Going to start uploading pictures from Day 1 as I go. Enjoy!
Thanks to friends who took such fabulous pictures that I had to use them :)
Sunday, February 20, 2011
Day 46: Last Day in Malawi
Woke up on my last day in Malawi. Enjoyed my last morning waking up because of the sun shining through the window instead of a blaring alarm clock. Made breakfast and made the 30 minute walk to the hospital. The house was in the more upper class of town, with the vice president's house two doors down. It was a very scenic walk. Close to the hospital, the food vendors were setting up as people swept the dirt sidewalks. There were always banana peels that I expected one day to slip on, just like the cartoons.
At handover, they went over the cases from the week. Itai, the medical student that I talked with the most, had a surprise presentation. He went over problems in the medical care in Malawi and if steroids would be of benefit. It was a very thorough and impassioned argument. It reminded me of the zeal that 1st year medical students usually start with and I was impressed that he was able to keep up the zeal, even with all the struggles in Malawi. Perhaps it is seeing all of the hardships in Malawi that keeps him driven. For example, when labs are lost and a child's life is dependent upon them, it does ignite a fire to fix the problem.
At the end of handover, there was tea and cake, as it was the Malawian students last day on the rotation. I was able to say goodbye to all the registrars and students and got a picture of 8 of the 13, 5th year students.
I went to the Moyo ward, which was the malnutrition ward. There were many kids with Kwashiorkor and Marasmus. Kwashiorkor is when kids develop edema with large bellies, whereas Marasmus is when children look emaciated. Fortunately, we were able to discharge most of the patients. Patients were improving with their packaged protein (I think it was peanut butter).
After rounds, I walked home. At home I said goodbye to Simoni (the cook) and to the guards.
We had our last dinner and packed our bags full. All 3 of us were at the max weight. We watched a movie and then went to our bunk beds for bed.
Day 47: Malawi to South Africa
I said goodbye to the 2 guys early in the morning.
I grabbed a new book that I started, "Labryinth," and sat out in the sun reading.
Went to the Blantyre airport (Chileka). XRay machine was down so they hand searched my bags. Then they did the customary pat-down.
After boarding it took me 2 hrs to get back to Jo-burg, compared to the week it took me to get from there.
I rechecked in at Jo-burg and boarded my flight to Paris
Day 48: Travel home
Slept on the plane from Jo-burg to Paris. I landed at 5am. There wasn't a long enough layover to see the Louvre :(
Fell asleep on top of bags for a couple hours and then wandered around the airport. Grabbed a croissant and some coffee.
Plane boarded that afternoon and I was pleasantly surprised to find that no one was in the seat next to me. I gained 7 hrs and so when I landed in Detoit it was 4pm, but it felt like 11pm.
Customs took awhile. As soon as I mentioned Africa, I had to take my bags through the XRay machine. Of course they found the orange that I had leftover from the plane ride. Luckily, they were understanding and let me through.
My boyfriend was there to meet me outside of customs and then my parents surprised me outside the elevators! We went out to dinner and I went home to unpack and get ready to start my urology rotation the next morning. Fell asleep in my own bed, enjoying the familiarity of my surroundings.
Day 49: Adjusting, Match Day and Valentine's Day
Woke up slightly confused on where I was and went to my rotation. I enjoyed having a cell phone and car again, but missed the weather and my morning walk. Continued to adjust throughout the day, which was a big one.
In the morning, I got a text from a friend letting me know that residency match results were posted. I checked my e-mail and found that I matched at Sparrow for their pediatric program! So I will be heading back to Lansing for the next 3 years.
The good day wrapped up with Valentine's day when I got home :)
Am still continuing to adjust. Malawi already seems like it was years ago. I'm trying to get used to the amount of sterility here and adult patients again. Hopefully, someday I will get a chance to go back to Malawi. But, as of right now, I'm glad to be home.
