Out of Office Reply

Out of office reply from Hayley G: the aforementioned blogger has spent the weekend in South Africa (again) seeing lots of cool animals (again). Upon her return she elected to eat takeout pizza and edit photos of lions instead of updating her silly little blog.

She regrets any inconvenience this may cause her adoring public (i.e her grandmother)

Cold early morning game drives merit Safari ponchos/snuggies.

Having a go at the slingshot (they use it to deter monkeys from stealing food. We could have used it when a monkey snuck into Liam's room and stole a packet of instant coffee.)

Walking to work

Takes about 30 min to walk from the flat where I live to the hospital. It's actually a great start/end to the day. I usually take this opportunity to unleash a flood of derm questions that have been building up during the day.

Lunchtime

Now that Doug is gone, Fresh Cafe has been put on hold (and is now probably out of business) and we've decided to explore some of the local (much cheaper) cuisine. We started with the Nurse's association which serves you a heaping plate of food for 16 pula ($2.50). We got there early because we heard that they run out of food so we met up with Panda (Liam) at 11:45. No one was there but they told us to sit down. Long story short, we finally got our food 1 hour later. Kari was basically going into hypoglycemic shock. Ah, Botswana time- how I will miss thee.

Kari's smile is hiding her desperation

The nurse's association has no sign and is on an unmarked dirt path

The next day we tried the "white house," a small restaurant-type place a block from the hospital where we payed a whooping 25 pula ($3.80) for our meals. Again, we were early (and we wonder why America has an obesity problem) and the lady who was serving the food let us sample everything. We settled on chicken, phaletshe (a maize paste just like ncima from Malawi) and begobe (a brownish porridge made from sorghum and maize. And no, I have no idea what sorghum is).

VisualDx Success

Using VisualDx Mobile with some pediatric residents in derm clinic

One of the projects I picked up while in Botswana is introducing a computer program called VisualDx (I wrote about it in an earlier post). It’s a super-impressive program with a very user-friendly interface that helps generate a differential diagnosis (list of possible diseases) for dermatology cases. It’s pretty amazing and we don’t even have it at PennMed yet (hint hint) but the creators donated a copy to Princess Marina Hospital.

Getting anything done at Princess Marina Hospital is a huge to-do and VisualDx was no exception. Finding the library, finding a working computer and getting the permission to install a program on a computer all involved numerous phone calls, text messages and visits to far-flung corners of the hospital. But anyone who knows me knows that I don't shy away from a challenge and I was determined to get this off the ground.

That gauntlet was nothing, however, compared to introducing it to the Department of Medicine. The original idea was to identify motivated residents, train them, and have them “spread the love.” I identified a few but they seemed reluctant and I was unsure if they would spread the knowledge. One of the head doctors told me to talk about it at morning report and then require all the doctors to have a training session.

Quick background- morning report is brutal. BRUTAL. Half the room is asleep and participation is literally unheard of. They once had a session assigning doctors to update certain protocols (each doctor was required to work on one section). They would read out a category and ask for volunteers and would be met with stony silence until the resident in charge assigned someone that section. This request-silence cycle went on for 20 different categories. It was painful.

Needless to say, the possibility of requiring these folks to do anything was less than desirable. Therefore, we decided instead to bring VisualDx to morning report. Kari was presenting a case (she nicely bumped the date of her presentation up to this week so I could present as well) and we incorporated VisualDx into her presentation. She talked about an ulcer that we saw on the wards and when she was done I showed how you could use VisualDx to create a differential that included the disease.

Given the apathy that characterizes morning repot, I was basically expecting crickets. I was shocked when people actually seemed to be paying attention and even seemed interested in VisualDx! Not only that but they actually signed up for an optional tutorial session! I was flabbergasted!

VisualDx tutorial

The tutorial session went really well and next step is to work on installing the program on computers in the wards (which will involve approximately 14058434 visits to the wards, the IT department, the department of medicine etc…I get a headache just thinking about it).

I have really loved being a part of this project and the wheels in my head are already turning…maybe they could use VisualDx in outreach clinics in Botswana….or maybe Uganda where my mother is helping set up an ENT residency. Maybe they need a med student to travel and install it! OK, OK, I’ll slow down and get some sleep.