Tuesday

So today started with another very productive lesson in Swahili, where we sang the equivalent of "heads, shoulders, knees and toes" which was great fun.

I then had probably the best lecture I've ever had about STIs in Africa, from professor David Mabey. Lots of interesting points, a few of which were a shock - that 80% of adults here have HSV-2 infection, which of course increases your chances of transmitting and acquiring HIV. A shocking number of mothers - 1 in a 100, have a stillborn child due to Syphilis infection. A point of care test exists but like most STI campaigns it's not simple to implement programmed here.

We've long known that other STIs, especially HSV can increase genital tract viral loads of HIV and therefore increase infectiousness. Yet in a country with an 80% prevalence, where access to healthcare is difficult at best, it's hard to envisage an effective solution on the horizon.

Our afternoon was an interesting mix of ocular pathology which i'd never see in the Uk. I'm always amazed at how cooperative our patients are given how bad our Swahili is.

Cases I saw today:

1) lady with keratitis
2) a Masai child with a shockingly large 5cm ocular neoplasm - who will almost certainly lose it and need chemotherapy and radiotherapy. Whether she gets it is another issue.
3) a lady with bilateral cataracts
4) a child with unilateral proptpsis and a divergent squint. We once again, fear the results of her cranial imaging.
5) a lady with pingeculae and glaucoma
6) a 12 year old girl who successfully received a corneal graft for keratoconus (specially flown in from the USA as there is no tissue bank here)