From Peter: 2 June 2011

I visited our 4 students who are doing their rural rotation at Buzi today, 160 km from Beira. They were making rounds in the medicine/pediatric ward when I arrived, and I saw the following patients with them. These were the only patients I saw

A 40 year old woman with urinary incontinence caused by terminal cervical cancer

A 3-year old with HIV and miliary TB on CXR

A 5-year old with a hemoglobin of 3.9

A 3 year old with HIV, dyspnea, treated for PCP pneumonia

A 50 year old man with HIV and meningitis, probably cryptococcus

A 15 year old girl with abrupt onset of lower extremity flaccid paralysis

A woman with urinary retention caused by terminal cervical cancer

A woman with HIV and a 10 inch, hard hip mass and inguinal nodes

A 30 year old man with severe ear, sinus, and mouth problems, probably nasopharyngeal carcinoma

A 3 year old with HIV who weighs 5.7 kg and is not gaining weight after 2 weeks in hospital

An 8 year old girl with septic knee arthritis and meningitis, successfully treated by the students with arthrotomy and ceftriaxone, but now deaf

A 4 year old with malaria and severe anemia

A 30 year old man with epilepsy who lives by himself, had a seizure, and fell in the fire.

And this in a hospital where the strongest available analgesic is one tablet of paracetamol/acetaminophen, the only antibiotics are cotrimoxazole, penicillin G, and ceftriaxone, no antifungals, no anticonvulsants, and no antiretrovirals (because they are not allowed to be administered to inpatients in Mozambique).

I felt like I was in the middle of a holocaust.

Peter