The Road to Thyolo

Yesterday I visited Beit Cure Hospital, a non-profit ortho hospital with pretty nice facilities. In the afternoon I was in clinic. My first impression of clinic was that it was going to be similar to our own clinic experience as I walked into a room full of patients. Quickly I realized there were significant differences - first, the patients wait patiently. Second, the patients come in with real problems, not just a little ache or pain as alot of our patients do. I saw alot of pathology and a few very interesting follow-ups. We saw a women that had intitially lost the ability to walk due to tuberculosis of the spine and had been operated on by Dr. Mkandawire, the chief. That was two months ago. Now, she hopped around the room and proudly showed of her beautiful surgical scar. Later I met a woman with epilepsy that fell into a fire while having a seizure. She sustained significant burns on her body including her hand and subsequently developed a flexion contracture of her wrist and thumb. We decided to operate on her. She is now collecting her guardians in preparation for her hospital stay. Her name is Athaonse, which means in Chichewa "everybody's gone." She was named this because all her older siblings had died prior to her birth. We look forward to seeing her again and doing our best to help her. I also met a beautiful old lady that came in because she could not lift her right arm much anymore. She had a mass the size of a large grapefruit in her scapula and a mass in her thyroid. There is little that can be done for many of the cancer patients here and as she was being told what she had she nodded occasionally. She then sat quietly for a minute or so as we wrote her visit notes then she said, "Maybe I am going to meet God then." She dressed, took her notebook filled with healthcare notes and left as quiet as she came.

The clinic seemed to move quickly with so much interesting pathology and stories.


Today, I went to Thyolo District Hospital. The road to Thyolo is what is called a "proper road" that winds along south of Blantyre through thousands of acres of tea plantations and mountains. It is really striking land. Thyolo is about an hour south of Blantyre and the homeotwn of the President. After his election, he quickly moved to have a very fine hospital facility built in Thyolo. We met Mr. Kennedy the orthopaedic officer there and he began showing us around. We ran into two Danish doctors that have been working in Thyolo for a year doing their "tropical medicine" rotation. The were extremely excited to have us there because they have many patients and many orthopaedic problems and limited orthopaedic experience. But they are working hard and doing the best they can - doing amputations, skin grafting, traction, stabilizing cervical spine fx/dislocations etc. They had many questions for us and really needed our input on many cases.

After finishing the ortho cases they took us to the only restaurant in Thyolo. We walked through the market - filled with people and animals to a very small but clean building. Walking through the sheet that covered the doorway we entered the restaurant and were seated at one of the tables. We ate chicken, greens and seema (a corn based grit). Utensils were optional so I just dug in. It was pretty good actually except for the neck of the chicken that I was given. I didn't really know what to do with that.

After lunch we were asked if we'd see a few other medical patients with them. We saw a young women who was having seizures on a daily basis now with no apparent diagnosis. We examined her and found some significant findings and just as we were about to check a few other things she had a seizure. I held her head to give her some support as they got some diazepam. We gave her the medication and then another dose and finally she broke out of the seizure. She mumbled things at first then began calling out names then eventually singing a song, then she fell asleep. Quite an experience. We recommended a transfer to the Queens hospital for further workup including a CT scan of her brain.

We saw a few more patients then made arrangements to return in about a weeks time. They are going to gather cases for us in the meantime.

Tonight the partying will begin and I plan to check out the bar/club in town. Drop down and get your eagle on...