OPD

I spent the day in the OPD (outpatient department) of Maluti Hospital today. It's bascially like the ER in the States, trauma cases combined with people who are there for routine care. There are no real private family physicians who have regular patients they see for things like the common cold, diabetes and hypertension care, and regular check-ups. People just go to the closest Health Center or OPD.

I was there trying to assess the record keeping system and to assist the hospital statistician to think about ways to improve it. It's a real challenge because the doctors who work in the OPD are mostly there from the States on one month rotations with the specific aim of providing patient care. There goals aren't based in building hospital management capacity, so a lot gets lots in translation (not literally) in terms of record keeping.

Anyway, as I was sitting in the OPD, a young man was brought in on a stretcher, in and out of consciousness, with lacerations on his face, and a severely broken leg. He was clearly a herd boy, wearing a blanket and rubber boots, like they all do. And he had the distinct scent of having been in the mountains for too long. He had a history of epilepsy, and two of his friends found him face down at the bottom of a 5 meter drop, just laying there. He'd apparently fallen, broken his leg, and knocked himself unconscious, or had a seizure. He'd been there since Saturday. In all likelihood, he was probably drunk or stoned (the herd boys smoke a lot of pot!) and possibly had gotten into a mulamo fight. In order to establish some sort of hierarchy, the herd boys fight with these metal sticks they carry around, and many of them wind up in the hospital with severe internal injuries and head trauma. They basically beat the living hell out of each other, and since they have nothing better to do, they fight while they are wasted on the weekends.

So, yeah, I watched the American short term residents reset his fracture (it was thankfully a closed one), with no pain killers. The herd boy, who had been totally out of it, snapped to life when they moved his leg and writhed in pain. It was awful to watch, but not an unusual occurrence. They do most things without local anesthetic or pain killers here because they are too expensive, and often out of stock.

Tomorrow I go up to Leribe to meet with the District Health Management Team. Fortunately, I'll just be at a conference table...