Kanye is exhausting

I did not post yesterday, as I was completely depleted by my Kanye experience. Just like last Thursday, my day began at 5 in the morning with a french press coffee so strong the spoon stood up in the cup. Justice arrived with the rising sun and hummingbirds nipping at the white blossoms on the tree outside the kitchen window, and we set off for Kanye. The town is 90 km outside of Gaborone down a two lane stretch of highway populated mostly by cattle, grazing in the tall grass on the side of the road.

We arrived at the hospital, where I delivered “grand rounds” consisting of an hour presentation on the language of dermatology (courtesy of Peter Lio). My audience struggles. They are verbal sluggards, accustomed to the monsyllabic descriptor “rash”, a term as useful as it is accurate. I try to impress upon them the inherent marriage between verbalization and conceptualization. Language is structure. Structure lends itself to differential, which lends itself to diagnosis. I think they understood every other sentence, but they seemed to appreciate the photos. After my presentation, I had clinic, where I saw 33 scheduled patients, and 2 old men that I did not have the heart to turn away. After clinic they asked me to come to the wards and see a sick boy with a rash.

Sekaetsewe is 11, and has had HIV since he was born. He was one of the many orphans of HIV in this country. As if a terminal disease acquired at birth from a mother who died shortly after were not enough, a few days ago he got toxic epidermolytic necrolysis. Somehow, at the Princess Marina Hospital, someone had dispensed efavirenz in lieu of combivir. Two weeks later, the pain in his eyes and mouth became sloughing and crusting. Burning pain seared his eroded urethra with every drop of urine. When I saw him, he was curled in a fetal position under a threadbare blanket in the corner of the room. No mother by his bedside. No family at all. Just a nurse who tended to him silently and perfunctorily, possessed of an impassivity foreign in its totality.

I am surrounded by patients with the worst skin condition we see, afflicting the patients already teetering on the edge, clinging to their tenuous health. I have so little to offer. We are accustomed, in the States, to the sense of control and empowerment afforded us by the tools we have at our disposal. As a resident, my expectation has always been that with sufficient study and preparation, I could treat nearly anyone. I could trace my failings in the clinic to a lack of knowledge or experience, not a lack of means. Here my inexperience and ignorance are compounded and magnified by the limitations of the system.I know that I have remarked on this sensation before, but sometimes it becomes overwhelming.

While my competence is being tested, I am also struggling to retain my empathy and my humanity. Seeing an eleven year old boy with no family, dying of a disease he inherited from a mother he never knew, faced with death before he can even comprehend the concept, should not feel ordinary. Yet it happens every day. Thursday a man hung himself from the side of his bed using a shoelace. He was lying feet from a nursing station and nobody noticed. The discussion in the doctors room at morning report was lighthearted and focused on containing the public relations disaster. The reputation of the hospital and medical officers seems to have suffered no ill effects from a prolonged strike during which scores of patients died, so it is likely a non-issue for everyone except the man, and his family, and everyone like him lining the halls.