Bugando: first impressions

It's hard to describe our first experiences at Bugando. To say that "things run differently" is a ridiculous understatement. I guess I'll just try to highlight a few things that I have found notable during our first few days.

1. Diagnostic Tools: To be frank, the residents here have to go much further with much less. Routine labs are anything but routine; things we take for granted like CBCs and X-rays take so long (even for ICU patients) that management in large part is based on: history, physical exam techniques, vital signs, and ultrasound (a skill at which we are both hoping to improve).

2. Severity of Pathology: I thought it would be different, but in 2 days I didn't think I'd see this much: a man with stage 4 tetanus with his jaw fixed in the class risus sardonicus lockjaw-grin, a tuberculous pericardial effusion so large that the mediastinal borders took up the entire chest, countless parasitic infections causing liver fibrosis and GI bleeding. But the most difficult, of course, have been the often futile challenges in managing complications which would be routine in the US: appendicitis complicated by an abscess, C-section complicated by peritonitis, a routine anterior myocardial infarction - none of these might even merit an ICU admission in the US, but here the house staff struggles to merely keep them alive (and often fails).

3. Yoga: tried it for the first time yesterday. As expected, it was very difficult, and I was pretty bad. (Annie's good at it though). But the class was on the beach, which was pretty soothing.

That's all for now!