I've had brief stints with mediocre physical fitness in my lifetime. In college, I had periods where I would go to the IMA and playing sports on a regular basis. The spring prior to residency I did about 4 months of P90x. That was pretty good. This past summer I did about 2 months of P90x again until I returned to my rightful slothlike baseline. One of my favorite lines to quote in life is from Tony Horton himself. It occurs during the Ab Ripper video right when I really start questioning why I'm doing Ab Ripper. Tony looks at the camera and walks toward it in a predatory fashion to say "I hate it...but I love it". That's kind of how I feel about underserved medicine. I hate seeing it somedays. Whether it's at DFM back at home or in clinic today. Sometimes it just rips your heart out and gives it an flying elbow from the top rope.
We had our first work day today at Ndirande, one of the "district hospitals" here in Blantyre. It functions much more like a clinic at it's current state but with enough time and support the hopes is for it to be a full spectrum release valve for the overburdened Queens hospital here. Driving in Ndirande (see slide show), you really had the feel that this was different. Not different from the United States, that's a given. But it had a different feel than what surrounds Queens hospital. The streets were more crowded. The roads were more narrow. No signs anywhere indicated there was a health center nearby. You really didn't know it was there until you stood 5 feet from it.
Once we arrived we quickly set up shop and got to work. We estimated we saw around 20-25 people in the morning session. For me, it was pure medicine. Each patient wanted and needed to be there. Clinical acumen was at a premium due to there only really being HIV testing nearby. Pretty much most other labs needed to be referred to Queens. Beth and I watched Elizabeth for a few patients then split our two humble rooms to see patients on our own. We debriefed a bit at the local ShopRite after work as we had to exchange dollars for large stacks of Kwacha (see Micah making it rain in gallery). Here's just some of what we saw:
- HIV (likely AIDS) with new diagnosis Kaposi Sarcoma
- Molar pregnancy
- Possible ectopic pregnancy
- New onset afib + HTN + bilateral, severe cataracts that had been brewing for years
- Lots and lots of abdominal pain +/- vaginal bleeding
Working with the underserved is a constant mash-up of feelings of inadequacy/outrage/fulfillment. You're constantly practicing medicine with one arm tied behind your back but you're treating the most vulnerable. The patients that likely need a stable bed or someone to acknowledge them more than a q3month hemoglobin A1c. Today was much in the same vein. I hated seeing what I saw but I loved that I was fortunate enough to be in a position to make a small dent into the unending burden of disease today.
After work, Elizabeth, Beth and I tagged along with a local internal medicine physician here from the UK for a rousing night of "circuits". This is the first I've heard of circuits. It's essentially interval training but this most assuredly had a Malawi twist. There was about 20 or so of us congregated outside a nearby boarding school field. After some jogging we had our course director, a very buff Malawian man, come out to lead us in activities that included tire pulls, tire lifts, and tire carries. Sprinkled in were some running activities as well. We then transitioned inside for more interval training which included planks, squats, and weight training - and tire carrying.
It was a bit of a surreal experience. Here I am with Beth and Elizabeth. We're covered in dirt and lift/carrying/pulling tires around a boarding school in Malawi. Both people who I have known for several years and respect - now transported to a locale that I wouldn't have ever fathomed 3 years ago. These are the experiences you remember long after you have dementia. It's something I'll probably be telling my nurse when I'm 80 and in an assisted-living facility.
I couldn't help but harken once again to my old friend Tony Horton as my body shook in a feeble attempt to maintain a plank at the end of the night. I'm hating it (disease burden, inequality, planks) but I'm absolutely loving it (Malawians, Beth/Hutchinsons, clinical care and learning).
-Ben Davis, SFH R3