned off the gas in between, but I guess some got caught in the lower part of the oven. When I opened it and stuck a match in, it exploded out at me. So my eyebrows got singed, as did the front part of my head hair, my eyelashes, and my forearm hair. Now the kitchen smells of burnt hair, and I look a bit odd. Not terrible, and hopefully after a shower it won't be noticeable.

On the bright side, I got my oven lit and ate two warm Dutch caramel-filled wafers. Yum.

Some more thoughts generated during my trip

2009-04-19T11:22:00.000-07:00

Jambo!

Yes, that's how they say "hello" in Kiswahili, the Kenyan dialect of Swahili. So now you're ready to visit, or at least more ready than I was when I arrived. This may be repetition for some of you, and I intend to upload pics and stuff, but so far I haven't gotten a good enough connection for that. Hopefully soon I will have a real internet connection, but I have learned not to hold my breath. Lots of delays everywhere.

Getting to Kenya takes about two days. The route I chose was a red-eye to Amsterdam on KLM, which was very nice overall, and then I wandered around Amsterdam and gazed at the canals for a while. I stopped twice for coffee which was very necessary, and tried to shop for a watch. I wasn't really willing to shell out 100 euros for that, so I left empty-handed. I did manage to snag some of those great Dutch wafers with syrup inside at the airport, and I'm still working my way through them. Other comfort food I got there included some Cote D'Or dark and milk chocolate bars with hazelnuts. I love those. Anyway.

Next was a new red-eye from Amsterdam to Nairobi on Kenya Airways. Not quite as nice, but I slept. The individual screens (which KLM did not have) didn't work. Like the flat-screen TV's at the Nairobi airport. I will soon show you the picture of the Nairobi domestic terminal. About the size of my apartment, packed with plastic chairs. I had all day to wait there as well, but decided not to wander the streets of Nairobi on my own.

So then a short flight to Kisumu. Kisumu is Kenya's 3rd-largest city, but it feels like the slum of a larger city. The downtown is one unbelievably crowded road, with street sellers and shops. Everyone sells prepaid cards to one of Kenya's two main cell phone operators. Turns out everyone in Kenya has two cell phones, since it's expensive to call between companies. I used to think cell phones were for rich people, but no. And a lot of really nice cell phones too. Kisumu is mostly paved, though a lot of dirt roads as well, which is a problem now because of the rainy season. I oriented a bit in the clinic there after a long sleep, and then took a nap, and then slept some more. After that I felt great, and I haven't been feeling jet-lagged since. I guess if you fuck up your sleep schedule enough with two red-eye flights in a row, your body will take what it can get. Or at least mine will.

The clinic in Kisumu is this concrete building, and the patients overflow. Most of them are there getting enrolled in anti-retroviral treatment (HAART), or are there to see docs due to side effects, new illnesses, or treatment failures. There are probably 20 anti-HIV drugs on the market, and here they have about 8 or so. So that's not so bad, but it means that they only have about two therapeutic options (since you have to be on at least 3 drugs) with a bit of room to play. If those don't work, and they sometimes don't, that's sort of about it. There are many of the diseases that go with HIV, like fungal infections of various body parts, TB (I saw one 13-year old who probably is going through his 4th bout of TB), weight loss, etc. But also some people doing well with their treatment, going on with their lives.

After a couple of days the clinic closed for four days for Easter, so I went with a Nurse Practitioner student, Karen, to the Masai Mara. This is the big wildlife reserve in Kenya, bordering the Serengeti reserve in Tanzania. Apparently this is where Out Of Africa was filmed. Not sure if I saw that movie, but the reserve was amazing. Huge expanses of savannah, zebras and giraffes and lions and elephants. I didn't see any rhinos or cheetahs or leopards, but that's OK. It would have been better if you weren't stuck in a "pop-top" ( http://www.footprint-adventures.co.uk/info/Toyota%20minibus%20pop-top%208%20seats%20.JPG ) all day. So including the flights, I spent a lot of time my first week sitting. So then it was time to go for a run, and I made the mistake of running on two of Kisumu's big streets. Lots of stares and good-natured yells. And lots of cows, cow shit, and ditches full of garbage. Oh well.

Finally, on Tuesday, I went to Suba. Suba is a region of the province of Nyanzaa (in which Kisumu is located). The apartment I live in is in the town of Mbita, which is reached by car and then ferry from Kisumu. The main regional health centre is in Sindo, 20 km away, which usually takes 15 min but due to rain, it takes a lot longer. No paved roads, just horrendous dirt roads which have ridiculous amounts of mud. It got a (probably badly driven) Toyota Land Cruiser stuck for a while. Not to mention the semi-trailer bringing bread from somewhere. I'm still not sure if there's a store to buy supplies around here but apparently there's a fruit/veg market, so I won't die of hunger. I brought stuff from Kisumu, like pasta which I had last night. And a chocolate bar.

So, this is long and just a series of events, but I wanted to catch you up. I'll see about posting this soon, maybe with pics, as soon as I have a good connection.

