Tues Jan 4th- made rounds in the am for a while and then helped out in the diabetes program. The hospital has set up a nice program that started 4 months ago. Pts are contacted by cell phone every week (all Kenyans have cell phones- it is very cheap) and staff writes down blood sugars and insulin doses. Most pts on insulin only take Humulin 70/30 twice daily and monitor their sugars twice a day. The staff enters the info on a computer and 1 doc (post internship), a PhD and an attending doc trained in IM review and make changes.
I have seen several young type 1 diabetics with several neuropathy and gastroparesis. There is very cute 18 yo girl named Edith who works in this program and is a DM1. She agreed to change to tid Humalog and Bid N for the first time. We will review her bs in person. (To you non-medical readers, the Humulin 70/30 is a terrible insulin regiment for an insulin dependent diabetic -something we used over 20 y ago).
Wed Jan 5th- rounds today again brought home how different things are. A woman may or may not have endocarditis (infection of the heart valves). It would be nice to get a blood culture to look for infection...oh they haven't had the blood culture bottles here for months (some say years).
Another woman came in yesterday with BP 210/140 (very high). Overnight they put her on minimal medication. Today she looks like she had a brain hemorrhage with unequal pupils and not responding. She would have been in the ICU in the states last night, but not here.
Our older woman with blood sugars under 30 and coma (see prior posts) could afford a CT scan and today it showed a probable huge liver cancer. Everytime we stop iv dextrose her blood sugar drops.
..and this was just the morning!!
I lectured to the Kenyan residents this am..they are very quiet but attentive. I think their book knowledge is superior, but they need help on taking care of patients in real life.
We took a cab into Eldoret to get to the ATM and buy a few things. All very dusty dirt roads and cars all over the place- they drive like your grandmother in Miami! 2 of us went to the ATM together as we were told to watch our backs!
All the attendings, residents and students are off to Indian Restaurant for dinner (yeah!!). Every Wed we all go out together..other nights we eat all our meals at the compound. Accommodations are basic but fine-love the mosquito netting.
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