11/24/06

Thoughts \ Developed Thoughts \ Rants \ Raves \ Writing

07/03/2005 07:23 +0200 GMT

Patients on Paper and in Person

It's been a busy, fulfilling few days. I've been switched in preparation to take over oversight of the Hercules Project, aptly named because it involves extracting the most informative data from over 20,000 charts located in over a dozen clinics around Lusaka. Most of the work has been done with extraordinary diligence by Kapata, Sangwani, Matilda, Andy, and Erin, but two are likely leaving next week, and so the baton must be passed. The actual work is tedious, sometimes boring, and marked with a learning curve. That's on the one hand. On the other hand, reviewing a chart provides a glimpse into the story of a person's life, their struggles, and their triumphs.

For example, on initial presentation, a woman may have a CD4 count of 54, an Hemoglobin (Hb) of 9.4, and a weight of 40 Kg. She's struggling to live, I think, and as I review the chart, and move from 7 months ago to present, I see a weight gain, and an improved Hb, and an increasing CD4 count. I find myself reading the patient's name, scanning for children, hoping for the patient's numbers to improve, and their well-being with them, turning the pages with hope. There is a satisfaction in seeing hope here, where before there was very little.

So I've seen many patients on paper, then today it was patients in person. Brad, Stewart, and I each followed physicians today in the outpatient clinic of Our Lady's Hospice in Kalingalinga. This was very educational, complementing what I see in the charts with what I could now see with my own eyes, feel with my own fingers, and hear with my own ears. These were two patients who stood out among the 10 or so I saw with Dr. Chelwe, an excellent teacher whose name I regret to be misspelling.

One small woman was informed of her CD4 count today. It was 54. She was walking, talking, and managing as we say here. She was not without problems, to be sure, but the pharmacy's now well-stocked, with antiretrovirals to assist against HIV, with antibiotics to prevent opportunistic infections, and an antifungal/steroidal pill (I think not an ointment) for a diffuse fungal rash she had on her trunk, and with multivitamins and adherence counseling to top things off. In my mind these sum up Hope, and I'll not soon forget that.

A second patient was another woman, aged 42, with a number of medical problems in addition to HIV. The most important was a mitral valve regurgitation, and an irregular cardiac rhythm. After systole, the mitral valve was not closing properly, causing a backward flow of blood. No pedal oedema was present. Despite treatment with Lasix, she was urinating less. The patient was a nurse, visiting home, but with regular work in Botswana. She was articulate, persuasive, intelligent, deferential to Dr. Chelwe, and calm.

When I listened to her heart, I noticed the irregular rhythm immediately, but despite hearing the history of mitral regurgitation, I didn't hear it. Like magic though, Dr. Chelwe encouraged me to listen again, and I it was then that I truly heard a heart murmur for the first time. The scales were lifted from my ears, if you will, as a result of good instruction from my clinical teacher, and the patience of a kind woman. I'll not soon forget that either.

That's enough for today. Brad, Stewart & I may get together for Indian food or for a Rugby tournament later (as supporters, not as participants).