The first day at the clinic

I'm officially licensed, though it was no small task! As I suspected, they gave me some trouble at the hospital. Since I'm an NP and do 'clinical diagnosing', they decided I would have to go back and do another 6 weeks under the Medical Council! because that involves things 'outside the scope of practice for a nurse in Malawi'!! After several hours of making me track down random people, wait for "meetings" to finish (the official term for an extended tea break!) and testing my ability to swallow my pride and humbly apologize for causing so much confusion--they signed me through! Whew!

Today I saw patients at the clinic for the first time. It was laid-back and manageable, with plenty of time with each patient. Actually down-right luxurious compared to the hectic pace of community clinics in the US! My first patient was a little confusing--she came in complaining initially of "dry mouth and throat" which then expanded to chest pain, abdominal pain, constipation, trouble breathing when lying down, possible "sugar" (diabetes) and a headache she's had for 30 years. She's taking a BP med but doesn't know what. Lovely! Her heart exam was not good--a murmur, a BP of 190/65 (called isolated systolic high blood pressure) and pulses differing in her two wrists. I think she has some sort of long-term heart problem (aortic stenosis?) on top of stomach ulcers, but with no x-ray, no ultrasound, no echocardiogram, and no way to treat whatever heart condition I diagnosed even if I did have those studies...I ran it by the doctor and she agreed that we can only recommend a follow-up next week with medication IN HAND, low salt diet, and treating the abdominal pain. The fact that she's lived this long (around 70 years, though she doesn't know) is great, and we won't be able to change whatever's causing her heart symptoms anyway. Such a different way of looking at health issues here! Fix what you can, let the rest about a 'paradigm shift' for me to get used to!


  1. Sounds like life may finally get a little easier for you. Praying for you all regularly. PD


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