On Friday I tried to get a surgery consult, and it was soooooo difficult to find someone. One of the nurses told me to call Ward D (surgical ward), and they told me no surgeons there, and to call the on call surgeon's direct phone...which I called many many times and no one picked up, and then they told me to try ward B, O, A, T, P (haha..."boat"), ...and probably some other letter. And with each call, no one would pick up until I stayed on the line for >1 minute and called multiple times. Of course, no surgeon at any of those and each told me to call another ward, and then finally I found the receptionist and asked him to try to call the surgeon, and then he told me the direct phone number was the wrong one, and he called some big surgeon boss who then gave me the right number. I'm kicking myself thinking, why didn't you tell me this earlier?!! ....well it's because this receptionist has a habit of disappearing and not being at the desk. But luckily, I got a hold of the surgeon, who came at 4:15pm, and managed to send the patient to get the procedure done before 5pm on a Friday. Sighs...it's just hard to reach people... But it was amazing they still managed to get something done at the end of a Friday. I was amazed.
Sunday, November 29, 2015
Friday, November 27, 2015
Day to Day in Lesotho
Daily commute:
Consists of barely waking up in time (7:25) to leave at 7:40am. Getting in ZaZa (my 3-door 4WD Mitsubishi Pajero). Get out of my gated complex and wave bye to the guard/gardener.
Take a left onto a small road, and then ensues the daily adventure of avoiding potholes, combies (the local minivan-bus) and taxis. It actually makes driving kind of exciting! Trying to drive fast to make it to work on time, but only so fast so that I can slow down enough not to go flying over speed bumps or killing my suspension over the potholes. And the the illegal things combies do...man, the list goes on. They would just stop in the middle of the road, drive on the wrong side of the street, even see them backing up in a large street.
Part of the route in the morning involves going on some dirt road too. My friends KP and MZ recently went on ATV rides, and truth be told, I was a little jealous, but in reality, who needs ATV's when you've got Lesotho dirt roads?
At the Baylor Clinic of Excellence (COE):
We start the day at 8am with singing, prayer, and announcements by the COE staff. Then it's off to seeing patients. There is no such thing as appointment time, just appointment day, so it's by first come first serve. Every morning, there would be benches of mothers and their kids waiting patiently in the waiting room as the doctors call them up one by one. It's amazing how much patience these mothers have compared to the patients in the States. I feel guilty for being upset for waiting for 1 hour for my doctor in the US.
The patients first get reviewed by the director of the day, who determines what services they need - triage (get vitals), blood drawn, doctor visit, and any other special services such as disclosure, social work, treatment literacy, or nutrition. This speeds up the process so not everyone needs everything, and also less people get missed services because doctors can forget to direct patients to a service when they have so many other things to focus on.
On the lighter days, physicians often work until all the patients are seen, then go for lunch, and then come back to see stragglers. Otherwise, we just take turns taking a lunch break, and then come back to work. When there aren't many patients in the afternoon, I often work on research projects.
It's very convenient that the COE has translators who help the non-Besotho doctors communicate with the patients. Although English is one of the official languages, many of the patients (maybe 70%) don't speak English or enough to express their medical need.
The first few days I saw patients and then checked it out with the director. But since the monitoring of HIV patients is fairly standard, I was soon able to work more or less independently and only ask for help in more difficult or complicated cases.
At the hospital:
A third of the time I spend my time at the hospital. The Queen Mamahato Hospital (or Tsepong or QMMH), is a hospital named after the first queen of Lesotho. Every morning, when you drive through the gate, a guard takes down your name and license place number. The hospital is quite nice! It's pretty new, has a lot of funding from outside sources (Tsepong - forgot what organization this is), and has some of the state of the art equipment such as CT scan, nice operating rooms (aka "theaters"), ultrasound, and even a helicopter pad - although I think they are still lacking a helicopter.
In the morning, we have a meeting in the nursery office where the overnight doctor goes over the new overnight admissions and anything of interest that may have happened such as labs that came back or patients that crashed or died. Sometimes there are announcements and sometimes there are presentations by one of the doctors on a case or a topic. If we are lucky, we then start rounds around 9am, but on some of the busier days we start later - one time we didn't start until 11am! It's rough when the pediatric clinical director, who doesn't have to round and see all the patients loses track of time and gets on a soap box regarding nursing-doctor relationship or how discrimination is bad. I mainly feel bad for the overnight doctor who needs desperately to go to sleep.
I've been mostly working in the M ward, which is the general pediatric ward. There are rooms 1 to 12. Rooms 1 to 7 are isolation rooms, which means there are either one or two beds for specific patients who need to be isolated because they may have something that can be transmitted to other patients. Rooms 8 to 12 can each hold 5 patients. The sickest patients are usually in room 8, and then 11 because they are easily seen from the nursing station. I've been mostly rounding in rooms 9-12 - usually 2 rooms, but sometimes 4 rooms. One the days when we only have two doctors in ward M, it's gets kind of hectic, and I feel stretched. Mais c'est la vie. The nurses have a rough time too because there are usually only 4 or 5 of them to take care of the whole ward, which is definitely not enough people.
Most of the time I try to round on all the patients before I go to lunch, but on the busy days when there are five admissions, sick patients, or patients requiring a lot of work, I may not eat until late or at all. One of the biggest time consumption here is that nurses don't draw labs or put in IV lines. So if I want any labs or a child needs to be on IV fluids or IV medication, I have to personally put the IV line in or draw blood. I've gotten pretty good at drawing blood, but I still struggle immensely with putting in IV lines, especially on those Michelin babies who have rolls of fat and no visible veins. Thankfully the other doctors had a lot more practice and they often take pity on me, seeing that I've been struggling for more than half an hour and just place the IV line for me. It's a constant battle between doctors and nurses here in QMMH - who's job is it really to put in IV lines.
After a long day of rounding, IV lines, and admissions, we finally have hand over around 5:15pm to the night doctor. We only hand over sick patients or patients who have labs to follow up because it's impossible for 1 doctor to care for all the patients in ward M, N (nursery), K (NICU). Thankfully as visiting doctors, we don't have to work on nights or weekends. Phew!
Post-Work Fun:
The expat community in Lesotho is pretty tight due to the small number of people here. That also means there are certain recurring events that are a common past-time for people. Here are a few of them:
Tuesday night: Bible study. This is a bible study group not affiliated with any church. It's nice that although I can't attend my usual bible study group in Houston, I can go to this one in Lesotho. We usually meet at one of the member's house, and watch a video or go through a discussion.
Wednesday night: Trivia at No. 7. It's a weekly battle between expat teams. Each week, the winner gets a prize, which ranges from beers to various life animals such as chicken and pig. At the end of the month, the team that had the highest score gets a cooking class. Although I really dislike trivia because I never contribute, a friend CY convinced me to go this past week and the team won! Woot! Cooking class!
Of note, Number 7 is a restaurant run by Kick4Life, which is a football (soccer) club. The soccer club is much more than just a place where people go to play soccer or learn soccer, it also expanded into a hotel and restaurant where they train locals service skills such as how to be a waiter or hotel concierge - skills that will help them in their life. They have also started providing food, counseling, and life skills for kids on the street.
Wednesday night during the spring: French movie screening at Alliance Francaise with English subtitles. It was really relaxing, calming, and the weather was perfect for an outdoor movie. I was also nicely surprised by their wonderful milkshake, until I got another one and it was the awfullest thing - all foam! Never again! But the movies were nice.
Thursday night: Salsa dancing at Piripiri. It's salsa lessons followed by salsa dancing afterwards. Although I have no dancing talent, the instructor is entertaining and super awesome, so it's fun to go. Piripiri is a restaurant named after a hot sauce in Lesotho. Although the food is good, it TAKES FOREVER - as any restaurant except for KFC (my favorite).
3rd Friday of the Month: Game night. There is a Peace Corp director person who organizes a game night every 3rd Friday of the month. And he has soooooo many games. We've played Carcasonne, American train (? butchering the name), Camel Up, some kind of coop game involving virus (not Pandemic)....yeah...that's probably 5% of the games that he has.
Friday Capello's hangout: Capello's is a cafe by day (where no one ever goes), and a bar by night (where too many people go to). At night it is a full swing bar with tons of people and music that's way too loud and makes me lose my voice in 3 minutes. I suppose I don't go here that often, but apparently it's the hangout place on Friday nights.
1st and 3rd Saturday fo the month: Teen club. This is where the HIV positive children who go to the COE get to have a chance to get together, have fun, play games, and learn about something. They also get refills that day - encourages adherence to their medicine.
Sundays: Hash Hikes. These are organized hikes that people set up on Saturday and then we go on on Sunday mornings. They are nothing like the Hashes in other countries where it involves a lot of drinking. It's the family friendly version.
Sundays: Victory Church. This is a church I started attending recnelty because my coworker goes there. The pastor speaks awesome understandable English and he's got some pretty great sermons too. :D
Consists of barely waking up in time (7:25) to leave at 7:40am. Getting in ZaZa (my 3-door 4WD Mitsubishi Pajero). Get out of my gated complex and wave bye to the guard/gardener.
Take a left onto a small road, and then ensues the daily adventure of avoiding potholes, combies (the local minivan-bus) and taxis. It actually makes driving kind of exciting! Trying to drive fast to make it to work on time, but only so fast so that I can slow down enough not to go flying over speed bumps or killing my suspension over the potholes. And the the illegal things combies do...man, the list goes on. They would just stop in the middle of the road, drive on the wrong side of the street, even see them backing up in a large street.
Part of the route in the morning involves going on some dirt road too. My friends KP and MZ recently went on ATV rides, and truth be told, I was a little jealous, but in reality, who needs ATV's when you've got Lesotho dirt roads?
At the Baylor Clinic of Excellence (COE):
We start the day at 8am with singing, prayer, and announcements by the COE staff. Then it's off to seeing patients. There is no such thing as appointment time, just appointment day, so it's by first come first serve. Every morning, there would be benches of mothers and their kids waiting patiently in the waiting room as the doctors call them up one by one. It's amazing how much patience these mothers have compared to the patients in the States. I feel guilty for being upset for waiting for 1 hour for my doctor in the US.
The patients first get reviewed by the director of the day, who determines what services they need - triage (get vitals), blood drawn, doctor visit, and any other special services such as disclosure, social work, treatment literacy, or nutrition. This speeds up the process so not everyone needs everything, and also less people get missed services because doctors can forget to direct patients to a service when they have so many other things to focus on.
On the lighter days, physicians often work until all the patients are seen, then go for lunch, and then come back to see stragglers. Otherwise, we just take turns taking a lunch break, and then come back to work. When there aren't many patients in the afternoon, I often work on research projects.
It's very convenient that the COE has translators who help the non-Besotho doctors communicate with the patients. Although English is one of the official languages, many of the patients (maybe 70%) don't speak English or enough to express their medical need.
The first few days I saw patients and then checked it out with the director. But since the monitoring of HIV patients is fairly standard, I was soon able to work more or less independently and only ask for help in more difficult or complicated cases.
At the hospital:
A third of the time I spend my time at the hospital. The Queen Mamahato Hospital (or Tsepong or QMMH), is a hospital named after the first queen of Lesotho. Every morning, when you drive through the gate, a guard takes down your name and license place number. The hospital is quite nice! It's pretty new, has a lot of funding from outside sources (Tsepong - forgot what organization this is), and has some of the state of the art equipment such as CT scan, nice operating rooms (aka "theaters"), ultrasound, and even a helicopter pad - although I think they are still lacking a helicopter.
In the morning, we have a meeting in the nursery office where the overnight doctor goes over the new overnight admissions and anything of interest that may have happened such as labs that came back or patients that crashed or died. Sometimes there are announcements and sometimes there are presentations by one of the doctors on a case or a topic. If we are lucky, we then start rounds around 9am, but on some of the busier days we start later - one time we didn't start until 11am! It's rough when the pediatric clinical director, who doesn't have to round and see all the patients loses track of time and gets on a soap box regarding nursing-doctor relationship or how discrimination is bad. I mainly feel bad for the overnight doctor who needs desperately to go to sleep.
