21 – 24 March 2010
Busy week. Sunday was fun starting with a 3 ½ hour service at the Hospital Chapel. About 200-300 people with the pastor one of the cardiologists and Dr Jacob Alfa as asst pastor, also a cardiologist. I didn’t realize cardiologists had such heart! Lots of singing and of course as the only Caucasian I had to bring greetings as well as a “word of encouragement” so I gave a brief message on Psalm 46. It turned out the main speaker (45 minutes vs my 10 minutes!) was preaching on “Holding on to God in times of trouble” so I was right in theme - funny how the Lord works these things out. Lots of great singing with many worship songs I knew and the choir did a nice piece called “The Potter’s House” which I really liked.
Jacob invited me to dinner after church with his family – they live on the same street I do in the hospital compound. Had a very nice meal with he and his wife with kids and her sisters in attendance. Turns ouit he also has 4 boys and a girl so that’s four of us now with the same mix here. We talked Nigerian politics, religion, etc and had a very good time. Rest of day was spent preparing talks for the week and fiddling with AC and power issues.
Monday I had a meeting with the provost (dean) to discuss the curriculum briefly then it was off to the HIV clinic where they had a full morning’s CME led by a young ID doc, May-Ann Etiebet, from U Maryland who is a technical advisor with Institute of Virology here. She is the daughter of a Nigerian dad and a Newfie mom who went to Yale and Columbia but is now based here in the city center. I had prepared a talk but the program was already filled but we had good discussions around 3 complex cases. Another participant was a Nigerian-born pediatrician now working at Michigan State so lots of interesting folks. In the afternoon. I presented examples of our COPS curriculum to the faculty. I’m not sure they’ll be able to put a lot of this in to their very proscribed course but they were interested with lots of questions.
Tuesday started with the usual good Addams breakfast then I gave a grand rounds on HIV Prevention to faculty – most attended but that still means only about 15 souls but they enjoyed it. After that it was supervising the Med400’s first foray into the wards. A nice young resident, Habib, who’s interested in ID, selected some patients and I had ½ the class (12) divide in pairs to take a history for an hour and then present them to me and Habib in the small ward conference room. It actually went very well and they seemed excited by their first patient contact . In the afternoon, I lectured on HIV and TB to the Med200 and 300’s.
Today, I had the opportunity to present a complex AIDS case from home to the ward group (naturally following a drug rep talk flogging enalapril!). Lots of interest and questions about the case. Then it was the second half of the Med400’s into the wards taking histories. Since we started more or less on time. I actually had time to go back to the bedside and demonstrate some good physical findings on patients for them – as always diseases in Africa present late and severely so physical findings are rarely subtle so easy to point out/ The 2 I looked at had advanced HIV related TB and alcoholic cirrhosis. In the afternoon after a brief foray into the ville for cash, beer, and soda, I continued my series of talks on physical diagnosis, finishing respiratory and moving into the cardiac exam. Fairly dry material, and I could see a few heads nodding in the late afternoon heat (40C again outside)
After work , I returned to quarters where my 3rd and final AC was being installed, this time a brand new one and working great! Unfortunately, the power was off, Addams had disappeared and so I couldn’t enjoy til later when he returned to start genny. Meanwhile, I had been invited up to Chapel where about 100 people showed up for a 2 hour Bible study, splitting into groups of 10 after some singing. They’re doing a series on “Grace” and it was really a very nice in=depth discussion in my group of 5 men and 4 women, led by one of the latter. Walked home in the warm, short twilight to heated left-over Chinese from my Saturday trip to city center which had weathered the last few days well and washed it down with a couple of Star lagers. Jet lag pretty much gone and hope to get a good snooze tonight!
Wednesday, March 24, 2010
Saturday, March 20, 2010
19-20 March 2010
19-20 March 2010
Well Friday was a bit of a bust. I was supposed to go to case round in the hospital to start but after looking into various conference rooms, a resident informed Jamda that there wasn’t one. So had some down time then lectured the Med 300s on HIV epidemiology for an hour and 30. Grabbed a pineapple jam Sammy back in the room – only jam found in a little store in town – then waited to be picked up for a 2pm session with residents, and waited, and waited! Got a text from J saying he would get me at 2:30 after prayers (he’s Muslim) but he finally came around 3:15. By that time most of the residents had wandered off so the 5 remaining thought we should reschedule next week.
