Monday Monday

This morning began slowly during my last day in See & Treat. Whenever it rains hard here, patients have more difficulty getting to the clinic due to transportation challenges. I was supposed to be in Infectious Diseases this week. It was very slow today so they suggested I go back to See & Treat. I saw some interesting cases there. A did an ECG on a man with cardiomegaly and a history of TB. A woman with severe lower back and leg pain came in an the x-ray suggested a compression of the sciatic nerve between L4 and L5. The orthopedic physician suggested she needed an MRI to confirm. However, it is difficult to get an MRI here as the patient must see the orthopedic physician before being referred. Thus, the general practitioner schedules another appointment the next week with the orthopod who then refers the patient for an MRI at the tertiary hospital and so forth. Essentially, there is a lot of waiting involved. I also saw a patient presenting with a gangrenous foot concentrated on the 2nd and 3rd phalanges. It had been developing for 6 months! The interesting thing here in South Africa is that many patients are so used to pain, poverty, and unwellness that they tend to let things persist and develop far too long. When they finally see a physician it is often too late to help the person substantially. It is frustrating to observe but I'm learning about how patients think and what prevents people from seeking help even when they have access free healthcare. Toward the end of the day a woman with a posterior stab wound came in to trauma. I went to watch as they performed a thoracotomy. They were attempting to massage the heart, repair the injuries, infuse blood, etc but the trauma was too great. They were unable to save the patient's life. Stab wounds are very common in this area due to high use and presence of TIK, crystal meth. People will steal, kill, and squabble over anything because they are so addicted. Violence persists in the Manenberg area where GF Jooste is situated. The rest of the week I will be in Surgery or "Theater" as they call it here. More medical stories to come...