January 7^th, the official start of the new year and the hospital is back in full swing.  The previous one minute it took to get through the security gate now takes 20 as cars line up to be searched prior to a wave through.  The wards, previously devoid of techs and nurses are now swarming with never before seen ancillary staff.  And finally, new interns, new medical registrars, and new medical officers have arrived which has coincided with the post holiday patient rush as those who had attempted to minimize illnesses over the holidays have now been admitted over the weekend.  The hospital is chaotic.  But surprisingly it is a controlled chaos and could have been a lot worse with all of the new interns.

The Iteach office is now open as well and I have been introduced to the entire staff who are all extremely friendly and helping me plan my cultural and community outreach trips.

ITeach Office:

Today seemed to be an acute hepatitis day.  At least 4 patients had LFTs into the 1000s.  One patient we were able to make the diagnosis of acute Hep B (something I have not yet seen in the states).  Others unfortunately did not have hep labs drawn so they will be discharged with follow up of labs on d/c.  The new consultant I am with also seems to have a better grasp on antibiotics than the previous ones and feels comfortable stopping unnecessary meds.  Patients on a seemingly common combination Augmentin/Flagyl for CAP are finally having the flagyl dc’d.  Bactrim has been dc’d on at least 5 patients with CD4 count s that have been > 200 for months.  We also had one patient who was in status right in front of our eyes and the consultant was able to counsel the new intern/medical officer team on how to get an expedited head CT that day (in a sense what we do at CUMC, don’t take no for an answer).  Finally he discussed appropriate fluid usage and transfusion goals with the new intern and medical officer.  The take away from this, even in resource poor situations, without readily accessible internet, without the appropriate speed for diagnostic tests, it is possible to practice reasonably evidence based medicine if it comes down to the basics such as appropriate antibiotic usage, appropriate fluid content and correct transfusion goals.

Edendale Hospital: