The rest of the week 1: a brief summary

Posted by Rachel Ng, MD (a second year Internal Medicine resident from Kaiser Permanente, San Francisco serving a global health elective at John F. Kennedy Memorial Medical Center in Monrovia, Liberia through the Yale/Stanford Johnson & Johnson Global Health Scholars Program).

3/7/10

Dear family and friends,

So the rest of the week breezed by quickly. On my first day of rounding with my team of interns and medical students, I learned that it was the last official day of school for the 3rd and 4th year students before they enter their 1 month study period prior to final exams in April. How disappointing! I barely got to know them and now they’re leaving the wards. However, a smaller team does have its advantages too, so I’m looking forward to working with my 1-2 interns for the rest of my time here.

A bit about the medical school: it appears to me there is only 1 medical school in the country. Studies and training were heavily disrupted by the war. Thus, the current class of interns consists of 13 doctors, but the 4th year class will be graduating close to 30 students and same with the 3rd year and so forth. After medical school graduation, internship at JFK requires 2 months rotation through medicine, surgery, ob/gyn, peds, ER, and other subspecialty. Then there is a several months period where they get further procedural/surgical training to prepare them for their time upcountry or in the bush, when they became the generalists who will head the clinic in the bushes. I’m not sure if this upcountry posting is required or not.

One of the reason I chose to work in Liberia was so that I could better communicate with my patients without a translator. For the most part, that has been the case. However, I’m sure there’s much more to learn.
(Medical) Liberian English:
-small small- can mean slowly or better
e.g. doc: “how are you feeling today?”
patient: “small small” = “I’m feeling a little better”

-Spot positive = HIV positive
-Koch’s disease = TB
-feeling hot = fever
-stomach running = diarrhea

The pathology is quite varied. Many malaria (the great mimcker here) cases as inpatient and OPD(clinic). Quinine is the 1st line drug used here. Almost everyone who comes in complaining of feeling “hot” gets a malaria smear and widal test (typhoid). Many new diagnosis of hypertension (high blood pressure) and diabetes.

Other cases seen thus far:
-pulmonary tuberculosis, abdominal tuberculosis, tetanus, pyomyositis, rhabdomyosarcoma, schizophrenia, pyelonephritis, pneumonia, bronchitis, congestive heart failure, liver cirrhosis, acute renal failure, oral candidiasis, kaposi’s sarcoma, diabetic ketoacidosis, flash pulmonary edema, urinary tract infection, hypertensive urgency/emergency, post-traumatic stress disorder, etc.

A lot of pleural effusion and ascites. Learned to put in a chest tube.

And a few even more interesting cases:
-persistent hiccup
-a girl who presented to clinic with h/o intermittent “barking like a dog”. Diagnosis made by referral doctor was rabies (but girl was bitten 10 years ago). My colleagues and I think it may be tic disorder/tourette’s syndrome.

The weather is very hot and humid here, even though the hospital is 2 blocks away from the coast. Occasionally there is a breeze that comes through. So many people are dehydrated, coming to clinic hypotensive or constipated that I’m mainly telling them they need to drink more water besides prescribing bisacodyl (the only laxative on the formulary). Even my CHF patient I’m telling them to drink more water.

Again, thanks for your prayers and encouragement. I’m very thankful to be happy, healthy, and safe. I’m still working on posting photos (I’ll have to shrink the files cause they are do big to upload).