Woke up on my last day in Malawi. Enjoyed my last morning waking up because of the sun shining through the window instead of a blaring alarm clock. Made breakfast and made the 30 minute walk to the hospital. The house was in the more upper class of town, with the vice president's house two doors down. It was a very scenic walk. Close to the hospital, the food vendors were setting up as people swept the dirt sidewalks. There were always banana peels that I expected one day to slip on, just like the cartoons.
At handover, they went over the cases from the week. Itai, the medical student that I talked with the most, had a surprise presentation. He went over problems in the medical care in Malawi and if steroids would be of benefit. It was a very thorough and impassioned argument. It reminded me of the zeal that 1st year medical students usually start with and I was impressed that he was able to keep up the zeal, even with all the struggles in Malawi. Perhaps it is seeing all of the hardships in Malawi that keeps him driven. For example, when labs are lost and a child's life is dependent upon them, it does ignite a fire to fix the problem.
At the end of handover, there was tea and cake, as it was the Malawian students last day on the rotation. I was able to say goodbye to all the registrars and students and got a picture of 8 of the 13, 5th year students.
I went to the Moyo ward, which was the malnutrition ward. There were many kids with Kwashiorkor and Marasmus. Kwashiorkor is when kids develop edema with large bellies, whereas Marasmus is when children look emaciated. Fortunately, we were able to discharge most of the patients. Patients were improving with their packaged protein (I think it was peanut butter).
After rounds, I walked home. At home I said goodbye to Simoni (the cook) and to the guards.
We had our last dinner and packed our bags full. All 3 of us were at the max weight. We watched a movie and then went to our bunk beds for bed.
Day 47: Malawi to South Africa
I said goodbye to the 2 guys early in the morning.
I grabbed a new book that I started, "Labryinth," and sat out in the sun reading.
Went to the Blantyre airport (Chileka). XRay machine was down so they hand searched my bags. Then they did the customary pat-down.
After boarding it took me 2 hrs to get back to Jo-burg, compared to the week it took me to get from there.
I rechecked in at Jo-burg and boarded my flight to Paris
Day 48: Travel home
Slept on the plane from Jo-burg to Paris. I landed at 5am. There wasn't a long enough layover to see the Louvre :(
Fell asleep on top of bags for a couple hours and then wandered around the airport. Grabbed a croissant and some coffee.
Plane boarded that afternoon and I was pleasantly surprised to find that no one was in the seat next to me. I gained 7 hrs and so when I landed in Detoit it was 4pm, but it felt like 11pm.
Customs took awhile. As soon as I mentioned Africa, I had to take my bags through the XRay machine. Of course they found the orange that I had leftover from the plane ride. Luckily, they were understanding and let me through.
My boyfriend was there to meet me outside of customs and then my parents surprised me outside the elevators! We went out to dinner and I went home to unpack and get ready to start my urology rotation the next morning. Fell asleep in my own bed, enjoying the familiarity of my surroundings.
Day 49: Adjusting, Match Day and Valentine's Day
Woke up slightly confused on where I was and went to my rotation. I enjoyed having a cell phone and car again, but missed the weather and my morning walk. Continued to adjust throughout the day, which was a big one.
In the morning, I got a text from a friend letting me know that residency match results were posted. I checked my e-mail and found that I matched at Sparrow for their pediatric program! So I will be heading back to Lansing for the next 3 years.
The good day wrapped up with Valentine's day when I got home :)
Am still continuing to adjust. Malawi already seems like it was years ago. I'm trying to get used to the amount of sterility here and adult patients again. Hopefully, someday I will get a chance to go back to Malawi. But, as of right now, I'm glad to be home.
Day 42: Happiness
Decided to try a full day in A&E. Mondays are the busiest because they are right after the weekend, so it was already in full swing when I got there. The resuscitation room was overflowing. I started seeing one patient, but when I was ready to present to the attending, when more serious patients came in, she was deemed stable enough to be admitted through the regular room.
While parents were waiting patiently in a line out the door (any of these kids would have been a priority 1 in the States), we noticed one kid who went floppy with her eyes rolling into the back of her head.
