It's easter today. Things really have a festive atmosphere over here. Last night I was up really late. Really late as in 10:30 pm. Usually I'm in bed by 8:30 or 9:00. I know... that's super super early buty I've pretty much adjusted my internal clock cycle to the sun. It gets really bright by around 5:30 am and pitch black by 6pm. Hence I now follow the motto: early to bed early to rise makes a man healthy wealthy and wise. I'm always running on time here in malawi. It's funny. In a country where everything runs super super slow, i am actualy punctual and running on time. Ppl who know me-my close friends, my family know that I run on Anil time. I'm always running late. 5-10 minutes usually. You can never count on me to be somewhere at the time stated. I'm really good at timing myself to be slightly late. I guess it's the genes. Indian ppl are always running late. There is something called the real time and then the indian standard time. It's all in good humor though and i find myself somewhat puzzled by my punctuallity over here.
Last night the darkness was filled by the sounds of techno music blasting away in the night. Usually the darkness is filled with howls of dogs and hyenas and other wild animals but not last night. God forbid if i hear the black eyed peas one more time. I might just go crazy. I think the music was coming frm the house next door but who knows. whereever the music was coming from they certainly were having a good time and are addicted to that soung "i've got a feeling".
I"m usually awoken by the sounds of roosters crowing. Seriously. that's my alarm clock. The start crowing around 5:30 am. Don't laugh.. if they don't crow, i won't wake up.
chickens.... there are tons walking aimlessly around. I see them everywhere especially on my morning commutes. I always wondered, how do ppl keep track of their chickens. after all they are often unattended to. Maybe it's the honor system. You learn to recognize your chickens and you NEVER steal a chicken that doesn't belong to you. That's taboo. after all ppl are always watching.

I've been feeling like crap for the last 3 days. Started off as a generalized malaise then progressed to a runny nose and now a vague headache. I was convinced this morning that I had cryptococcal meningitis but the logical side of my brain told me that i was just biased from all the cases of meningitis i had seen at the hospital. Regardless, the dorky side of me decided to do the kernig's maneuvar on myself. laying flat on my back, i gently flexed my left knee and then extended it. i was relieved! I didn't scream from severe neck pain and rigidity. Given that i had no neck stiffness or focal neurological signs or obvious defects I gave up on the idea that i have crypto meningitis. I am alert and oriented times 2 only- i didn't know what date it was . but then again the days go by so fast that i can't keep track.

I've been working at the hospital all weekend. I'm glad i came in this weekend. there are no doctors that work in the weekend and often patient's just lay in the wards unattended to. there are some pretty damn sick patients in the hospital right no.w. Last weekend I took both saturday and sunday off for the first time in 4 weeks and one of my patients who i had been doing a pretty good job micromanaging and taking care of died bc of neglect. while i don't take it personally i would just prefer to work all days so it doesn't happen again. The story of one patient i saw yesterday really touched me. This was a patient who is in his late 30s. He doesn't have a name nor does he have much of a history. Aparently he was brought into the hospital by one of the human rights watch groups who routinely surveys the prison systems here in malawi and was brought in b/c he was having hemoptysis. apparently he was brought in a few days before also but was discharged on an antimalarial and erythromycin. this guy was known sputum positive for TB but his treatement was never completed since he went to prison. He was cachectic, wasting way with temporal wasting, scaphoid abdomen, skin tenting and severely dehydrated. He was brought in by the guard few days ago and was just shackled to the bed and was left there.... unattended to. He had no guardian, no family members and was shackled to the bed. No bed sheets, no food and in fact had been neglected by hospital staff. a doctor had not even seen him since he arrived.

whlie making rounds yesterday i took notice of this gentleman and had a family member for another patient translate for me. Apparently this patient had been having severe chills, rigors, fevers, dry cough, abdominal pain and diarrhea. He also could not see for one week-blurry vision and had a palpable sore in his rectal area. He had no family members and said his name was steven. this guy was severely dehydrated. I asked if he had eaten and apparently he was relying on the good samaratans from other patients who would just leave food by his bedside. I quickly evaluted him. he had a dry cough, scaling skin, and a look in his eyes one could see that his iris was cloudy. he also had a rectal nodule which hurt when i palpated. I prescribed him empiric treatment for a pneumonia, recommended repeat sputum analaysis and tb treatment, VCT for HIV testing, and for his diarrhea treated him with albendzole,. metronidazole. for his eyes ciprofloxacin drops. I decided that despite what he may have done to land him in prison, my role was to be unbiased as I treat the disease and the human being irrespective of who the person is or what they've done. I ended up finding bedding for this patient, and decided that since this patient did not have a guardian i would be the guardian for the patient this weekend. I went outside and purchased a bunch of bananas, a sobo pinaapple juice box, and crackers and told him he had to eat. Almost from a movie script, I went home last night and was just flipping through a tropical medicine and parasites color atlas that's at the house and i came across something interestigah ha this could be the diagnosis. It was as if this was scripted and i was meant to see this patient. the diagnosis right in front of me. Why, This patient could have onchocerciasis, river blindness. It's a chronic disease of the skin and eye casued by an infestation witha filarial worm. the adult worm causes nodules in the skin and the larvae cause dermatitis and blindness. It's common onnly in certain parts of africa. The bite of an infected simulium (small black fly) injects infecti.ve larvae of the worm. the larvae develop into adult worms in the skin of the infected person and the adults cause painless nodules under teh kin. they can disseminate into the blood go into the eys and it's a very common cause of acute blindness.

the plan today will be to go to the hospital. to take a piece of his skin place it on a slide and watch the worms come out and migrate to a pool of saline that i will place on the slide. I will also do an Incision and drainage of that rectal mass. maybe there might be worms, maybe not. in any case my book tells me i should treat with ivermectin... maybe that's what i'll do. In fact i'll do it right now.