V-town...

...is the name I am trying to associate with Vulindlela among the locals around the office. Its CAPRISA's rural site about 1.5 hours outside Durban. I throw around phrases like G-town (Galveston), H-town (Houston), and Utopia (Austin), so why not shorten the cumbersome Zulu town down to this abbreviation. Needless to say, its not catching on.

So I was in V-town today. Saw several patients at varying stages of AIDS. All were in our treatment program and thus on HIV medication, but most started out with very low CD4 counts (and low in Africa is LOW, like 12, 4, and even 1). I am not sure how one only has 1 CD4 cell, and if so how they find it, but this is the case with several patients. Ok, I am kind of joking, the CD4 count is a cell/ml count, not an absolute, full body count.

Things went pretty well for the day. As I have in medical school, I try my hardest to go very slow with patients. If they see me, they get asked all kinds of questions and get all kinds of explanations. I make sure they understand what a CD4 count actually is. I always ask how they understand that HIV is transmitted. I think they arent used to being quizzed at the doctor's office, but they catch on pretty quickly.

The only drawback today was my interpreter/nurse, who will be refered to as R. I doubt this Zulu nurse checks out my blog very frequently, but just in case, we'll refer to her as R. Despite extremely frustrating translation challenges, R also made the following egregious medical errors:

-Subtracting 10 Kg from a patient's weight because he couldnt take off one of his shoes. Does anyone really think a shoe weighs 10 Kg, that is like 22 lbs!! She also failed to mention that she made this mental calculation, and I thought that the patient has lost 10 Kg in the past month until I weighed him again.

-Wrapping the blood pressure cuff around the patient's arm inside out so that as she inflates, the velcro comes apart. I showed her how to do it properly, and took the BP myself. I wrote it down as 122/68. She seemed stunned that I was able to discern anything on the sphygomanometer that was not a multiple of 10 (i.e. 120/70).

-Finally, a patient came in wrapped in a coat and sweatpants, was shivering despite the fact that it was pretty hot outside. R tried to tell me her temperature was a cool 36 degrees Celsius (totally normal). I told her this couldnt be right, and asked her take it again, this time leaving the thermometer in for longer than 12 seconds. She looked at the temperature and said "Oh my, this patient's temperature has gone up doctor!" The patient had a fever of 37.9. We later diagnosed her with pneumonia.

This, all coming from an "experienced" nurse who has worked in clinics her whole life. I couldnt believe all this, and began to wonder how reliable blood pressures and temperatures taken by South African nurses were in the past. Still, its hard to be angry at a doughty Zulu woman in her 50's who is oblivious to her medical mishaps. Deep breaths.