Greetings from Bambari

 Baby steps: PICU is admittedly not all that intensive, given absence of pressors, vents, portable imaging, CR monitoring, EKG, chem panels, micro studies, heme labs, specialists.  But, if we deploy everything we have with optimal efficiency, we can and do save some otherwise doomed kids. Night coverage is the "on call intern" who is a 6th year med student, covering the whole hospital. I have to schedule point of care hemoglobins and glucose checks, to identify actionable reversible decompensations before they become irrecoverable - typically when the kid presents agonal breathing they call the intern, do some hopeless cpr, maybe a round of epi then pronounce the kid dead.  So, scheduling interventions and tests when I am not there is high value but also difficult.  Previously, my yield on orders to be carried out in my absence was between 10-20%.  The "Nurse Activity Manager" came up with a brilliant idea - a whiteboard with tasks, dates and times.  We did a quick

 Non-medical blog post. The piquant mixture of every stage of human history, simultaneously in one place at one time:  Biblical plagues, medieval afflictions, colonial depredations, modern technology - in one day in Bambari. Today with help of my boss I go downtown to buy a smartphone - we negotiate a package deal, him and me discount.  My Galaxy is getting mildly glitchy and I need something to carry my to-do list and protocols around, snap pictures of x-rays.  For about $120 I can get 64 gigs storage and 4 gigs ram.  In Bambari!  It's a Tecno brand Spark 8!  The proprieter of the store is a little apologetic as he is still setting up display of his stock.  He agrees to a picture (of the display, not him).       He is "not from around here" so although his Sango and mine are equivalent, his accent is funky.  He speaks to his friends in Tchad-style Arabic, not Fulani, but he reports knowing Hindustani too.  Namaskar, we exchange! I have agreed to a price, which far exceed

     On the way to work we turn left onto the main road and straight into a huge parade, marching into and around us.  An enthusiastic throng in support of an upcoming referendum.  Our driver pulls over to one side of the road.        One of the policemen escorting the paraders (you know them from their blue camouflage fatigues labelled "Police" and automatic weapons) approaches the driver's window angrily telling our driver that he is manifesting disorder.  The front seat passenger, a scrub nurse expat, starts explaining to the Central African driver how important it is to be deferential to an armed, angry law enforcement official, as if our driver reached adulthood in this country, alive yet somehow unaware of the danger such an encounter can pose.  Thanks, dude!  The moment, and the parade, pass quickly, and we continue on to the hospital.  I'm still not totally clear on when, or what, the referendum is to be.  There are several marchers carrying what look like clu

Diagnoses come in bunches, wherever you are. We are enjoying pleural effusion week at Bambari Regional. Families (and doctors) are getting frustrated when two weeks roll by and the pus just keeps on coming. I am trying to negotiate special arrangements for refractory gram positive cocci and some weird filamentous things that may be fungus (one expert says, real vs contaminant) or nocardia/actinomyces (yes you said that, you know who you are), get some culture transport medium delivered to us and then send back to Bangui for culture, speciation and maybe even sensitivities.  She has a left supraclavicular node today, so that brings her score for TB likelihood (Keith Edward score, validated in India!) to treatment level despite AFB and  GenXpert gene probe neg - I've started on that.  Mom says she's HIV negative and hates needles so won't test- we're working on that, too.      Another tiny baby, healthy well nourished, supercute three month old with left chest whiteo