Meanwhile the AC saga continued with a new (old) machine in the room not quite cutting it in the 40C heat but better than none. J decided to bite the bullet and buy a new one with Accordia approval on Monday. He’s very hospitable and wants to make sure I’m OK but thinks (and I’d agree) that doing all this logistical support is a little beneath his pay grade as a prof! He thinks to go forward we ought to hire a local Victoria equivalent to coordinate the PIRs, etc. Had a long phoine call with Kelly in DC in the evening re first week impressions. I’m not sure that AUTH and the Abuja med school is the right spot for a WAIDI but we’ll see.
Saturday morning after my pour bath and a good breakfast from Addams of porridge, eggs, beans, and toast it was off to Abuja to see the sights, get some groceries, and have a meal. David picked me up in the Pajero and off we went retracing the route pat the airport and into downtown. The highway is under constant construction and improving all the way in the 60km from Gwagwalada but unfortunately that means all the traffic including boda-boda;s (called “go-in’s “ here) just go faster still ignoring most traffic laws. Some of the finished road is 6 lanes with a median and it looks like even 8 lanes are planned. Part of the unfinished road has signs saying no vehicles and there are concrete barriers every 500 -1000 meters with a one lane hole which you race for in a game of chicken! No slow traffic moves to the right so you pass right or left and even on the shoulder in speeds up to 140 kph – exciting! Also there are still pedestrians dashing across the “freeway” and street hawkers when a jam or slowdown occurs. David says he sees an accident or 2 on every trip, from minor fender-benders to major crashes. I’ve seen 5 so far this week. In fact, Jamda had planned to go with me to Abuja today but on Thursday one of his best school chums, an architect, was killed in an accident and so he had to attend the funeral. He rather non=chalantly said that he had killed a “go-in” driver who had cut in front of him 2 months ago! I’m thinking court cases, law suits, etc. but he says nothing usually results from all the RTAs they have.
One more irony – they have a Road Safety semi-police cadre wearing blue smocks who look into cars at slow downs to see whether you are wearing a seat belt! Fine can be 15K naira ($100) if you don’t comply.
Our drive was uneventful - the city gradually emerged from the permanent haze. There is no blue sky because of the dry season so it’s sort of a bright white cast. The city abounds with quite beautiful buildings – high rise structures in myriad shapes and colors. It’s also clean if dusty unlike the suburbs which are equal to or worse than Kampala re trash; they have regular clean up crews and sweeper trucks it appears. Each government ministry has it’s edifice and we passed the new stadium which would make any US metropolis proud. There is almost no residential property in downtown – people3 commute from suburbs or the edges. David swung me buy the National Hospital – a very swank place, much nicer and larger than AUTH which makes me wonder why it wouldn’t be a better site for WAIDI as it obviously has better infrastructure.
Next stop was the Hilton which is huge and upscale, sitting in a large park. I finally saw my first Europeans and Asians there (with the exception of the drug rep early in the week!). Beautiful marble foyer, classy restaurants and pool if you can afford the $270/night. I thought of grabbing a cheeseburger but at $20 seemed a little pricey. So off we went to the only Western supermarket called Amigo in a little shopping plaza so I could stock up on a few items, like cheese, not available in Gwagalada. Interestingly, supermarkets in Kampala are much better and cheaper. I did buy a small fresh chicken ($8) to give adamm something other than tough grisly beef to cook with. After shopping, final stop was a Chinese restaurant called Chopsticks in a part of the city called Maitema where the wealthy live including all the ex-ministers according to David who have these palatial estates on the hillside. Basically a ministerial post is the way to secure everlasting security for your extended family – corruption is rampant and expected with lots of oil money to go around and unliuke Uganda, not even lip service to an anti-corruption agenda.
The restaurant was cool, clean and excellent although my meal was $35 – did get a doggy bag though so can relive the experience back in dusty Gwagwalada. Trip back also uneventful with mad dashes through the chicanes arriving home to see Addams doing my laundry by hand in the back yard.
Overall impression of Abuja? Large, clean and new but not much to do or see – I’d think very boring for a Westerner. Kampala has a lot more to offer in my opinion and also perhaps a smidgeon less disparity between rich and poor.
Tomorrow should be fun – going to the Hospital Chapel with Dr Alpha. He’s the secretary and one of the other docs I met is the pastor. Service starts with prayer at 8 and lasts til 12! Hopefully lots of good music to go along.
