My first few days on the wards

Being a foreigner in a completely different medical system has been a challenge.  I'm still learning what my role will be on the wards and in the education of the med students and residents. 

Even still, the first few days have been eye opening:
In the hospital, attendings do not round or go over the patients with their teams on a daily basis.  Rounds start haphazardly and with no specific schedule.  For someone who thrives on order and routine, this has been difficult for me.

My first rounding experience was with the resident who is on heme/onc.  We made our way through the open ward and she made her notes in the paper charts and provided the patients with order slips to carry out the orders for their medications and workups.  The cases were varied but almost always something end stage.  There was one young woman with nasopharyngeal cancer who had the matted, immobile lymph nodes that I have read about but have never seen or felt to such an extreme.  The lymph nodes in her axilla were about the size of lemons.  There two women in her 60s or 70s who looked about 8 months pregnant who without much guesswork you could tell had stage 4 ovarian cancer. 

My next rounding experience was on the Pulmonary ward.  Here, the most striking (and sad) case was a young man in his 20s or 30s who had been admitted on April 10th with known HIV who had a cough, fever, weight loss and complaint of dysuria.  The plan at that time was to treat him for pneumonia with ceftriaxone and do a number of diagnostic tests.  I saw him with the team consisting of the Makerere University Intern and medical students and Stanford resident on April 13th.  He was cachectic, obtunded, obviously tachypneic, had pale conjunctiva, had two unopened vials of ceftriaxone on his bed but NO IV access.  He was breathing at 48 breaths per minute, with a heart rate in the 130s, oxygen saturation of 93% on room air.  His xray had complete opacification of the right upper lobe with an accompanying effusion and reticular infiltrate throughout the rest of the lungs (my interpretation, there was no report). I'm thinking this could definitely be TB or PCP or a number of other things.  
Off to the ICU?  No.  In the hospital there are 4 ventilators and per the staff, it is unclear that they are all functional. As such, very few people get intubated.
EKG and monitoring?  No.
Oxygen?  The intern protested a bit stating there was no room on the ward that had oxygen available. I asked them to move him anyway.
Transfusion?  I had no cbc to back me up but we all agreed that with conjunctiva that pale, he was anemic.  No type and screen done yet but that and the cbc were requested 
Fluids?  Finally, this was something that could be done for him.  The nurses got to work on establishing access and hung the fluids and hung 500cc of normal saline.   
There was so much to be done regarding stabilization that the diagnostics had to take a back seat.  It was incredibly disheartening to see someone so sick, know what he needed but not be able to provide it.

We moved on to seeing the other patients.  About 10 feet away was a young man who was admitted with pneumonia and pancytopenia.  His white count was 1.6, hgb was 4.2 (yes FOUR point TWO) and a platelet count of 40.  He was right next to a man with pleural TB, 5 feet across from a man with an active productive cough and about 10 feet from the patient who needed to be in the ICU.  Isolation? No.
My solution?  Put a mask on him and hope that no one touches him or breathes directly on him.  Since there are very few areas to thoroughly wash hands, sanitation is definitely an issue.