The St. Stephen's Experience: the cocky gunner medical intern, the seizure, and the home visit

Yesterday was a day spent away from the hustle and bustle of Mulago Hospital.  St. Stephen's is a smaller (much smaller) community hospital in the northern portion of Kampala.  It has an operating theatre, several wards and an outpatient clinic.

(St. Stephen's Hospital)

(empty ward at St. Stephens)

We started off rounding with with the medical officer and saw patients who were being treated for routine issues: malaria, tb, etc etc.  One of the visits was a post op follow up from a total abdominal hysterectomy about 3 days earlier.  When I reviewed her chart, I saw her anesthesia consisted of some lidocaine derivative and diazepam.  Meaning she was not asleep.  I hope to never have a hysterectomy, but if I do I will be knocked out with general anesthesia, none of this regional block with anti-anxiety medication business.

After rounds we headed to the room enclosed by a metal door with prison-like locks and pass through called the clinic.  Here is where I encountered the "cocky gunner medical intern".  Now this is a species that I thought only existed in halls and call rooms of hospitals in the United States.  Somehow, this breed has crossed the Atlantic and landed in Uganda. He sat at his desk, chest puffed out and condescendingly explained that pneumonia meant that the patient had an infection of the lungs.  I politely humored his lecture about how pneumonia is treated with some nods and smiles wondering when he would shut up. The smiles got a little tight when he repeatedly tried to pimp me on what burning with urination could mean.  The smile flatlined when he told me I needed to "open any book" and read about how hypertension causes peripheral neuropathy.  I shut him down when he tried to teach me how to do an abdominal exam.

In the midst of dealing the the cocky gunner medical intern, a woman brought in a 1 year old child who was actively convulsing with an oxygen saturation of 56% and poor respiratory effort.  Cocky gunner medical intern was still flapping at the gums, not taking decisive action.  Luckily the Yale med-peds resident stepped in.  Frankly, sick kids scare me and it has been so long since I have taken care of a child, that I would not have been able to handle this one on my own.  We managed to stabilize her with meds and no intubation!

During the afternoon, we had what was probably the best (and calmest part of the day).  We did two home visits in a more remote area.  Chickens, goats and cows were sharing the road with us as we drove to the first home visit.  I was amazed at how happy and grateful they were to see us.