Well Friday was a bit of a bust. I was supposed to go to case round in the hospital to start but after looking into various conference rooms, a resident informed Jamda that there wasn’t one. So had some down time then lectured the Med 300s on HIV epidemiology for an hour and 30. Grabbed a pineapple jam Sammy back in the room – only jam found in a little store in town – then waited to be picked up for a 2pm session with residents, and waited, and waited! Got a text from J saying he would get me at 2:30 after prayers (he’s Muslim) but he finally came around 3:15. By that time most of the residents had wandered off so the 5 remaining thought we should reschedule next week.
Meanwhile the AC saga continued with a new (old) machine in the room not quite cutting it in the 40C heat but better than none. J decided to bite the bullet and buy a new one with Accordia approval on Monday. He’s very hospitable and wants to make sure I’m OK but thinks (and I’d agree) that doing all this logistical support is a little beneath his pay grade as a prof! He thinks to go forward we ought to hire a local Victoria equivalent to coordinate the PIRs, etc. Had a long phoine call with Kelly in DC in the evening re first week impressions. I’m not sure that AUTH and the Abuja med school is the right spot for a WAIDI but we’ll see.
Saturday morning after my pour bath and a good breakfast from Addams of porridge, eggs, beans, and toast it was off to Abuja to see the sights, get some groceries, and have a meal. David picked me up in the Pajero and off we went retracing the route pat the airport and into downtown. The highway is under constant construction and improving all the way in the 60km from Gwagwalada but unfortunately that means all the traffic including boda-boda;s (called “go-in’s “ here) just go faster still ignoring most traffic laws. Some of the finished road is 6 lanes with a median and it looks like even 8 lanes are planned. Part of the unfinished road has signs saying no vehicles and there are concrete barriers every 500 -1000 meters with a one lane hole which you race for in a game of chicken! No slow traffic moves to the right so you pass right or left and even on the shoulder in speeds up to 140 kph – exciting! Also there are still pedestrians dashing across the “freeway” and street hawkers when a jam or slowdown occurs. David says he sees an accident or 2 on every trip, from minor fender-benders to major crashes. I’ve seen 5 so far this week. In fact, Jamda had planned to go with me to Abuja today but on Thursday one of his best school chums, an architect, was killed in an accident and so he had to attend the funeral. He rather non=chalantly said that he had killed a “go-in” driver who had cut in front of him 2 months ago! I’m thinking court cases, law suits, etc. but he says nothing usually results from all the RTAs they have.
One more irony – they have a Road Safety semi-police cadre wearing blue smocks who look into cars at slow downs to see whether you are wearing a seat belt! Fine can be 15K naira ($100) if you don’t comply.
Our drive was uneventful - the city gradually emerged from the permanent haze. There is no blue sky because of the dry season so it’s sort of a bright white cast. The city abounds with quite beautiful buildings – high rise structures in myriad shapes and colors. It’s also clean if dusty unlike the suburbs which are equal to or worse than Kampala re trash; they have regular clean up crews and sweeper trucks it appears. Each government ministry has it’s edifice and we passed the new stadium which would make any US metropolis proud. There is almost no residential property in downtown – people3 commute from suburbs or the edges. David swung me buy the National Hospital – a very swank place, much nicer and larger than AUTH which makes me wonder why it wouldn’t be a better site for WAIDI as it obviously has better infrastructure.
Next stop was the Hilton which is huge and upscale, sitting in a large park. I finally saw my first Europeans and Asians there (with the exception of the drug rep early in the week!). Beautiful marble foyer, classy restaurants and pool if you can afford the $270/night. I thought of grabbing a cheeseburger but at $20 seemed a little pricey. So off we went to the only Western supermarket called Amigo in a little shopping plaza so I could stock up on a few items, like cheese, not available in Gwagalada. Interestingly, supermarkets in Kampala are much better and cheaper. I did buy a small fresh chicken ($8) to give adamm something other than tough grisly beef to cook with. After shopping, final stop was a Chinese restaurant called Chopsticks in a part of the city called Maitema where the wealthy live including all the ex-ministers according to David who have these palatial estates on the hillside. Basically a ministerial post is the way to secure everlasting security for your extended family – corruption is rampant and expected with lots of oil money to go around and unliuke Uganda, not even lip service to an anti-corruption agenda.
The restaurant was cool, clean and excellent although my meal was $35 – did get a doggy bag though so can relive the experience back in dusty Gwagwalada. Trip back also uneventful with mad dashes through the chicanes arriving home to see Addams doing my laundry by hand in the back yard.
