My team at PMH

We were on call tonight and got a lot of patients. We have a new MO – Mpho Mpape. She’s not very good. But she’s pretty good at doing scut. She disappeared for like 3 hours in the middle of the day. But I guess then she stayed late (only until about 5) doing stuff.

There was a little tiff at the end of the night – Boipelo came on for call at 9pm and found a chart on the female side that said the patient was in the ward at 7:30pm and she got all mad because she had not been admitted yet. She got upset at Amy, the resident who was on call on the female side, and also at Shabnam, the Indian MO who is on call until 9pm. But both of them said they had not seen any new admissions! It’s interesting – the MO’s are very strict when it comes to whom new admissions are clocked by and which team new patients are assigned to. It makes sense – they don’t want to do any more work than absolutely necessary. In this case it turns out that Amy had already clocked this new admission but the nurses lost the admission note and so put the file back into the new patient box. So Amy was able to find the lost admission note and put it back in, but people were still aggravated at each other.

In general, I think my team is great, even though it’s the smallest one. We have as much work as every other team, but for some reason we don't get any new students, residents, or interns! At least so far it has been manageable. Boipelo (our MO) has always been there, although she’s taking the next two weeks off for vacation, starting Monday, and is being replaced by Mpape. She’s actually on call tonight. Not all the MO’s are that good, but she’s pretty good, even though she definitely has an attitude and is pretty cynical. She also works pretty hard. The work ethic is pretty interesting around here. Most of the Motswana MO’s and some of the doctors work relatively slowly, compared to the doctors in the U.S. It’s just a different pace – they tend to take 1 hour lunches (at least) and they don’t rush to try to get everything done. If by 4:00 pm there are some things that are left to do, they just leave anyways. They just try to get to the most important stuff early in the day. This I understand, but not necessarily agree with. There is just so much to do that sometimes one person just can’t get to it all. I do get frustrated on occasion, because there doesn’t seem to be a need for 1-2 hour lunches when you can be working on patients!

I think especially on the teams that have Penn people, the MO’s have a lot less work to do because the Penn people are “extra”. And on call nights when Penn people are on call, the MO’s tend to take off early or disappear, because we are also “extra” help on those nights. It can be really frustrating – often, an MO will just disappear for hours at a time because they feel there’s someone else there to do the work! Some of them are really starting to take advantage of us, and the MO’s are starting to fight to be on teams that have Penn people so they don’t have to work so hard. It’s annoying, because although we are there for patient care, Penn people rotate in and out, and we don’t always know the correct way to do something, or what resources are available to us. And more importantly, we can’t speak Setswana, so we need those Motswana doctors and MO’s to help us translate! It’ll be interesting to see how this plays out in the future because I don’t see it getting better unless there’s some kind of intervention.

Each team also has a specialist, who is equivalent to an attending in the states – they make the big decisions and do a lot of teaching. For my team, the specialist keeps on changing. The first two weeks it was Dr. Stefanski, the next two weeks it was Sarah, and now it’s Shanthi. They all do quite a bit of teaching, and are all very good (not all the specialists are good) but I think I liked Sarah the best because she knows how the hospital works and helps us out with the work after rounding. Shanthi will probably be like that too, but she’s relatively new, and is still learning the system.

Below is a picture of my most recent team – it’s Boipelo, Sarah, and I.