New and Old

People everywhere. Lining the roads on the way in from the airport and along the city streets. Lining the hallways and benches of BMC. Mwanza, Tanzania is a city situated on Lake Victoria. It has hillsides lined with rock formations and homes the color of the rock and earth. It's a bit dry here now and the prevailing background is brown though scattered green trees and flowering bushes break up the earthtones. The city's construction is similarly a monotonous color of concrete broken up by some unusually colored pastel structures. The lake is a lovely, deep blue. The lake attracts as many birds as people.
The theme of the day is "I haven't seen this before."
Today was my first day on the job and introductions to some casualty staff were made. I wasn't prepared to take care of patients. Nonetheless, I saw a few of the many. And it gave me pause.
The cachectic(markedly thin) man leaning over the stretcher with the complaint of throat pain. His neck was visibly swollen symetrically and anteriorly above the suprasternal notch and I swear the swollen area felt crepitant. No history of vomiting or procedures is about all the history my language barrier allowed me to gather. This was a very sick man. Quietly he and his friend waited. The surgery staff was evaluating him amongst many others. Eventually he was gone, admitted to the ward. No diagnostic testing or treatment had been performed.
Along side him sat a young teen with draining areas on both legs and left forearm that he volunteered had been present for years. His x rays were markedly abnormal. It had begun as leg stiffness he noted playing futbol. Now both knees were fused in flexion. He seemed otherwise well. The only other patient I saw was a 3 year old girl with sickle cell disease with fever and cough one week out from a hospital stay where she had been treated with antimalarials and antibiotics. Mildly inactive, she was alert and having no respiratory difficulty.
Only 3 patients today on a day I hadn't planned on seeing any. There seemed to be hundreds waiting. All 3 presented diagnostic and treatment dilemnas. I am supposed to be an old, experienced E.D. doc. Why then does it all seem new to me?