She was placed on a table, given oxygen via a bag valve mask while IV lines were placed. Mom grabbed me, frantic and crying while asking "Is she dead?!" I said that she was alive but that she was very sick.
The glucose was checked and blood was drawn. I drew up some glucose which was given. A NG tube was placed. Meds were given and she started to come back. After she stabilized, we learned her story. This was a 9 month old girl named Happiness who was having intermittent seizures. One of the Scottish students kept an eye on her while the rest of us went back to the others.
I went with the attending to help with a 4 month old named Happiness (we will call her Wee Happiness and the 9month old Big Happiness). Wee Happiness had a bad case of gastroenteritis that left her severely dehydrated. She had no good veins because she was so dehydrated and cold. The attending tried in the feet, hands, arms, femoral, the scalp and the neck while I held her down. She barely even whimpered throughout this ordeal she was so weak. Finally the attending was able to use a regular needle to drill into her shin bone (interosseous). Then we could pump some fluids into her. After a few boluses, the attending was able to get a line in her neck and she warmed and perked up.
Another memorable patient from that day was the 3 year old that I saw in the triage room. He was wheezing and coughing. I drew up Salbutamol (opens the airways) and placed him on a breathing treatment (like a humidifier). We gave him some meds for his pneumonia (here they use X-penicillin and gentamicin) and admitted him.
The rest of the patients in the resucitation room were diagnosed with cerebral malaria and we transferred them to the malaria research ward. When A&E "closed" for the evening (the ER is moved to a different area), we piled 4 sick kids on a stretcher. The stretcher included Big Happiness, Wee Happiness, a cerebral malaria child and a 1 month old child with oxygen tanks. We grabbed a bag-valve-mask and wheeled them to their respective wards.
After the walk home, I arrived just in time to see 2 students and 1 of the guards chasing chickens around the yard. They caught and killed two of them. It is true that chickens do run around without their heads after death. Kind of creepy.
They then plucked and removed the insides and we had a fantastic meal with steak, chicken, mashed potatoes, green beans and brownies. Two of the other guys arrived back late that evening from their Victoria Falls trip.
Day 43: Chatinka Nursery
In the morning, I said goodbye to 3 of the crew as they left to continue their travels (they had taken extra time off).
I went to Chatinka Nursery, which is where infants go right after birth if they have any complications or are just a low birth weight. They also have something called Kangaroo care where the moms wrap the baby to their chest to keep them warm, stimulated and to have a place to sleep. It's cool to see. The mom with twins wraps both of them up to her front. There are a lot of twins here because the pregnancies are considered more complicated, so they are sent to Queen Elizabeth Hospital.
I was able to see spina bifida, learn about feeding, guessing babies’ gestational age, and treating jaundice. We also monitored the premature babies for hypothermia, hypoglycemia and infection.
After the day at the hospital, I took a minibus to Shoprite and Game, which are grocery and department stores. It was such a relief to not have to barter. Then I took a minibus to the wood market and purchased my last souvenirs. Ironically I saw one my school’s club t-shirts on one of the guys that someone had used to barter with. It made me smile
That night I said goodbye to two more members as they headed off to Zambia or Tanzania.
Day 44: Twins
I went to Chatinka nursery again, as I had such a good experience there. I was able to write notes and examine the kids. Helped out in a “jaundice study” where they are determining how accurate the bilirubin monitor is to what the actual number is in the babies’ serum. There have been numerous studies, but very few dealing with darker skin children, which could give false readings on the machine.
At handover in the morning, I heard a story about a mum with post-partum depression who had brought her newborn in. The child was very sick and should have been brought to a hospital sooner. Whether or not the mum delayed care due to her post-partum depression was debatable. The infant was too sick and passed away shortly after arrival. The mum had a very flat affect; she was expressionless. The worry was that she had another infant (twin) at home and what could happen if she wasn’t treated for her depression.
However, I learned that her lack of sorrow at the death of her child may also be due to cultural reasons. Apparently, when there are twins, if one dies, then the mum may not mourn, as it is considered bad luck for the surviving twin. Which I found interesting, for obvious reasons. Still they were going to try and treat her.