Overall impression of Abuja? Large, clean and new but not much to do or see – I’d think very boring for a Westerner. Kampala has a lot more to offer in my opinion and also perhaps a smidgeon less disparity between rich and poor.
Tomorrow should be fun – going to the Hospital Chapel with Dr Alpha. He’s the secretary and one of the other docs I met is the pastor. Service starts with prayer at 8 and lasts til 12! Hopefully lots of good music to go along.
Friday, March 19, 2010
17-19 March 2010
17-19 March 2010
Friday morning and an update. Have time since apparently no case round to attend this morning although on my schedule.
Wednesday am started with a grand rounds with 4 presenters on acute renal failure – quite good I thought. Led by the young nephrologist Dr Hamven. I was a little taken aback when she berated the first presenter as being ill prepared and too slow. They seem to be as concerned about time for each talk as they were about the content! She gave a nice review of their own experience with ARF so even if she’s not faculty there is some research being done by the hospital consultants. I did learn that all the consultants get the same salary regardless of discipline…a lesson for us?? Unbelievably, at the end they allowed a pharmacy rep from GSK to give a 15 min talk on asthma promoting their product! Never allowed in North America in an academic center.
After the rounds, I went with team B to the wards – saw a mix of patients , about half advanced HIV with a mix of ETOHism and CCF as well. Also met a GP in with poorly controlled diabetes who is president of the Nigerian CMDS. There is quite a lot of Hep B and in fact all the house staff do get immunized. My host is a carrier from birth (mother and 2 sibs also positive) so we discussed treatment and surveillance for hepatoma.
In the afternoon I started my talks on history and physical for the Med 400 class who should be on the wards right now but have never been taught any of this as yet! They seemed to take it in but this is really not my forte and trying to compress what our students learn ½ day/wk over 2 years into 4 2 hr sessions will be an uphill battle.
Back to quarters where major AC troubles persist as well as inet but cold pour baths help And in fact yesterday a new box put in and I got a bundle for the inet finally so no problem! Dinner was some spaghetti – not too bad – washed down with Star lager.
Yesterday started with Journal club which I presented on a recent pneumococcal vaccine paper. However, I was told the session would begin with 15 minutes on the benefits of ginkgo biloba from another drug rep! While he spoke I looked up the data on Cochrane reviews and did a little counter detailing when he asked for questions (no evidence of benefit!).
The rest of the morning was spent with the head doc, Dr Rohimi, in the PEPFAR clinic (Special Treatment Clinic). He seems very knowledgeable and good as we reviewed patients together. They have 4 rooms for 5 docs, 8 RN’s and 8 counsellors with 6,392 currently on ARVs. Unlike, Uganda and South Africa, they trust their patients more, so when stable they get drugs for 3 months which really cuts the work load. CD4s are done every 6 months and VL’s only if failure suspected. No resistance testing although there is a Harvard sponsored program(AIDS Prevention Initiative in Nigeria) in Jos which does some for research Although their ARV enrollments are capped for walk-ins apparently ward referrals and from the hospital Heart-to-Heart VCT testing center and the hospital PMTCT program are still eligible. There are 3 other local PEPFAR clinics which take others in the area. Unfairly, the clinic does not get access to their own data from PEPFAR – I hope to discuss that with the PEPFAR folks next week.
In seeing patients, pretty much the same as Uganda and SA. Most getting TDV/EFV as start up now with new guidelines. He’s not sure about numbers on second line which is usually Alluvia.
In the afternoon it was second round with the med 400’s starting on the physical exam. I’m going to concentrate on respiratory, cardiac, and abdomen but although planned next week I don’t see how I can take 25 students to the ward and supervise them on my own – we’ll see!
Spent last evening prepping talks in a much cooler bedroom and had a nice long Skype with Mary before bed. Sleep only interrupted by the first thunderstorm with rain in weeks so everybody a little happier with this harbinger of the rainy season.
Friday morning and an update. Have time since apparently no case round to attend this morning although on my schedule.
Wednesday am started with a grand rounds with 4 presenters on acute renal failure – quite good I thought. Led by the young nephrologist Dr Hamven. I was a little taken aback when she berated the first presenter as being ill prepared and too slow. They seem to be as concerned about time for each talk as they were about the content! She gave a nice review of their own experience with ARF so even if she’s not faculty there is some research being done by the hospital consultants. I did learn that all the consultants get the same salary regardless of discipline…a lesson for us?? Unbelievably, at the end they allowed a pharmacy rep from GSK to give a 15 min talk on asthma promoting their product! Never allowed in North America in an academic center.
