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| Panorama of Good Shepherd Eye Clinic Siteki, Swaziland The eye clinic is on the lower level. Level two is where the OR is located and the overnight wards for the surgical patients. Level three does not belong to the eye clinic. It is the pediatric inpatient ward for Good Shepherd Hospital. |
Today was the first Wednesday that Jono was back in clinic. He had been doing work in the U.S. for the previous three weeks. Wednesday is our busiest clinic day. Anyway, word got out that Dr. Pons was back in town and so everyone decided to show up.
We don't really schedule appointments for clinic. We do have follow-ups and we tell them what day to come back. But new patients can just show up whenever. So...I showed up today with an entire waiting room full of patients. Every seat was taken, there were people standing, and they were streaming out the door. Needless to say, it was a bit daunting.
I started seeing patients immediately and worked until about 1:30 PM, alongside Dr. Pons. Then we hopped in his car, drove quickly back to Mabuda Farm (about 2 kilometers), and his wife and his family members (visiting from America and South Africa) had arranged a delicious lunch on the rocks near the lily pond. It was perfect weather, great food, and great company. It was a nice break from all the chaos in clinic.
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| Lunch on the rocks at Mabuda Farm with Jono's extended family. |
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| Helen and Jono's new stove for cooking. It is fueled by sticks of wood instead of gas or charcoal. We boiled water for tea/coffee on it and it worked well! |
We promptly returned to the clinic and continued seeing patients until about 6:30 PM. We literally did not stop! Jono figures we saw about 80 patients in clinic today. EIGHTY. But it was fun, and it taught me that I am capable of getting through these days! And I feel like everyone got the time and attention that they needed.
Jono and I had a discussion about why we are able to see more patients in a day here in Swaziland. He has four reasons: 1.)The patients don't expect a long conversation/discussion with the doctor. They want to know what is wrong and if/how it can be fixed. 2) We can't do much "extra" testing here such as automated visual field testing or imaging of the macula and nerve. Therefore, we save time by not ordering a bunch of specialized tests. 3) The patients all sit on a bench in the same exam room and just scoot down the bench until they arrive at the chair to be seen by the doctor. Therefore, "turnover" time between patients is about 10 seconds. Much less private but much more efficient than in the United States. And finally 4) I am not practicing "defensive" medicine here. I am truly doing for each patient what I am able and what I would do for my own friends/family. Therefore, we avoid lots of unnecessary things that might otherwise slow me down. Don't get me wrong--I try to be very judicious in the U.S. about testing, etc, but I also spent A LOT of time documenting, making sure that I have written down absolutely EVERY detail about the exam/consultation. Here, I write a very accurate and complete, but succinct note on a paper chart. There is no electronic health record (EHR). There is no ridiculous amount of coding to be done. There is no "best practices" things that have to be checked and double checked in the EHR. It isn't better or worse, just different. There are pros and cons to both.
After the clinic patients were seen, we did biometry (lens calculations) for the pre-op patients. The surgical patients for the week come in the day before surgery, stay overnight in the clinic ward, and have surgery the next day. They stay overnight one more night, see us post-operatively the next day and then go home. The lens calculations (deciding the intraocular lens to be placed in the eye) occurs after clinic the night before. All of the lodging, calculations and surgery is included in the price of the surgery, which is 600 Emalangeni (equivalent to 600 South African Rand--both currencies are accepted in Swaziland and are of equivalent value). That is about $55 in the U.S. This may seem expensive, but it helps the clinic stay open. And for those that are destitute and have no money, we find funding to cover their surgery.
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| Dr. Pons doing biometry for patients that are to undergo cataract surgery the next day |
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| Where the surgical patients sleep the night before and night of surgery. There are about 5 people to a room. There are two rooms with "private beds" and a bathroom for patients that pay more money. |
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| Swazi currency: Emalangeni |
Photo for the day:
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| Beautiful Swaziland |
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