They also mentioned a child who was involved in a minibus accident where he was walking and was hit. He was unable to move half of his body and they were going to get a MRI on him to look for any brain damage.
That evening I went to the market and bought fabric, as I was trying to use up all of my kwatcha (Malawian money) before the weekend.
Day 45: Exams
I was awakened at 3am by the other 2 guys coming back from Victoria Falls. I heard all about their travels, including their bungee jumps. Watched the video and it was insane. They wrapped their ankles with a towel each and then a towel between. Then there was one safety harness. They had to jump straight out and head first, looking at the rapids below. Crazy.
I went to the neuro clinic in the morning, where I saw Seraphina, a girl I had seen my first week. She was still having some behavioral problems and developmental delay, which is common here. Another girl who was very similar to Seraphina, actually ran away from home and was missing for 2 weeks. She was then found in Mulange (1 hr drive away) where she had been abused. The developmentally challenged are difficult to treat, especially in underdeveloped areas. The neurologist was trying any medication he could think of, but not one of them did much.
Another child was having seizures, nystagmus (eye movement) with right-sided paralysis. They were still doing a work-up on him.
And finally, one of the girls I have seen on some other ward came in for a follow-up on her craniopharyngioma. She still had a shunt in her head to keep her from getting hydrocephalus, but was going to South Africa to be evaluated for surgery. The parents were quite religious and were insistent to the neurologist to take the shunt out and let them visit a “South African priest who does miracles.” The neurologist had a long discussion with them about believing in the power of prayer with the surgery, but said that she would have a poor outcome if they removed the shunt and didn’t remove the craniopharyngioma. That being said, both the priests and surgeons are in South Africa, so who knows what the family will do.
That afternoon I was volunteered to be a timer for the Malawian med students exam. It was interesting how they do it here (makes sense) because they have stations that have you show your clinical exam skills, resuscitation skills, history taking skills, and physical exam skills. For the history taking and talking to a “mom” about giving oxygen, there were actors. They had a dummy for the resuscitation room and then real patients for the physical exam room. The babies kept crying so much that they had to keep rotating them out. One of the “patients” was actually the patient who I removed his peritoneal tap, when I was on the Medical Bay ward. He waved as he walked past. It was nice because I got to see all of the med students that I worked with over the past 6 weeks.
Decided to try a full day in A&E. Mondays are the busiest because they are right after the weekend, so it was already in full swing when I got there. The resuscitation room was overflowing. I started seeing one patient, but when I was ready to present to the attending, when more serious patients came in, she was deemed stable enough to be admitted through the regular room.
While parents were waiting patiently in a line out the door (any of these kids would have been a priority 1 in the States), we noticed one kid who went floppy with her eyes rolling into the back of her head.
She was placed on a table, given oxygen via a bag valve mask while IV lines were placed. Mom grabbed me, frantic and crying while asking "Is she dead?!" I said that she was alive but that she was very sick.
The glucose was checked and blood was drawn. I drew up some glucose which was given. A NG tube was placed. Meds were given and she started to come back. After she stabilized, we learned her story. This was a 9 month old girl named Happiness who was having intermittent seizures. One of the Scottish students kept an eye on her while the rest of us went back to the others.
I went with the attending to help with a 4 month old named Happiness (we will call her Wee Happiness and the 9month old Big Happiness). Wee Happiness had a bad case of gastroenteritis that left her severely dehydrated. She had no good veins because she was so dehydrated and cold. The attending tried in the feet, hands, arms, femoral, the scalp and the neck while I held her down. She barely even whimpered throughout this ordeal she was so weak. Finally the attending was able to use a regular needle to drill into her shin bone (interosseous). Then we could pump some fluids into her. After a few boluses, the attending was able to get a line in her neck and she warmed and perked up.
Another memorable patient from that day was the 3 year old that I saw in the triage room. He was wheezing and coughing. I drew up Salbutamol (opens the airways) and placed him on a breathing treatment (like a humidifier). We gave him some meds for his pneumonia (here they use X-penicillin and gentamicin) and admitted him.