After the rounds, I went with team B to the wards – saw a mix of patients , about half advanced HIV with a mix of ETOHism and CCF as well. Also met a GP in with poorly controlled diabetes who is president of the Nigerian CMDS. There is quite a lot of Hep B and in fact all the house staff do get immunized. My host is a carrier from birth (mother and 2 sibs also positive) so we discussed treatment and surveillance for hepatoma.
In the afternoon I started my talks on history and physical for the Med 400 class who should be on the wards right now but have never been taught any of this as yet! They seemed to take it in but this is really not my forte and trying to compress what our students learn ½ day/wk over 2 years into 4 2 hr sessions will be an uphill battle.
Back to quarters where major AC troubles persist as well as inet but cold pour baths help And in fact yesterday a new box put in and I got a bundle for the inet finally so no problem! Dinner was some spaghetti – not too bad – washed down with Star lager.
Yesterday started with Journal club which I presented on a recent pneumococcal vaccine paper. However, I was told the session would begin with 15 minutes on the benefits of ginkgo biloba from another drug rep! While he spoke I looked up the data on Cochrane reviews and did a little counter detailing when he asked for questions (no evidence of benefit!).
The rest of the morning was spent with the head doc, Dr Rohimi, in the PEPFAR clinic (Special Treatment Clinic). He seems very knowledgeable and good as we reviewed patients together. They have 4 rooms for 5 docs, 8 RN’s and 8 counsellors with 6,392 currently on ARVs. Unlike, Uganda and South Africa, they trust their patients more, so when stable they get drugs for 3 months which really cuts the work load. CD4s are done every 6 months and VL’s only if failure suspected. No resistance testing although there is a Harvard sponsored program(AIDS Prevention Initiative in Nigeria) in Jos which does some for research Although their ARV enrollments are capped for walk-ins apparently ward referrals and from the hospital Heart-to-Heart VCT testing center and the hospital PMTCT program are still eligible. There are 3 other local PEPFAR clinics which take others in the area. Unfairly, the clinic does not get access to their own data from PEPFAR – I hope to discuss that with the PEPFAR folks next week.
In seeing patients, pretty much the same as Uganda and SA. Most getting TDV/EFV as start up now with new guidelines. He’s not sure about numbers on second line which is usually Alluvia.
In the afternoon it was second round with the med 400’s starting on the physical exam. I’m going to concentrate on respiratory, cardiac, and abdomen but although planned next week I don’t see how I can take 25 students to the ward and supervise them on my own – we’ll see!
Spent last evening prepping talks in a much cooler bedroom and had a nice long Skype with Mary before bed. Sleep only interrupted by the first thunderstorm with rain in weeks so everybody a little happier with this harbinger of the rainy season.
Tuesday, March 16, 2010
Off to Nigeria!
13-16 March 2010
Off on a new adventure! This time teaching at the new med school in Abuja, Nigeria. I’m the first Professor-in-Residence sponsored by Accordia Global Health as part of an initiative to establish a West African IDI . Nigeria seems logical as lots of ID problems and an evolving AIDS problem. As important, a majotr oil producer so opens up multi-national corporate funding for support – nuff said! Abuja is the Nigerian Federal capital, purpose built, a la Brasilia , in the center of the country and at the interface of Muslim north and Christian south.
Left on the 13th from Florida where I’ve idled for the last month surf fishing and golfing with Mary and Mom-in-law in preparation. Long flight took me from Orlando to Abuja via San Francisco and Frankfurt arriving late on the 14th. Trip uneventful and arrived in Abuja at 5pm. No one waiting until I fortunately turned on the cell phone I’d been FedExed which promptly rang with David in the parking lot! I thought I was staying at the Hilton but his instructions were to motor down to Gwagwalada. The site of the med school and hospital so no problem. It turns out the complex is 40 plus km from Abuja but still in the FCD
First impression – they drive on the right despite Commonwealth ties! Second was better roads than Uganda but barely and saw 2 accidents on the way - definitely feels like Africa! Abuja is hot = much more so than Uganda and AC was appreciated.
