It is winter in Malawi but despite this image it is not snowing – we whinge and whine about the cold but it gets down to a shocking 8’C at night and it a very pleasant 20 to 25’C during the day – sounds like an English summer! So self evidently this is not snow but the Malawian way of re-spraying the patient’s beds – just do it on the grass, which will recover/get cut – it has much to commend it although is not aesthetically pleasing. Nor is the not one but three fly tipping sites
Creation Care a low priority
on the hill approaching our house which distressed me greatly with broken bit of cars and tyres scattered in the ditch beside the road.
More tut tutting ensued when young children set to burning the rubbish but despite my misgivings the rubber has burnt and the metal bits seem to have vanished – no doubt to be recycled or sold somewhere. The only residuum, apart from blackened earth and vegetation is the broken glass!
Eyes down for exams
We have both been in the throws of exams, Caroline worrying over her first years and hoping they have actually managed to grasp some of things she has been trying to teach them, and me the final year MBBS medical students as well as the Clinical Officers. We had an examiners meeting after the event at which the main focus appeared to be who we were going to fail. My concern, however, was that no-one got a distinction – apparently no-one has achieved this in the past 6 years – clearly to my mind there is something wrong – I pointed out that one candidate averaged 75.4% and another 74.8% (75% = distinction) but the regulations state they have to get more than 75% in every single exam they take – quite unreasonable! At least the Dean agrees that this must change – what is the point of the student striving for excellence with such stringent criteria?
MRI scan showing cerebral infarct
The other subject exercising my mind at present is exemplified by a patient who raises the question of the value of applying first world medicine in a third world setting – we recently admitted a 40 year old village chief who has now had 4 strokes since his heart valve replacement in India seven months ago, and is left severely disabled. Against all the odds he was put forward for valve replacement in India paid for by the Malawian health service and sent back to us for further care – the problem is that he had a metal valve replacement and clearly requires anti-coagulation with warfarin for the rest of his life.
Metal work clearly seen on Xray
Whilst we can get warfarin here we have no way of checking that he is adequately anti-coagulated – the requisite INR test can be done in the private hospital but not at Queens – and he cannot afford the private fees for the test. So his anti-coagulation is woefully inadequate (INR 1.3 – needs to be more than 2.5) and he keeps having strokes. Was the referral for cardiac surgery in India appropriate – he may have survived 5 years without the operation and now he has had 4 strokes in 7 months – what is his QALY outcome (quality of life)? A recipe for therapeutic nihilism!
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