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My Away Rotation in Lesotho

Cassandra Grenade, MD:

I went to Lesotho for the month of February. Lesotho is an independent kingdom located within and surrounded by South Africa. It is known for its beautiful luscious green mountains, rich culture and friendly people. Unfortunately Lesotho is also known as the country with the third highest prevalence of HIV in the world. About 1/4 people have HIV. A great saying I saw stated "There are two types of people in Lesotho; those infected and those affected by HIV/AIDS”. We saw the effects on young children orphans after both parents died to HIV and they were left to raise their younger siblings. Fortunately there is a sense of community living and in those situations another family member usually takes on the responsibility of raising the orphan children. The government along with WHO and other organizations have taken on several initiatives to deal with the prevalence of HIV in the population. In 2004 the government launch a testing campaign to have every person >12yrs have HIV testing. The government also provides free ARV (HAART) therapies and free TB treatment. However, we saw that people were still not open to discussing HIV and sex education especially since we were on an SDA campus. 
Its took us over 24 hours of traveling to get from Ohio to Maluti Adventist Hospital (MAH). This is a seventh day Adventist (SDA) hospital. Therefore there was a religious background to everything. This also meant that the diet was vegetarian. The hospital is divided into different wards-male, female, pediatrics and ob/gyn. Resources were severely limited. Here are a few examples, there was no IV pumps, mechanical ventilators only for the OR, no elective intubation, no pressors, no central line, lumbar puncture or thoracentesis kit instead make-shift kits. No lancets to check blood glucose instead needles were used. Just to name a few. There was a surgical theater or operating theater. The hospital is managed by two surgeons. One is the hospital administrator. There are foreign residents who rotate there for about three years and also rotating medical students. There are no native Lesotho physicians-most doctors were from Zimbabwe, Congo and South Africa. They are family medicine resident trained in all aspect and capable of doing all aspects of medicine-from delivery babies (including c-section), radiology, to all types of surgeries even ENT procedures. They are mainly self taught or if one learns of a skill in SA, returns and teach the others.

A typical day was rounding on one of the inpatient wards then spending the remainder of the day in outpatient clinic also called OPD. Rounds were brief, we did not really examined the patients and documentation was sparse. On the wards we saw abdominal TB, crytococcus meningitis and any complication of HIV/TB hat you can think of. 

Normally there were greater than 100 patients waiting daily by the time we arrive in OPD. OPD had four rooms and each physician took a room or pulled up a chair and see patients in the hallway. On average I saw about 20 patients a day. Most patients had HIV and/or TB and related complications. Other common diagnoses were orthopedic fractures requiring casting, malnutrition, sepsis, GI bleed and gyn diseases. Our first day at work we had a floppy baby needing oxygen and IV access + fluids. It took us about ten minutes to get the oxygen set up. The doctors have to place their own IVs and there are no pumps for IVs fluids. Antibiotics were limited to ampicillin, gentamicin, cipro, flagyl and bactrim. Fluconazole was donated by Pfizer and only for used for HIV related complications. Dring the entire month the lab did not have the reagent to check chemistries. We were able to check UA, VDRL, viral load and cbc only. There was no hemodialysis in the entire country nearest is in South Africa. 

As far as our accommodations. The campus was pretty large. It included several schools and most of the workers lived on campus. The campus was safe and crime was not an issue. Please see pictures. We learned on our arrival plane that the country had a water shortage due to pipes bursting in the mountains. We were out of running water for the entire month. We had intermittent periods of running water lasting 1-6hrs (one day). We used rain waters collected in tanks and bottle spring water for cooking. 

Overall, this was a great experience and I am so blessed to have this opportunity. I learned to appreciate the things that I have. We were able to make a contribution and provided assistance to a well needed community and people.