The rest of the patients in the resucitation room were diagnosed with cerebral malaria and we transferred them to the malaria research ward. When A&E "closed" for the evening (the ER is moved to a different area), we piled 4 sick kids on a stretcher. The stretcher included Big Happiness, Wee Happiness, a cerebral malaria child and a 1 month old child with oxygen tanks. We grabbed a bag-valve-mask and wheeled them to their respective wards.
After the walk home, I arrived just in time to see 2 students and 1 of the guards chasing chickens around the yard. They caught and killed two of them. It is true that chickens do run around without their heads after death. Kind of creepy.
They then plucked and removed the insides and we had a fantastic meal with steak, chicken, mashed potatoes, green beans and brownies. Two of the other guys arrived back late that evening from their Victoria Falls trip.
Day 43: Chatinka Nursery
In the morning, I said goodbye to 3 of the crew as they left to continue their travels (they had taken extra time off).
I went to Chatinka Nursery, which is where infants go right after birth if they have any complications or are just a low birth weight. They also have something called Kangaroo care where the moms wrap the baby to their chest to keep them warm, stimulated and to have a place to sleep. It's cool to see. The mom with twins wraps both of them up to her front. There are a lot of twins here because the pregnancies are considered more complicated, so they are sent to Queen Elizabeth Hospital.
I was able to see spina bifida, learn about feeding, guessing babies’ gestational age, and treating jaundice. We also monitored the premature babies for hypothermia, hypoglycemia and infection.
After the day at the hospital, I took a minibus to Shoprite and Game, which are grocery and department stores. It was such a relief to not have to barter. Then I took a minibus to the wood market and purchased my last souvenirs. Ironically I saw one my school’s club t-shirts on one of the guys that someone had used to barter with. It made me smile
That night I said goodbye to two more members as they headed off to Zambia or Tanzania.
Day 44: Twins
I went to Chatinka nursery again, as I had such a good experience there. I was able to write notes and examine the kids. Helped out in a “jaundice study” where they are determining how accurate the bilirubin monitor is to what the actual number is in the babies’ serum. There have been numerous studies, but very few dealing with darker skin children, which could give false readings on the machine.
At handover in the morning, I heard a story about a mum with post-partum depression who had brought her newborn in. The child was very sick and should have been brought to a hospital sooner. Whether or not the mum delayed care due to her post-partum depression was debatable. The infant was too sick and passed away shortly after arrival. The mum had a very flat affect; she was expressionless. The worry was that she had another infant (twin) at home and what could happen if she wasn’t treated for her depression.
However, I learned that her lack of sorrow at the death of her child may also be due to cultural reasons. Apparently, when there are twins, if one dies, then the mum may not mourn, as it is considered bad luck for the surviving twin. Which I found interesting, for obvious reasons. Still they were going to try and treat her.
They also mentioned a child who was involved in a minibus accident where he was walking and was hit. He was unable to move half of his body and they were going to get a MRI on him to look for any brain damage.
That evening I went to the market and bought fabric, as I was trying to use up all of my kwatcha (Malawian money) before the weekend.
Day 45: Exams
I was awakened at 3am by the other 2 guys coming back from Victoria Falls. I heard all about their travels, including their bungee jumps. Watched the video and it was insane. They wrapped their ankles with a towel each and then a towel between. Then there was one safety harness. They had to jump straight out and head first, looking at the rapids below. Crazy.
I went to the neuro clinic in the morning, where I saw Seraphina, a girl I had seen my first week. She was still having some behavioral problems and developmental delay, which is common here. Another girl who was very similar to Seraphina, actually ran away from home and was missing for 2 weeks. She was then found in Mulange (1 hr drive away) where she had been abused. The developmentally challenged are difficult to treat, especially in underdeveloped areas. The neurologist was trying any medication he could think of, but not one of them did much.
Another child was having seizures, nystagmus (eye movement) with right-sided paralysis. They were still doing a work-up on him.
