4 October 2007
Dinner last night was very nice and relaxed. The McConnachies have lived here fulltime for about 12 years. He was an orthopedic surgeon in No Carolina before that. After trying to balance going back and forth for stints of volunteer work they felt they needed to make a choice and just do one thing. He works at the Bedford Orthopedic Hospital. She is a nurse and runs the community center I mentioned previously. It is called Itipini. They live in a house near Mthatha General Hospital which is adjacent to Nelson Mandela Hospital. They have 2 Newfoundlands which are beautiful. I obviously found a few minutes to get large (and sloppy) hugs from these 2 wonderful dogs. It felt really good after being dogless for a week. We do have a dog (of questionable heritage) who roams the compound where I live and I am told is called Scooby. He is very friendly and makes it seems safer here. He seems to have a sense of who belongs. He accepted me immediately but barked at Ed when he dropped me off last night. Once I told him it was OK, he was fine. This is a dog I have only known for 3 days! So now you can all worry about me a little less. Scooby is watching over me.

Stan will be proud of my accomplishment in finding that 2nd twin as it appears it didn’t really disappear as one of the interns suspected! I found that my US skills, while quite rusty, seem to be well matched to this machine as it appears to of about the same vintage (OK it’s a little newer) as my US training.

For such well trained and knowledgeable physicians, I am amazed at how they accept the limited equipment and supplies they have. The students were unable to scrub on Tuesday because they ran out of shoe covers. They can’t do endometrial biopsies because they can’t get pipelles. All those women are admitted for a D&C. Cervical dysplasia is almost all treated by cold cone biopsy. Unfortunately there seems to be as much Stage IIIb as dysplasia.

What I learned today:
*Schistosomiasis is in the differential of splenomegaly and most commonly is S. mansoni in liver or splenic disorders. However if it is found in the bladder, think of S. haematobium. Obviously, don’t forget malaria in your differential for splenomegaly!!!
*Glucose is measured as mmol/l which I have determined as requiring approximately a factor of 18 to convert to familiar numbers. It still seems wrong to talk about normal values of 7.0
*Normal CD4 counts (to follow HIV)should be 500-1400 or can be reported as a percentage. The normal value isn’t changed by pregnancy but will be by stress or steroids among other things.
*The medical students are very enthusiastic and seem to be well prepared to work hard. They are very interested in differences in practice between the US and Africa.
*Malpractice suits are becoming an issue in South Africa, especially obstetrical (what a surprise!)
How to get the internet working, so I can blog now!