Marie's Blog from Lambaréné, Gabon<-- back
First week at the Hospital
August 4, 2008
I have finally begun my first week at the hospital. Monday was certainly overwhelming as it is the busiest day at the hospital. Adding to the stress is the fact that everyone here speaks French. I speak French, but medical French is different, and I had a blank stare by the end of the day. I was able to familiarize myself with the layout of the hospital grounds, our daily schedules, and the location of our most coveted building on the grounds—the malaria research lab, where we access the internet!
The hospital offers care in internal medicine, obstetrics, pediatrics, surgery, urgent care, and “PMI” or protection maternelle et infantile, their program equivalent of maternal-fetal medicine and childhood immunization outreach efforts. There is also a pharmacy and clinical laboratory on site. I am working in internal medicine where our inpatient service serves up to 26 patients per day. In addition, our outpatient consultation service sees about 25 patients each day. In all, hundreds of people of are seen each day at the hospital. After a couple of weeks, or when they feel I am ready to begin consultations on my own, I will see patients independently. At this point, I think two weeks is rather hopeful. Surprisingly, I do not have any trouble taking patient histories, doing physical exams, or working up a differential diagnosis, as these are the almost universal aspects of medicine. I am lost, however, when it comes to figuring out the medications, as they have different names here. I can tell this will be a challenge, first to figure out the name equivalent, then to find out if the hospital has it in stock. Good thing I love a good challenge!
Let me tell you a bit about my typical day. I am up and out of “the clean zone” by 6:30 a.m., and have breakfast at the La Refectoire (cafeteria) at 7:00 a.m. Then I have La Visite (morning rounds) in the internal medicine ward, which everyone refers to as the “La Kopp.” Rounds usually last for a couple of hours, depending on the patient load, and then we head over to La Polyclinique for consultation service. We usually see about 10 patients in the morning and then about 10 to 15 in the afternoon. Since most patients travel great distances to reach the hospital, the system is set up so that the patients who are seen in the morning, can get their blood work or other necessary testing done over the lunch hour, and then return in the afternoon for the results and treatment evaluation. I haven’t learned the prices yet, but I do know that it costs about $143 to stay at the hospital. Patients must pay this up front to receive admission, but there are exceptions for special or urgent cases. Patients must also pay for their testing or medications before being rendered even in outpatient services. If a patient happens to receive a test she has not paid for, she will not be given the results until she does pay. Can you imagine telling a patient in the U.S. “I am sorry, but I see you did not pay your bill today, so I am not going to tell your test results?!?”
I have already seen more diseases that we think of as rare in the U.S. than most physicians see in their lifetime practicing domestically. I have never seen anything in my medical education that could come close to this. I saw half a dozen patients with toxoplasmosis this week, which in the U.S. is usually seen in the most advanced AIDS patients. Tuberculosis is also rampant here, as every other patient seems to have it or is just finishing their seven-month protocol of treatment. Thirty percent of the patient load this week had HIV. As for tropical medicine, which I am so excited to learn more about here, I had a patient with loa loa. Loa loa takes at least 10 months to show up in your blood, and it grows as a worm in the body. It is transmitted by a fly that apparently loves the color blue. Yikes! Most of my scrubs are blue!!! There are ailments that we know quite well in the United States, that are also very common here. Many patients have hypertension, congestive heart failure (as they never saw a physician for their hypertension), diabetes, gastric reflux disease, arthritis….the list goes on.