I've been mostly working in the M ward, which is the general pediatric ward. There are rooms 1 to 12. Rooms 1 to 7 are isolation rooms, which means there are either one or two beds for specific patients who need to be isolated because they may have something that can be transmitted to other patients. Rooms 8 to 12 can each hold 5 patients. The sickest patients are usually in room 8, and then 11 because they are easily seen from the nursing station. I've been mostly rounding in rooms 9-12 - usually 2 rooms, but sometimes 4 rooms. One the days when we only have two doctors in ward M, it's gets kind of hectic, and I feel stretched. Mais c'est la vie. The nurses have a rough time too because there are usually only 4 or 5 of them to take care of the whole ward, which is definitely not enough people.
Most of the time I try to round on all the patients before I go to lunch, but on the busy days when there are five admissions, sick patients, or patients requiring a lot of work, I may not eat until late or at all. One of the biggest time consumption here is that nurses don't draw labs or put in IV lines. So if I want any labs or a child needs to be on IV fluids or IV medication, I have to personally put the IV line in or draw blood. I've gotten pretty good at drawing blood, but I still struggle immensely with putting in IV lines, especially on those Michelin babies who have rolls of fat and no visible veins. Thankfully the other doctors had a lot more practice and they often take pity on me, seeing that I've been struggling for more than half an hour and just place the IV line for me. It's a constant battle between doctors and nurses here in QMMH - who's job is it really to put in IV lines.
After a long day of rounding, IV lines, and admissions, we finally have hand over around 5:15pm to the night doctor. We only hand over sick patients or patients who have labs to follow up because it's impossible for 1 doctor to care for all the patients in ward M, N (nursery), K (NICU). Thankfully as visiting doctors, we don't have to work on nights or weekends. Phew!
Post-Work Fun:
The expat community in Lesotho is pretty tight due to the small number of people here. That also means there are certain recurring events that are a common past-time for people. Here are a few of them:
Tuesday night: Bible study. This is a bible study group not affiliated with any church. It's nice that although I can't attend my usual bible study group in Houston, I can go to this one in Lesotho. We usually meet at one of the member's house, and watch a video or go through a discussion.
Wednesday night: Trivia at No. 7. It's a weekly battle between expat teams. Each week, the winner gets a prize, which ranges from beers to various life animals such as chicken and pig. At the end of the month, the team that had the highest score gets a cooking class. Although I really dislike trivia because I never contribute, a friend CY convinced me to go this past week and the team won! Woot! Cooking class!
Of note, Number 7 is a restaurant run by Kick4Life, which is a football (soccer) club. The soccer club is much more than just a place where people go to play soccer or learn soccer, it also expanded into a hotel and restaurant where they train locals service skills such as how to be a waiter or hotel concierge - skills that will help them in their life. They have also started providing food, counseling, and life skills for kids on the street.
Wednesday night during the spring: French movie screening at Alliance Francaise with English subtitles. It was really relaxing, calming, and the weather was perfect for an outdoor movie. I was also nicely surprised by their wonderful milkshake, until I got another one and it was the awfullest thing - all foam! Never again! But the movies were nice.
Thursday night: Salsa dancing at Piripiri. It's salsa lessons followed by salsa dancing afterwards. Although I have no dancing talent, the instructor is entertaining and super awesome, so it's fun to go. Piripiri is a restaurant named after a hot sauce in Lesotho. Although the food is good, it TAKES FOREVER - as any restaurant except for KFC (my favorite).
3rd Friday of the Month: Game night. There is a Peace Corp director person who organizes a game night every 3rd Friday of the month. And he has soooooo many games. We've played Carcasonne, American train (? butchering the name), Camel Up, some kind of coop game involving virus (not Pandemic)....yeah...that's probably 5% of the games that he has.
Friday Capello's hangout: Capello's is a cafe by day (where no one ever goes), and a bar by night (where too many people go to). At night it is a full swing bar with tons of people and music that's way too loud and makes me lose my voice in 3 minutes. I suppose I don't go here that often, but apparently it's the hangout place on Friday nights.
