Field report General Internal Medicine – Dr. Corinne Rindisbacher

Since many Namibian patients suffer from diabetes, I gave a lecture on the various aspects of diabetes as a chronic disease. In the process, we got into an honest conversation with each other. The Namibian patients and doctors are not used to talking about the mental state of the patients. They recognized the need, but also expressed concern that the patients would find this very unfamiliar. I was able to encourage them to just try it once in a while. 
 
Compared to last year’s stay, antibiotics were used much more cautiously and rationally, as the issue of resistance is now better known.
 
The common snack and lunch among us doctors was always a nice break from the daily routine and an opportunity to talk a bit more personal. After lunch, I went along on the ward rounds in internal medicine. The resident and I discussed many practical issues and together we practiced examination techniques at the bedside that she was not yet familiar with.
 
As in the previous year, many severely malnourished infants were hospitalized in the pediatric department. Children also died despite all the efforts of the doctors. Another major factor is that the laboratory facilities are very limited, partly because blood salts or inflammation values are not determined on-site. The blood has to be sent to Windhoek and the results are never completely up-to-date.
 
The hospital social worker also told me that the suicide rate in Namibia has unfortunately increased considerably. Many Namibians are doing very badly socially and the high alcohol consumption is and unfortunately remains a big issue. In the afternoon I saw patients with various problems in the OPD (outpatient department) with different doctors. We practiced together the careful questioning and examination of the patients and also the procedure for making a diagnosis. The four days together passed very quickly and at the end, we were given a very warm and grateful farewell by the team of doctors.
 
After a relaxing weekend in Etosha National Park with safari and beautiful animal encounters, we drove the next five hundred kilometers further north to Andara. Finally arrived at the shipping container house of Mudiro, we were warmly welcomed and entertained by Barbara Müller. Afterward we went on a sightseeing tour to the nearby school children’s home and the Catholic hospital. 
 
Behind the hospital is the newly built, empty Covid 19 ward. Although there were currently many children with infections in the hospital, the government did not allow the new department to be opened and put to good use.
 
The 120-bed hospital is run by 4 doctors. In the morning report, cases were discussed, and sometimes there was time for technical discussions. Afterward, I went on rounds with Dr. Alice to the children’s and men’s wards. The pediatric ward was always very crowded. There were 36 small patients in 4 rooms, each with an adult relative. Most of the children were suffering from gastroenteritis or cough with fever. A considerable number of the children were also malnourished. Fortunately, the evaluation of malnutrition is technically quite simple. Using a special measuring tape, the upper arm circumference of the children is measured. This is constant from 1-6 years of age and gives surprisingly accurate results.  According to a uniform, predetermined scheme, these children were fed special milk or then also with plumpy nuts.
 
The children were discharged as soon as possible so that they did not infect each other with other infections. The malnutrition was not finally solved at the time of discharge and, in my opinion, is also due to the poverty of the local population.
 
On the ward, there was also a few days old baby with sepsis (blood poisoning). The mother, although instructed in umbilical care, had disinfected the umbilicus with ashes. An encounter with an elderly man in the OPD I have not forgotten. I questioned and examined the diabetic man alone. He had been suffering from very distressing night pains (polyneuropathy) for a long time. I examined the patient’s feet and I was able to explain the reason for his pain. Fortunately, I was also able to give him the appropriate medication. The patient was very grateful and told me that his feet had never been examined before.
 
Time crunch! Time constraints: Namibian doctors often have to treat a lot of patients in a very short time. 
How else could four of them run a 120-bed hospital, attend to emergencies and treat at least 50 patients in the OPD? This also leads to the fact that the questioning, the examination, and the conversation with the patients often come too short.