And finally, one of the girls I have seen on some other ward came in for a follow-up on her craniopharyngioma. She still had a shunt in her head to keep her from getting hydrocephalus, but was going to South Africa to be evaluated for surgery. The parents were quite religious and were insistent to the neurologist to take the shunt out and let them visit a “South African priest who does miracles.” The neurologist had a long discussion with them about believing in the power of prayer with the surgery, but said that she would have a poor outcome if they removed the shunt and didn’t remove the craniopharyngioma. That being said, both the priests and surgeons are in South Africa, so who knows what the family will do.
That afternoon I was volunteered to be a timer for the Malawian med students exam. It was interesting how they do it here (makes sense) because they have stations that have you show your clinical exam skills, resuscitation skills, history taking skills, and physical exam skills. For the history taking and talking to a “mom” about giving oxygen, there were actors. They had a dummy for the resuscitation room and then real patients for the physical exam room. The babies kept crying so much that they had to keep rotating them out. One of the “patients” was actually the patient who I removed his peritoneal tap, when I was on the Medical Bay ward. He waved as he walked past. It was nice because I got to see all of the med students that I worked with over the past 6 weeks.
Tuesday, February 8, 2011
Day 40: Night
The girls had left to climb Mt Mulange and the guys for Victoria Falls. I opted for a weekend in Blantyre to experience the local culture, since I will be traveling all next weekend. I went out to "Mustang Sally's" with my Scottish/Irish med student friends. Wales was playing England in Rugby and the game was being shown. I was taught the general rules of Rugby (still not sure I quite understand). We also talked to some of the Malawian locals about the private vs state run hospitals.
One guy told us the story of his grandmother's health care. When she had a heart attack at home, he drove her to the private hospital. He had to pay $5000 up front just so they would see her. If he had gone to the state-run hospital, her care would have been free, but they would not have seen her right away and she might not have made it. The state hospitals here are overrun with patients. That is why in A&E they have a triage room so that the severe patients get seen earlier in one room. Unfortunately, still some patients wait forever to be seen. And yet, Malawians seem to have more patience for waiting than people do in the States.
Day 41: Relax
Had a nice relaxing day at the house. Was able to go to the wood market and into town to get last minute souvenirs, etc. I was able to sketch, read and sleep. It was also quiet at the house so I could play music and re-energize. For dinner, I met with the med students again, this time at a place called the Blue Elephant. We ran into some of the registrars and it turned into a big party. A DJ showed up and we were able to dance under the stars. They played some familiar American songs and it was interesting to watch how similar everyone danced even though we were all from different countries.
Day 42: Word
A couple of us wanted to go to church and experience the local music and service. They found a place called "Word Alive!" which had everyone up clapping, singing and dancing for the first hour. Another difference between services in the States and the one at this church is that people pray aloud. It reminded me of the service where the gospel is read aloud in different languages. Definitely interesting to be a part of. The second hour was a sermon about being a house of God.
Afterward, we went to the nearby fruit/vegetable market and then I made the walk home. When the girls got back from Mt Mulange and we went and got pedicures. A nice end to the weekend.
Day 42: A day of Happiness
Next posting will be about my experience in A&E with 2 girls named "Happiness."
It is now 1 week until I find out if I matched at a residency program (ironically on Valentine's day).
Less than a week until I'm back in the States
The girls had left to climb Mt Mulange and the guys for Victoria Falls. I opted for a weekend in Blantyre to experience the local culture, since I will be traveling all next weekend. I went out to "Mustang Sally's" with my Scottish/Irish med student friends. Wales was playing England in Rugby and the game was being shown. I was taught the general rules of Rugby (still not sure I quite understand). We also talked to some of the Malawian locals about the private vs state run hospitals.
One guy told us the story of his grandmother's health care. When she had a heart attack at home, he drove her to the private hospital. He had to pay $5000 up front just so they would see her. If he had gone to the state-run hospital, her care would have been free, but they would not have seen her right away and she might not have made it. The state hospitals here are overrun with patients. That is why in A&E they have a triage room so that the severe patients get seen earlier in one room. Unfortunately, still some patients wait forever to be seen. And yet, Malawians seem to have more patience for waiting than people do in the States.