Arrived to meet my main contact, Mustapha Jamda, a young community health prof who gave me a hand shake and a hug at the guesthouse where I’m staying. We shared family stories he has 5 kids with one girl in the middle of 4 boys so right on! I was introduced to Sediya who manages the house and Addams who will cook for me. Quarters are Spartan with no running water but a big plastic garbage can filled for washing - at least the toilet and tub drain properly. Light fixtures are flaky but the room does have AC! Unfortunately power is a real issue – out several times per day but Addams can put on the genny when necessary. He’ was also handy this evening in bypassing a blown fuse in my AC with a judiciously placed bit of wire to get the sucker going!
Monday am Jamda picked me up to meet the med faculty and Dr Alfa who was to show me the hospital. The faculty occupies a rather run down “temporary” office about 5 min away from the hospital. I met the dean and the provost and had a nice introduction and then was off with Dr Alfa to the hospital grounds which is located in a broad dry and dusty field. The hospital itself is 350-500 beds and really looks a lot like Mulago but less crowded. I felt right at home but a little surprised that Nigeria, with much more resources than Uganda, isn’t doing better with health infrastructure. In fact, Uganda is better in that there is little or no free medical care – patients pay for everything unless they are enrolled in one of 2 programs – TB DOTS or the HIV clinic.
I visited the relatively new and less shabby HIV clinic ( here the code word is “Special Treatment Clinic”). This is totally funded by PEPFAR, has registered 12 K patients with 7K active and I think about 5K on ARVs. Unfortunately there are no new ARV starts available so there is down referral elsewhere for ARVs from the Global Fund. A brief glance at the waiting area suggests a 2/3 female cohort, very similar to East and Southern Africa. I’ll learn more on Thursday when I’ll be spending half a day there.
After the tour, I met briefly with the Chief Medical Director, who is a young neurologist. He has several outer offices for petitioners but we only waited a short time to see him. Seems friendly and supportive although more later about the relation between hospital and med school. He does rounds which is good to see despite the heavy admin burden.
In the afternoon, I met briefly with the AUTH residents including “Luckman” the chief. They have 13 in the program and I offered to meet with them any time and we planned a couple of lectures for Friday.
Arrived home to find a nice late lunch of fish and saffron rice and veggies and then spent rest of time in the AC working on talks.
This am we went to meet all the med faculty in their quarters. There were about 12 there and I talked for an hour about their curriculum and ours. The real problem is that there 3rd and 4th yr students have no clinical experience, not even how to do H&P’s so I’m to focus on that Wed and Thurs afternoons. The hospital and med faculty have been at loggerheads over perceived slights which until recently excluded the latter from even stepping foot on hospital grounds! Things are changing but I still sense a little unease on both parts.
After the facultry meeting, we drove to the university “mini” campus to meet the Vice Chancellor (equivalent to our university president). Unfortunately, he was delayed so it was bacik for rounds at the hospital. I joined a young staff nephrologist who led team A and we saw 6-7 patients, 2 with HIV but the others with CKD getting intermittent dialysis. Patients pay around $100 per dialysis and buy as much as they can from the 3 machines! This of course means lots of uremia and fluid retention! Those who can’t afford are given some medical interventions (no free drugs though) qand then I guess just go home. The 2 HIV patients had far advanced TB clinically but were being worked up to the extent they could afford.
After rounds, we finally reconnected with the VC who was pleasant and supportive, obviously hoping that Accordia will bring resources to his young medical faculty. We each made appropriate supportive remarks although he was constantly interrupted with calls on 2 cell phones – a busy guy! After that I gave a lecture to the med 200 class on HIV epidemiology – they seemed interested and had lots of questions so seems a good start.
Back to the quarters in the 34C heat to assess the power (off) and the AC(broken) but surviving wqith the fan a cold Star lager, one of the local brewskis. Hope the jet lag not too bad tonight as I’m trying to husband my sleeping pills!
Off on a new adventure! This time teaching at the new med school in Abuja, Nigeria. I’m the first Professor-in-Residence sponsored by Accordia Global Health as part of an initiative to establish a West African IDI . Nigeria seems logical as lots of ID problems and an evolving AIDS problem. As important, a majotr oil producer so opens up multi-national corporate funding for support – nuff said! Abuja is the Nigerian Federal capital, purpose built, a la Brasilia , in the center of the country and at the interface of Muslim north and Christian south.
