A Day in Mwanza

I've received a few messages asking what my day to day existence is like here inn Mwanza, so I thought it might be useful to talk about my schedule at the Bugando Medical Center.

My day starts around 6:30 am when I wake up. I'll usually lay there for a bit (it's only over the past 4 or 5 days that I've finally started to sleep ok here) before getting out of bed and showering. I usually eat at house next door. Breakfast is on our own to prepare, so I usually will make some toast and throw some peanut butter and jelly on it. Around 7:45 we walk into work.

Morning report starts at 8 AM. It is on the 7th floor of the hospital (the ground floor is the 3rd floor). It usually consists of the interns and residents on call from the night before presenting any of their admissions. The amount of discussion on these admissions is highly variable, determined by the number of attending (supervising) doctors presents. Sometimes there is a presentation on a topic after this. Morning report ends at about 9 AM.

The visiting Medicine residents then head down to the second floor to round in the ICU. The ICU team here consists of an AMO (AMOs are equivalent to PAs or NPs in the US), Dr. Peck (a member of the faculty here and at Cornell, and the director of our visiting program, a pulmonary fellow who is visiting from Cornell, and 3 medicine residents. It is here in the ICU that the limitations of the facilities and services here si most acutely felt. Intubation is rare, medications available are limited, central venous access is not available. There are two pressors for blood pressure support in the setting of shock, and both the families must pay for in advance. It is a constant struggle for the Bugando residents to do they best they can with these critically ill patients, and they deserve so much credit for accomplishing what they can. ICU rounds typically end by 10:30 or 11 AM.

After that, we head to Major Ward rounds. My ward is back on the 7th floor, so I climb 5 flights of stairs to get back there. The ward team consists of 1 intern, 2 MD5s (senior medical students), a third year Bugando resident, and a visiting medicine resident. We round on a huge number of patients. There are 4-5 large rooms on each floor, each with 8 beds, and we walk from bed to bed, talking to and about patients, examining, performing procedures if emergent. Most of the time the wards are full. At the end of the large rooms, there are usually several smaller private rooms as well, which only have 1-2 patients in them (which is more akin to the layout of most american hospitals these days). Ward rounds last until about 1 PM.

We all head back to the Guest House for lunch at 1pm, and usually stay there until about 2pm. Lunch is prepared, it usually consists of a tomato + cucumber salad, plus some sort of carb. After lunch, we head back around 2pm.

In the afternoon, we primarily teach the medical students. We return to the wards to see if there is anything they need help with. We then usually give a case-based lecture until about 4pm. After that, we usually go back to the wards briefly, then head to the library. There we try our best to use the internet there to check email, work on future lectures, etc. It's often not very effective :/

I'm usually back at the Guest house by 5:30 or so. Several of us usually will go for a run every other day around then, 3-4 miles long. Dinner is at 7pm. Our nights usually consist of working on lectures +/- watching some dvds that people brought on one of our laptops. Occasionally there is a bottle of Kili or Castle or Safari thrown in there.

The weekends are ours for the most part- Saturday mornings us folks from Internal Medicine go to round on the ICU patients for an hour or 2, but then head back. Sundays are off.

I hope this helps to give you an idea of what my daily schedule is!