Day 41: Relax
Had a nice relaxing day at the house. Was able to go to the wood market and into town to get last minute souvenirs, etc. I was able to sketch, read and sleep. It was also quiet at the house so I could play music and re-energize. For dinner, I met with the med students again, this time at a place called the Blue Elephant. We ran into some of the registrars and it turned into a big party. A DJ showed up and we were able to dance under the stars. They played some familiar American songs and it was interesting to watch how similar everyone danced even though we were all from different countries.
Day 42: Word
A couple of us wanted to go to church and experience the local music and service. They found a place called "Word Alive!" which had everyone up clapping, singing and dancing for the first hour. Another difference between services in the States and the one at this church is that people pray aloud. It reminded me of the service where the gospel is read aloud in different languages. Definitely interesting to be a part of. The second hour was a sermon about being a house of God.
Afterward, we went to the nearby fruit/vegetable market and then I made the walk home. When the girls got back from Mt Mulange and we went and got pedicures. A nice end to the weekend.
Day 42: A day of Happiness
Next posting will be about my experience in A&E with 2 girls named "Happiness."
It is now 1 week until I find out if I matched at a residency program (ironically on Valentine's day).
Less than a week until I'm back in the States
Saturday, February 5, 2011
Malawian government tries to make farting a crime
http://www.nyasatimes.com/national/malawi-%E2%80%98farting-crime%E2%80%99-makes-british-headlines.html
Seriously?
Seriously?
Day 36: 1st day in Pediatric Nursery
Went to the Pediatric Nursery this week, which is where children under 1 year go. Chatinka is the other nursery and that is where the newborns go after birth.
Saw many little ones with bronchiolitis (respiratory infection), pneumonia and gastroenteritis (vomiting and diarrhea), along with the usual hydrocephalus, etc. Many come through and only stay for a few days, but others are in the more intensive care unit. Rounds are relatively short here and we got out early.
I've been reading a lot more books since being here. So far have finished:
"The Girl who Played with Fire" (interesting, although frustrating because the book leaves you hanging. I don't have book 3 with me)
"House of God" (a must read for future doctors, albeit scary to think about),
"Darkfall" (a good old fashioned mystery).
Right now I'm in the middle of "To Kill a Mockingbird," which is an interesting read considering the cultural dynamics here.
If anyone has any book recommendations for when I get back, let me know :)
Day 37: Asthma, a formidable foe
Morning rounds went as usual. Learned a bit about murmurs, as we have a child with a loud VSD. The hole in his heart is actually quite small, but the smaller the hole, the louder the murmur.
Got out early again so went down to A&E. I was in the triage admission room working up patients best I could with my limited number of Chichewa words. I worked with a 3rd year med student, who helped translate as I helped him take a complete history and come up with differential diagnoses.
One child came in profusely bleeding from his lip. He had been born with a hemangioma (blood vessel malformation), which had recently been treated with sclerotherapy. It had gotten infected so he had come back in. HIV status was unknown and he was covered with blood. We kept having to change his dressings because any time he would cry, the clot would bust open and he would soak through the gauze.
Meanwhile, the intern had placed an 11-year old girl with a nebulizer in the corner, as she had come in with difficulty breathing. Asthma is actually not that common here, but if the patient has it, it is usually severe because it is rarely controlled. In the middle of working up a patient with pneumonia, the nurse called me over to the girl. The nebs weren't working. The 3rd year grabbed the intern while I listened to her chest. She had wheezes bilaterally, but a lot of her chest was silent (not a good sign). The intern and I hauled her over to the resuscitation room. I went back to the triage room.
