6am... alarm sounds... UGH... I'm not any better at early mornings, no matter how many days in a row I get up at 6am.
7am... arrive at hospital, squish moto in the crowded Parking, and stumble into the hospital, still half asleep. Say several "Ani sogoma"s to people as I head in. If patients have arrived, start seeing patients.
If no patients, at 7:30am we go to "Staff" or morning report. (At least one of us goes each day). The Intern who was on call over night presents... "3 cases of severe malaria with anemia, 2 cases of severe neurologic malaria, 1 case of malaria with jaundice"... 
Discuss differential diagnoses... as far as the interns can tell, every child either has "malaria" or "meningitis"... despite all our teaching and encouragement, their diagnostic possibilities never get any broader.
Discuss death... a common scenario: child arrives, the intern assesses & recognizes that the child is in shock, writes prescription for IV, tubing, fluids, quinine, maybe antibiotics. The parents head out to find the money and then find pharmacies that have the above items. Sometimes it takes 3 hours. Sometimes on their return, the child is dead.
8:30... Sort out the one or two rooms between 2-4 MDs. Start seeing clinic patients. When one child leaves, the next one comes in... so sometimes they come in order of who has the pushiest mom rather than first come first serve. If a kid doesn't come in, we head into the main waiting area and try to figure out which ones are "our" kids without asking anyone if they have HIV.
Draw labs (or help to do so). Search for porter, don't find, so run samples to lab myself. Write ARV prescriptions. Count pills. Weigh kids. Dispense medications, explain medications.
9:30am... A child comes late for their blood draw (or isn't sitting with all the rest and gets missed)... draw blood, run back to lab, beg lab techs to accept the sample after the 9am deadline. Run back to room. Write ARV prescriptions. Count pills. Race to pharmacy to try to get needed medications for OIs. Weigh kids. Watch kids losing weight despite faithfully attending the CREN. Realise that a crucial piece of information is in the other room, 100m down the hall. Dodge slowly moving mothers to get to the other room. Try to take history but unable to because counsellor has gone somewhere and mom doesn't speak French. Look for counsellor, ask her to return to consultation room. Try again to take history. Dispense medications, explain medications. Try to fit in some HIV teaching. Receive lab results & write in chart & file in binders. Realize that the child I've started to see isn't "one of ours" - send them back to wait for the other room, knowing that the consultations in that room are done and that the patient won't be seen before 3pm now. Go back to lab searching for missing lab results. Wash plastic tongue depressors & "single use" ear speculums (at least we only use gloves once!). Bring home hand towel to wash at home.
13:30... wait a minute, how can it already be 13:30?!? Finish paper work, file charts. Head home, desperate for a drink of water & a bathroom break.
Lunch & siesta if at all possible (it really makes the afternoon better!) then some rushed preparation for the afternoon's activities.
15:00... meetings or med student teaching most afternoons. Then, work on designing clinical protocols for us, the health records system, the drug procurement, the lab protocols and partnerships, prepare teaching sessions, find articles for HIV Staff meeting, provide feedback on colleagues work.
17:30 - yoga break (yay for yoga video podcasts!)
19:30 or so - stop working, phone family, do personal emails (wish for more emails from home), watch DVDs, surf the net. Suddenly its past my bedtime and it all starts again. Speaking of bedtime... time for me to say goodnight.
ps... the photos are of a kid from clinic today with Justine in the background, and his attempt at being the photographer with me as the subject.
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