lots of love,

Allon

Some random thoughts from my first two weeks in Kenya

2009-04-18T05:49:00.000-07:00

I’ve never blogged before, so bear with me. Hopefully I can make the page look sort of decent (like a kitchen someone once wanted), and maybe embed pics and stuff in a way that isn’t horrible. I’ll start with my trip to Kenya, this being a coming of age of sorts. Although I’m not sure what sort. In any case, I’ll blog from here when I get a chance. Right now I’m not blogging at all since I don’t have an internet connection. I’m at the domestic terminal of the Kenya International Airport. Pretty much as one might expect, the airport is small, cramped, the arrivals “hall” has like 6 foot ceilings and 2 immigration agents. This is the entirety of the waiting area of the domestic terminal. The business class lounge looks like a prison with half-silvered windows. Of course the price of the visa has gone down since I paid, from $50 to $25, so there go three more hours of my work.
Then I have all day to hang out here, which is why I’m blogging. Or typing offline. Whatever. I have no idea what I’d do with eight hours in Nairobi, and I’m pretty much too tired to think about it, so I’m just sitting at the airport. I already finished 2 of the three books I brought with me, so hopefully I really like that last one, ‘cause I’m stuck with it.
I spent my last two nights on airplanes, which pretty much sums up how I feel. Not like I’ve been hit by a truck. Like I’ve spent the last two nights on airplanes. For me, jet lag is a feeling like I’m made of sludge and I’m oozing out of my own pores. Is that weird? Anyway, I spent the last two nights taking sleeping pills, so that’s enough of that. Also, I think I’ll stop drinking coffee for the month. Maybe till I get back to SF. I’m not really that interested in shitty coffee, and hopefully I’ll sleep here, unperturbed by spouses, doing dishes, or cats’ noses two millimetres from my face at 5:00 am, purring loudly. As if I’d done anything to deserve that purr.
So let’s see. Amsterdam was OK, but I wasn’t up to smoking up, and I didn’t know anyone, so I wandered aimlessly and found a lot of really expensive watches. I forgot my watch at home, and it’s only taken me a couple of hours to reprogram the time in my Palm. I pretty much need a watch. But not for 135 Euros, even if that’s 50% off. 50% off their 300% inflated price.

One of the books I finished was “The Girl With the Dragon Tattoo”, which , other than having some very disturbing scenes, was pretty good. Definitely a page-turner, with enough insight and class to be a definite step up on other page-turners I’ve read (there haven’t been many) like “The Da Vinci Code”. But I don’t know about that ending. A bit too contrived, a bit too anti-Hollywood just for the sake of being that way. I’m not saying I know how it should end, but it seemed that he set it up too much to be the way he wanted, to get the emotions out one last time. Anyway. The other book I just read in its entirety here in the airport was “The Year of Magical Thinking”. I don’t think I’ve read Didion before, and I expect this is different than her other stuff, but it was good. The first half was actually very moving; I didn’t particularly want to cry in the airport, but some tears had to be held back. Toward the end it maybe wore a bit thin. But then, I guess she didn’t write it for me, she wrote it for herself, and maybe for some people to benefit from it. I can definitely see how Western thinking has pathologized grief, and that even though we allow it to some extent, we label it as pathologic when it has those characteristics we don’t like, like going on for over six months or rendering the person suffering from it unable to function. I think it’s Western culture that can’t adapt to grief, perhaps analogously to the way it can’t adapt to schizophrenia. If we didn’t make such constant demands on people, demands that have deadlines like bills to pay and appointments to keep, but could support them through such processes as birth, death, severe mental illness, maybe we’d be better off. But no, we’d rather give 6 weeks maternity leave, or drug schizophrenics until they behave the way we want, or be strong enough to deal with the death of a loved one. This is a bit extreme perhaps, it’s not like I think psychosis is all that, but we have no patience, no ability to support without doing something. We have to do things all the time.
I guess seeing kids with AIDS here in Kenya will teach me about doing things. Enough out of me. Only 3 more hours till my plane.

16/04/2009

I’m learning to write dates like a Canadian again, here in Kenya. Soon I’ll be a Canadian again. That will be nice. I had my first taste of medical care here in Kenya. These people know a lot about HIV and TB and malaria. And really not much else. It seems that they know a handful of drugs and their side-effects, and are able to follow indices of HIV progression. Malaria is easy, it’s everyone with a fever and no cough. TB is easy too – everyone with fever and a cough. OK, not quite that simple, but not too far off. So a 7 month old baby was admitted to the hospital here in Sindo with pneumonia. She was given some oxygen (there’s no ability to monitor oxygen in the blood here, either with a pulse oximeter or with a blood gas) and placed on penicillin and gentamicin. Seems appropriate enough. So I went to see her. One glance tells me she has Down Syndrome. One listen tells me she has a whopping murmur. And one look at her X-ray shows me that she does not, in fact, have pneumonia. She has congenital heart disease, and all the antibiotics in the world will not help her. It’s hard for me to know exactly whether her heart lesion is survivable, but she doesn’t look so great with what I can see. Cardiac surgery, of course, is out of the question.
It’s interesting to note that the cardiac surgeon at Montreal Children’s, where I’ll be starting in July, has started an international cardiac surgery initiative. I don’t know how successful or widespread it is, but maybe he wants to go to rural Kenya.
In any case, I’m getting used to the HIV regimens, the TB regimens, the malaria regimens. But the general medical knowledge is so poor, it makes it hard for me. For example, yesterday there was a lecture on classification of anemia. It was at about the level of a 1st year medical school lecture, given by a poor lecturer who didn’t quite understand anemia. I had to restrain myself from correcting him on several points. And I don’t know much about anemia, let me tell you.
And for those less queasy, there was this patient who was complaining of black stool, a classic story for an upper GI bleed (upper meaning above the large intestine, so in the stomach or small intestine). The clinician I was working with didn’t notice. So I ordered a hemoglobin (one of the handful of tests I have available here) on my own, and it came back low. So the clinician wanted to change his HIV regimen to exclude AZT, a drug which has anemia as one of its side effects. But of course, the AZT isn’t the culprit, it’s the guy’s bleeding ulcer or something. Again, we can’t really figure it out, since we can’t do endoscopy or anything like that, but I had to convince him to at least place the patient on an iron supplement.
So it turns out I know more than just pediatrics, and it’s difficult for me to see patients being mismanaged, to the point that a resident in pediatrics has to reevaluate adult patients. Anyway. I guess I’ll see a lot of that in my life, and not just in Kenya.