The Real McCoy

Here at last. The Real McCoy of Africa. Underlined by views of arid plains sparsely covered with scrub stretching in all directions around Lilongwe, as seen from the descending plane.

Arrived this afternoon after what seemed like weeks of intermittent napping on planes broken only by one call for medical help from the arline. Step in yours truly - diagnosis of vasovagal/panic attack in a 50 yr old African lady on the way to her father's funeral - then back to Stilnoct induced hemi-slumber (or maybe I dreamt it all, with the Lariam?).

Disembarked to blue skies, gentle breeze - about 22 deg C - this is as good as it gets for me. However for the locals this is the bleak mid-winter complete with the occasional winter woolly jumpers.

Accommodation seems super - a secure, enclosed quadrangle bungalow development with 2 major "apartments" facing the lawn. Each apartment has about 4 bedrooms, I think. I seem to have landed on my feet getting allotted the visiting Professor's suite until one of the other guys leaves (in 4 days) - until then I have en suite facilities and plenty of space.

I wandered up to the hospital shortly after being dropped off at the Guest House. There I found the department head, a senior American ID doctor, who was finishing a clinic. She showed me around to the admin people and made introductions.

Then my first medical work - at about 530 pm. Dan, the physician who has been covering the project prior to my arrival, came by with news of one of our patients who was in acute renal failure and vomiting. She is Day 26 of the study and recently had a UTI, but did not take the required antibiotics. She has advanced HIV with CD4 under 40 and looks like she weighs under 40 kg. She came in vomiting, febrile, anaemic, with a Creatinine about 6 times the upper limit of normal and a dangerously high potassium. Fluids helped somewhat, but not greatly. We performed a LP to outrule other infection and to document her opening pressure (due to vomiting) and started iv antibiotics prior to coming away. Most likely diagnosis of acute renal failure secondary to urosepsis.

The hospital is impressive - 4 storeys - open plan, central courtyard. No luxuries, minimal necessities. However when it boils down to it, the role of the hospital is to house the patients near the facilities and staff. We did the same procedure, more or less, for this young lady than we would have in an Irish hospital. She also received the same antibiotics and fluids as she would have received elsewhere. Monitoring and diagnostics are less available, and certainly choice of medications is not always as well matched, however. We'll see how she gets on overnight - touch and go, really.

I'll leave it a bit till my next post. Maybe a few pictures to add. Certainly more and better stories than these ones.

Keep well!