TGIF

I gave a talk on treatment of hypertension to day at Faith Alive. I had an illuminating dialogue on which meds to use. They still use Aldomet alot which we stopped using about 1973 bec of side effects. Pts can't afford even the one a day meds we have so have to take captopril 3xs a day instead of one a day lisinopril. The pharmacist was there and he verified that some of the meds I were advocating weren't as expensive as they thought , so I think I gave them some useful knowledge. They thanked me profusely.

Saw a 37 yr old man who broke his femur 5 wks ago and was seeing the traditional healer but got SOB suddenly and came to the hospital. Prob. has a fat embolism or a pulmonary emolism. He had a dressing and a 4" splint on his thigh and didn't want us to treat his fx bec we would put a long cast on his leg and never take it off---so he will let the trad. healer treat his fx. He came to the hospital bec he knows the white man has the best medicine for SOB and chest pain.
Evangel Hospital where I see inpts. requires pts to pay for tests first, so we often order tests that don't get done bec of poverty. Today a lady with Stage IV AIDS, prob TB and very weak and cha chetic--sp? finally told us after the 3rd day that the reason she couldn't pay for the chest X-ray was that her family who were standing there, couldn't help her and she would have to go to the bank to get money, and she can't stand up----which is the truth. So I paid for the X-ray, as it was only $5.00. Interestingly . an abd US is only $4.50.
The main problem is that many pts have a combination of HIV, hepatitis B, TB, malaria and chronic liver disease. So which sx are due to what and what can you treat. They make alot of home brew called Goskola which leads to liver disease .Typhoids always a possibility and tests don't reliably rule it out ---same for malaria and TB. So you treat based on experience without alot of evidence and if you have any treatment for it. Is no treatment here for hepatitis B or C.
Tomorrow I am paying for 7 other docs and myself to go to one of only 2 wild game parks in Nigeria. We will do it in one day. Should see alot of pesky baboons and warthogs. It is pretty expensive for Nigerians so the docs were excited to have the chance ---it is 3 hr away.
More later.
Will