1st and 3rd Saturday fo the month: Teen club. This is where the HIV positive children who go to the COE get to have a chance to get together, have fun, play games, and learn about something. They also get refills that day - encourages adherence to their medicine.
Sundays: Hash Hikes. These are organized hikes that people set up on Saturday and then we go on on Sunday mornings. They are nothing like the Hashes in other countries where it involves a lot of drinking. It's the family friendly version.
Sundays: Victory Church. This is a church I started attending recnelty because my coworker goes there. The pastor speaks awesome understandable English and he's got some pretty great sermons too. :D
Friday, November 13, 2015
Quilone Falls
What a "spectacular hike!" as a friend would put it. Initially I was undecided whether to do this hike or another hike, but I'm sure glad I did this one!
Directions:
On the way to Mohale Dam, after driving past one mountain, it's right at "God Help Me Pass." Make a left at the "Donkey trekking" sign (white sign with red letters), which takes you to a place where you can park your car for R20 (about 2 dollars).
Then you take the trial on the left, and go under some trees, then when you reach an area close to a water crossing where the trail goes right or left, take the left trail (where it almost looks like there's no trail). I think you cross water twice before getting on a ridge where if you just continue straight on the biggest path, then you reach a great view of a river and a besotho hat mountain (shaped like the traditional besotho hats).
Then you follow the ledge (keep right), until you reach a river, where you cross to the other bank. From there, you just go straight up (not much of a trail), until you come across a main trail. That will continue to take you up the mountain, until you get a great view of the falls. From there, it's downhill to the falls.
It's beautiful! But don't be deceived by the pictures of people in the water - it's frigid! But despite the could, people did some mini-cliff jumping. I wasn't as adventurous, so I waded in the water to get used to the temperature, and then jumped in and took a swim. Too cold to stay long!
But some adventurous folks decided to hike farther up. And soon, while we were drying out at the bottom of the falls, we saw some little heads pop out of the top of the falls. We all decided to follow suit and went to the top, which was gorgeous!
The top had many gentle pools carved out by the great river, and at the very top of the falls, right where the water plunges down was one big pool where everyone decided to take a dip. Despite appearing dangerous, it was quite safe as there was essentially a wall blocking off us from the fall. You can even see the wine bottle sitting on top of this "wall." Unfortunately this wine bottle did fall to its death shortly after our arrival.
Directions:
On the way to Mohale Dam, after driving past one mountain, it's right at "God Help Me Pass." Make a left at the "Donkey trekking" sign (white sign with red letters), which takes you to a place where you can park your car for R20 (about 2 dollars).
Then you take the trial on the left, and go under some trees, then when you reach an area close to a water crossing where the trail goes right or left, take the left trail (where it almost looks like there's no trail). I think you cross water twice before getting on a ridge where if you just continue straight on the biggest path, then you reach a great view of a river and a besotho hat mountain (shaped like the traditional besotho hats).
Then you follow the ledge (keep right), until you reach a river, where you cross to the other bank. From there, you just go straight up (not much of a trail), until you come across a main trail. That will continue to take you up the mountain, until you get a great view of the falls. From there, it's downhill to the falls.
It's beautiful! But don't be deceived by the pictures of people in the water - it's frigid! But despite the could, people did some mini-cliff jumping. I wasn't as adventurous, so I waded in the water to get used to the temperature, and then jumped in and took a swim. Too cold to stay long!
But some adventurous folks decided to hike farther up. And soon, while we were drying out at the bottom of the falls, we saw some little heads pop out of the top of the falls. We all decided to follow suit and went to the top, which was gorgeous!
The top had many gentle pools carved out by the great river, and at the very top of the falls, right where the water plunges down was one big pool where everyone decided to take a dip. Despite appearing dangerous, it was quite safe as there was essentially a wall blocking off us from the fall. You can even see the wine bottle sitting on top of this "wall." Unfortunately this wine bottle did fall to its death shortly after our arrival.