Left on the 13th from Florida where I’ve idled for the last month surf fishing and golfing with Mary and Mom-in-law in preparation. Long flight took me from Orlando to Abuja via San Francisco and Frankfurt arriving late on the 14th. Trip uneventful and arrived in Abuja at 5pm. No one waiting until I fortunately turned on the cell phone I’d been FedExed which promptly rang with David in the parking lot! I thought I was staying at the Hilton but his instructions were to motor down to Gwagwalada. The site of the med school and hospital so no problem. It turns out the complex is 40 plus km from Abuja but still in the FCD
First impression – they drive on the right despite Commonwealth ties! Second was better roads than Uganda but barely and saw 2 accidents on the way - definitely feels like Africa! Abuja is hot = much more so than Uganda and AC was appreciated.
Arrived to meet my main contact, Mustapha Jamda, a young community health prof who gave me a hand shake and a hug at the guesthouse where I’m staying. We shared family stories he has 5 kids with one girl in the middle of 4 boys so right on! I was introduced to Sediya who manages the house and Addams who will cook for me. Quarters are Spartan with no running water but a big plastic garbage can filled for washing - at least the toilet and tub drain properly. Light fixtures are flaky but the room does have AC! Unfortunately power is a real issue – out several times per day but Addams can put on the genny when necessary. He’ was also handy this evening in bypassing a blown fuse in my AC with a judiciously placed bit of wire to get the sucker going!
Monday am Jamda picked me up to meet the med faculty and Dr Alfa who was to show me the hospital. The faculty occupies a rather run down “temporary” office about 5 min away from the hospital. I met the dean and the provost and had a nice introduction and then was off with Dr Alfa to the hospital grounds which is located in a broad dry and dusty field. The hospital itself is 350-500 beds and really looks a lot like Mulago but less crowded. I felt right at home but a little surprised that Nigeria, with much more resources than Uganda, isn’t doing better with health infrastructure. In fact, Uganda is better in that there is little or no free medical care – patients pay for everything unless they are enrolled in one of 2 programs – TB DOTS or the HIV clinic.
I visited the relatively new and less shabby HIV clinic ( here the code word is “Special Treatment Clinic”). This is totally funded by PEPFAR, has registered 12 K patients with 7K active and I think about 5K on ARVs. Unfortunately there are no new ARV starts available so there is down referral elsewhere for ARVs from the Global Fund. A brief glance at the waiting area suggests a 2/3 female cohort, very similar to East and Southern Africa. I’ll learn more on Thursday when I’ll be spending half a day there.
After the tour, I met briefly with the Chief Medical Director, who is a young neurologist. He has several outer offices for petitioners but we only waited a short time to see him. Seems friendly and supportive although more later about the relation between hospital and med school. He does rounds which is good to see despite the heavy admin burden.
In the afternoon, I met briefly with the AUTH residents including “Luckman” the chief. They have 13 in the program and I offered to meet with them any time and we planned a couple of lectures for Friday.
Arrived home to find a nice late lunch of fish and saffron rice and veggies and then spent rest of time in the AC working on talks.
This am we went to meet all the med faculty in their quarters. There were about 12 there and I talked for an hour about their curriculum and ours. The real problem is that there 3rd and 4th yr students have no clinical experience, not even how to do H&P’s so I’m to focus on that Wed and Thurs afternoons. The hospital and med faculty have been at loggerheads over perceived slights which until recently excluded the latter from even stepping foot on hospital grounds! Things are changing but I still sense a little unease on both parts.
After the facultry meeting, we drove to the university “mini” campus to meet the Vice Chancellor (equivalent to our university president). Unfortunately, he was delayed so it was bacik for rounds at the hospital. I joined a young staff nephrologist who led team A and we saw 6-7 patients, 2 with HIV but the others with CKD getting intermittent dialysis. Patients pay around $100 per dialysis and buy as much as they can from the 3 machines! This of course means lots of uremia and fluid retention! Those who can’t afford are given some medical interventions (no free drugs though) qand then I guess just go home. The 2 HIV patients had far advanced TB clinically but were being worked up to the extent they could afford.
After rounds, we finally reconnected with the VC who was pleasant and supportive, obviously hoping that Accordia will bring resources to his young medical faculty. We each made appropriate supportive remarks although he was constantly interrupted with calls on 2 cell phones – a busy guy! After that I gave a lecture to the med 200 class on HIV epidemiology – they seemed interested and had lots of questions so seems a good start.
Back to the quarters in the 34C heat to assess the power (off) and the AC(broken) but surviving wqith the fan a cold Star lager, one of the local brewskis. Hope the jet lag not too bad tonight as I’m trying to husband my sleeping pills!
