nonfunctional

Last Saturday we had a breakthrough with our internet connection.  For the first time we had about 6 hours worth of consistent email and internet access.  We listened to music, responded to emails, and I downloaded Malawian medical resources for which I have been starving.  We were connected and feeling content as if traveling down a river with a gentle current.  Ah Comfort. 

Incidentally we had purchased a router for our home in Seattle just before we left (to make sure that the internet was reliable for our tenants.)  The router we purchased in Seattle was the size of a cereal box, black and ugly.  In contrast, when we purchased a router here about a week ago we were pleased at its size (the dimensions of a thick credit card) and its sleek modern appearance.  How nicely it would into the stark modern décor of our home!  However over the past few days I have a new adjective to add to sleek and modern: non functional.  I think we shorted it out by trying to open a few web pages at once. 

Though I am frustrated with the lack of internet capability now, I do not share this story for that reason. Rather, I share the story because I feel that the router and I have a lot in common. 

My last blog post was about a week ago. It seems that I was contentedly traveling downstream with the current of life. I was feeling quite sleek and modern (if I do say so) in my bright white coat carrying my pulse oximeter and thinking about the ways that I could contribute to teaching in Malawi. I spent a week on OB/GYN, am now part way through my week of pediatrics and am certain that I am completely non functional.  I am shorting out.  There are too many web pages open in my brain. 

Web page #1:  Navigating Queen Elizabeth Hospital.  This is a building the like of which I have never seen before. It is a series of buildings connected by covered walkways which split and T to corridors leading to various wards and departments.  The first time I walked in I felt like a hamster making my way through a hamster palace of tubes and compartments.  Each time I have walked through the hospital I have found myself in new corridors and come to new end-points.  No one seems to be lost except for me.  And when I ask for direction the answer is the same, “just over there.” I have considered bring string in with me so that I could use it to retrace my steps. 

 

Web page #2:  Learning new abbreviations.  PCV is blood count, xpen is penicillin, LA is malarial treatment, R is HIV positive and I could go on and on and on. I am the only one who doesn’t have a clue what is written and spoken about and yet I am expected to be a “consultant.”  Being a consultant is not too effective when all I want to say is “what are you talking about?”

Web page #3.  Getting my head around morning “hand off.” Hand off takes place at 8am for all departments.  The forum is the interns (usually 2) who have been on call overnight discuss the statistics of the night and the difficult cases.  A common hand off on OB/GYN would sound like:  “there were 32 vaginal deliveries, 10 caesars, 30 admissions to antepartum and 33 to GYN.   There were 5 maternal deaths and 8 infant mortalities.”  They would then go on to talk about the “special cases” of the past 24 hours including all of the deaths.  The numbers of the pediatrics hand off is about double. There are over 200 patients on the pediatric service.   I have seen more pathology in the past  1.5 weeks than I have seen in all of my training and have encountered more morbidity and mortality than I ever imagined would be here. 

Web page #4.  Ndirande district hospital. This will be a big part of my role while I am here, but my time will not be devoted there until after my 6 week time at Queens is done.  This is where my heart is though and I am eager to start thinking about the work that needs to be done there as well as setting up for the Swedish residents who will be joining me in about a month.  I have been working with a wonderful Malawian family doctor who is incredibly smart, passionate and thoughtful and I can envision good things happening at this district hospital. The needs here are that of a medical director, figuring out the supplies, personnel and functions that need to be organized. Developing a budget, protocols and teaching.  The needs here are also of a researcher, figuring out what baseline metrics need to be established so that this pilot can be monitored over time.  The need is also for me to be a consultants to look over difficult cases.

Web page #5.  HIV, TB, Malara, shistosomniasis, rabies, tetnus, medical protocols that I should know like the back of my hand…

Web page #6.  I am a family doctor. I am supposed to be able to care for the family, the person in the context of her illness.  And oh right, I don’t understand anything that is being said around me. I need to learn chechewa.

Our sleek modern modem is overwhelmed, but alas it is not completely garbage.  Tonight, though it is not capable of opening any full web pages, it is allowing a few emails to download.  I will hold on to hope that I also am not complete garbage despite the way things seem now.