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Clinic: My Multi-talented Team

7/31/12

Posted by Amanda Thornton, MD (a third year Internal Medicine resident from Kaiser Permanente, Oakland while on a global health elective in Lusaka, Zambia with University Teaching Hospital).

I had my first clinic here on Monday. Each team admits patients one day of the week, and each team has one designated day for seeing patient’s in clinic. We see as many patients that have appointments- which can be around 15-20 in the morning per attending. The interviews are done in a mixture of English and the two local languages, Bemba and Nyanja, which the attending, patients, and medical students all speak with various skill levels. Between 4 members of my team that morning, we had speakers of French, Russian, Bemba, Nyanja, Chinese, and English!

Some patients come in for hospital follow-up and some have chronic conditions which are not severe enough for admission but still need regular appointments. Some patients are referred from other clinics for the speciality of internal medicine- like the 22 year old HIV+ on antiretroviral treatment with new onset renal dysfunction and 2 months of right hip pain who was sent from orthopedic clinic due to concern for skeletal tuberculosis- in a slightly atypical location. She had brought her hip images with her demonstrating bony destruction, however, a careful history taking yielded a story of migratory poly-arthritis not consistent with TB as an etiology, as well as new renal failure after starting a tenofovir based anti-retroviral regimen, which raised the possibility of gout as a possible etiology.

I was just surprised at how young the patients’ were- despite the regular hypertension, diabetes and post-stroke presentations. The average age is certainly well below 40, and around an even mix of males and females. The soonest follow-up day available is usually 7 days in the future, and if the patient needs follow up sooner, physicians may have to make special arrangements.

Also, I noted (as seen in the picture below- an advertisement for free adult circumcision) that public health continues to be focused on stemming disease spread- HIV in particular. I have also seen several billboards encouraging regular HIV testing and condom use. Given the multiple complications of antiretroviral disease and extremely high prevalence in this population, circumcision seemed a sensible suggestion, but my hosts told me that it was more likely guided by grant money from the CDC and other venues which supported adult and infant circumcision as the best way to stem the spread of HIV- and they had seen other attempts pushed and fail.

Flyer for circumcision

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