Friday, November 27, 2009
24-26 Nov 2009
Weather continues to be good with sunny days and cool nights although a whopper of a T-storm at the moment. Tuesday and Wednesday clinics went well with new triage system meaning earlier end. I spoke on WHO staging and introduced topic of research on Tuesday – after all this rural clinic has more patients already than most if not all Canadian clinics. They need inet and more human resources for data analysis but they seem enthusiastic.
Alice gave me a nice bottle of Aragula for a going away present and they though a party for me Wednesday after clinic with some nice crafts for gifts. It seems I’ve made a real difference here bringing the clinic some needed change. Matron brought her daughter over to meet me – she’s a 6th grader and wants to be an “event planner”! Her classmate wants to be a “pilot” so we hit it off as well.
Wednesday clinic presented a surrogate (Mom) who said her daughter was too sick to come so Phil decided to go visit her with me with Mom giving directions – my first home visit! We went up the Dullstroom road just a few kilometers and turned off to a cattle farm with 5 laborer homesteads which were pretty primitive but neat as a pin . A beautiful place – made me want to take up farming again! The girl was not all that sick with gastroenteritis but a tough road ahead – 18years old, no education, 8 mo pregnant, no husband (+/- boyfriend), and low CD4 count – the picture of South African HIV infection! She is on ARVs however but her life prospects ain’t great.
Had a nice fish with Luow Wednesday evening and caught a few small bass. Adele came up and took a photo of the 2 fishing buddies. I then went over to Dr Kumar’s for a great dinner – part Indian – with Phil. He’s a Kerala grad and plans to return home after retiring next year. He’s a true GP doing deliveries and surgery including 15 minute C-sections! His house is right next to Louw’s! The hospital has not had a staff MD for 8 mo, running on locums and private coverage so it’s great he’s here.
I said my goodbyes today after clinic (Phil’s wife came in and gave me some nice gifts and thanks) and then headed to the dam for a couple of bass and a nice rainbow before being driven in by lightning. Headed off to Steers for a King burger and so to bed. Organized an extra night here – who wants to spend an extra day in Pretoria when I could fish!
Tomorrow I’m off to Pretoria for a debrief at FPD, then SA Airways to JFK on Sat night. I’ve arranged to get to airport early so I can catch the Boks vs Ireland in the lounge before boarding the plane!
Weather continues to be good with sunny days and cool nights although a whopper of a T-storm at the moment. Tuesday and Wednesday clinics went well with new triage system meaning earlier end. I spoke on WHO staging and introduced topic of research on Tuesday – after all this rural clinic has more patients already than most if not all Canadian clinics. They need inet and more human resources for data analysis but they seem enthusiastic.
Alice gave me a nice bottle of Aragula for a going away present and they though a party for me Wednesday after clinic with some nice crafts for gifts. It seems I’ve made a real difference here bringing the clinic some needed change. Matron brought her daughter over to meet me – she’s a 6th grader and wants to be an “event planner”! Her classmate wants to be a “pilot” so we hit it off as well.
Wednesday clinic presented a surrogate (Mom) who said her daughter was too sick to come so Phil decided to go visit her with me with Mom giving directions – my first home visit! We went up the Dullstroom road just a few kilometers and turned off to a cattle farm with 5 laborer homesteads which were pretty primitive but neat as a pin . A beautiful place – made me want to take up farming again! The girl was not all that sick with gastroenteritis but a tough road ahead – 18years old, no education, 8 mo pregnant, no husband (+/- boyfriend), and low CD4 count – the picture of South African HIV infection! She is on ARVs however but her life prospects ain’t great.
Had a nice fish with Luow Wednesday evening and caught a few small bass. Adele came up and took a photo of the 2 fishing buddies. I then went over to Dr Kumar’s for a great dinner – part Indian – with Phil. He’s a Kerala grad and plans to return home after retiring next year. He’s a true GP doing deliveries and surgery including 15 minute C-sections! His house is right next to Louw’s! The hospital has not had a staff MD for 8 mo, running on locums and private coverage so it’s great he’s here.
I said my goodbyes today after clinic (Phil’s wife came in and gave me some nice gifts and thanks) and then headed to the dam for a couple of bass and a nice rainbow before being driven in by lightning. Headed off to Steers for a King burger and so to bed. Organized an extra night here – who wants to spend an extra day in Pretoria when I could fish!
Tomorrow I’m off to Pretoria for a debrief at FPD, then SA Airways to JFK on Sat night. I’ve arranged to get to airport early so I can catch the Boks vs Ireland in the lounge before boarding the plane!
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