RHD

RHD... Rheumatic Heart Disease.  I've been given the job of reviewing these patients, in preparation for the cardiologist's visit in October.  Many of you (those a bit older - say no more) will remember rheumatic fever, and how it can affect the heart.  It's not common in mainstream medicine, but is a reality here, as people have many streptococcal infections and some develop rheumatic  fever.  They then require a monthly injection of long acting penicillin, to prevent recurrences which may make the heart effects worse.  The team here have found that it's sometimes easier for them to go out and see the people in their homes.

Reviewing the patients has pushed me out of the comfort of the ivory-tower clinic.  I've taken the nurses' maps of the community and driven round the streets, stopping at the relevant houses and asking if the person is there, then sitting on the verandah or the tiled floor inside, and doing a check up.  I've found people generally helpful and welcoming, and I've had some good times with them.  Sometimes I've needed to go back to a home several times before I connect with the person concerned.  I've realised that people have their English name, that we know them by, and they also have a name in their language,  that they call each other by.  They all know the English names as well.  It's another example of how much the people need to know, in order to work within systems that are so white-mainstream-western.

Anyway, we leave on Friday, and I'm not sure I'll have seen everyone I need to.  That's chronic disease - the work goes on and doesn't finish.  I'll be able to leave a list for Dr Simon to follow up.  It's good to know that he's here 3 days a week, working with chronic disease patients.  This week, Rosemary came back.  She's been coming for 10 years.  She's come back to be the chronic disease coordinator.

Meanwhile, Tim has been working on the acute side.  Hopefully he'll write something!