So aside from the fact that Matt and I get called doctor half a dozen times a day, this week was the first time I really felt like one (only six years premature). On Tuesday we spent the whole day actually seeing patients in the ARV clinic prescribing their HIV medications. We were under the supervision of Dr. Makhakhe for a lot of it but soon enough we'll be pretty independent. We fill out the prescription forms ourselves and he told us to write MBCHB as our qualification, which is the equivalent of MD. His reasoning was, "You're training to be doctors anyways". We saw about 20 patients and surprisingly enough changed the regimens on about half of them because they were improper or experiencing side effects or something. We know almost everything we need to about the drugs we are just getting familiar with the clinics operations, which are a mess. Essentially the patients have scheduled blood draw and checkup dates which they come in on, then wait for their file, then wait for a sister to fill out a paper, then wait for a doctor to see them, and their files are improperly filled out about half the time so we end up doing error checks for a good chunk of the consultation. Dr. Makhakhe told us all the changes he would like to make but doesn't have the power to, especially getting a computer to keep track of blood work and things. One of the patients was resistant to the first line so we switched to her to the second (and last) line of treatment. Several had problems with side effects, almost always from Stavudine, so we changed them if we were able and prescribed them other medications if we weren't. The last patient we saw was wearing a goat skin because she is a traditional healer. I found it ironic that she was coming into a hospital to be treated.
The rest of our time at the hospital has been pretty good too. Matt and I have dubbed this 'Diversity Week' because we started in the ARV clinic, yesterday was oncology (cancer) clinic, and tomorrow we are doing rounds at the MDR (multi-drug resistant) TB clinic. Lots of interesting stuff and it has put my medical notes up to 30 pages. In the oncology clinic we say our first cases of Kaposi's Sarcoma, which is a type of cancer that shows up as blueish ulcer-like lesions around the body in immunosuppressed patients. She also had a 6" diameter fungal lesion on her back so they were not able to give her full chemo until that is treated and gone otherwise it could get worse. There was another patient with an abscess near his waist which was severely infected and draining pus. He had to be admitted for antibiotics and surgery because gangrene was spreading across his abdomen. And for those of who are curious, HIV and TB has not been eradicated in the last week by any means.
The Village is now up to six kids so it is starting to be more lively around there, and the car is a bit more packed on the morning ride to the school and hospital. The Neihoffs and O'Tools met with another couple this week to discuss partnering to build a church in Thabong and start an outreach ministry there. A lot of things are still up in there but it is an area in huge need so it would really be amazing on all sides if it worked out. For church now we are still meeting at the school and this last week Matt and I led Sunday School for the kids. I've been a camp counselor before so I thought I had it under control but I never had to keep track of 20 kids before, several which didn't speak English. It still went just fine and we learned about being "fishers of men".
Today was a national holiday so we stayed and worked at the Village. We painted the container so it is no longer the evergreen lodge, but it looks much better. The second children's home is coming along nicely and the drywall is nearly finished. The kids were even helping plant new stuff in the garden (winter in SA and they still manage to grow plants). When the team comes in a couple weeks we'll be staying back several days a week and working at the Village. Everything is going pretty well around here except that one of Louis and Amber's dogs got hit by a car before Bible study the other night which was a little sad. Bless their hearts though, they've still invited me to supper so I have to go eat now. Tsamaya hantl! (that's Sotho for goodbye)
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