After about 15 minutes, I realized that the 3rd year and intern had disappeared and I couldn't do anymore without getting a proper history. No other medical people were in the room. I went to the resuscitation room, and there were 2 registrars, a Scottish 5th year, the 3rd year and the intern holding the girl down while they were sticking a NG tube and IV lines in her. She was screaming, and I don't blame her. I switched with the intern and held down her legs so he could go back to the triage room and move patients along. Additionally, a younger boy had passed away on the bed next to us and his mom was keening. There was a lot going on at once.
I found out that the girl had gone severely hypoxic (no oxygen) and had become agitated. She "shat" all over herself and every human bodily fluid was on the floor. While the attending was putting in the NG tube, gastric juices and blood sprayed out and covered the registrar's arm and white shirt. They then gave the girl Ketamine, bag-valve-masked her and intubated her. The Scottish student took over the breathing and we all stopped holding her down, as she was sedated.
I remember several discussions about asthma that I had back in the States. Intubation is always the last resort. Also, what most pediatricians fear is an acute asthma attack, because those kids can go down quickly. Now, I see why.
The girl was sent to the HDU (ICU) and was to be ventilated for 48hours. Last I heard they were able to give her nebulizers through the tube and she was looking better.
Day 38: Failure to thrive
A 5th year medical student and I were seeing patients together. The one patient that stuck out was a small, wrinkly-looking child. She wasn't dehydrated (good skin turgor, moist mucous membranes, capillary refill <2seconds, no sunken eyes, alert), but something wasn't right. The diagnosis was gastroenteritis, but there seemed to be more. We found out that she had been losing weight and when the attending came over, we learned that she was a twin. She weighed 2.9kg and her sister weighed 4.1kg. At birth they weighed 2.5kg and 2.6kg respectively. We ordered a chest x-ray and an HIV test and were doing a full work-up on failure to thrive.
The other one I remember was a 5-month old with pneumonia, but who also had Down syndrome. I was told it isn't very common in the hospital to see Down's, but that you do see individuals out in the villages with Down's. I wonder how common it actually is here versus the incidence in the States.
Other children we saw that day had hydrocephalus, hemangiomas, and cleft palates.
Day 39: Figuring out what's wrong
I walked into the ward and saw a 5-month old gasping for breath with her eyes rolling in back of her head. I grabbed the registrar and while she got the bag-valve mask, I extended the neck and thrust her jaw forward. After she gave her breaths for a couple of minutes, the girl came back and was breathing on her own. She was placed on ceftriaxone and that was it. I still don't know why she had an episode of apnea.
I also saw the child with the VSD and checked up on him. He was more active and alert, but still appeared frail looking. He was on TB, PCP and pneumonia treatment due to some lung findings and questionable sepsis, but his HIV test was negative. Since he looked more stable, he was sent to get a chest x-ray. It showed an enlarged heart and some hilar adenopathy (white stuff in the middle). We didn't know what is causing him to be so sick.
Day 40: Where did the LA go?
On morning handover it was announced that the whole hospital is out of LA (a medicine used to treat malaria). So they were going to have to use a more complicated malaria regime using 2 different medications. There are many rumors circulating around the hospital about a lost shipment, but no one really knows what happened.
I checked in on my VSD patient. The attending was out of ideas as to why he was not improving, so he consulted another attending. She recommended re-testing for HIV as he is now over 6months and infants can seroconvert to being HIV positive. They were going to place him back on Cotrimazole and anti-virals were discussed. The epinephrine didn't do anything. Although he was on day 4 of a fever, they are going to give him steroids and see if that will open up his airways.
The other patient I rounded on was less responsive than the day before. She had had no new episodes of apnea, but she had lost interest in anything, including eating. We placed her on IV fluids and stuck a NG tube to keep her fed. The skin on her stomach felt like dough and the attending thought that she may be in hypernatremic dehydration (too much salt because of losing so much water from her vomiting and diarrhea). Not that we have any way to check sodium here. I'm just going to have to wait and see what happens to these two over the weekend and hope for the best.
Went to the Pediatric Nursery this week, which is where children under 1 year go. Chatinka is the other nursery and that is where the newborns go after birth.
Saw many little ones with bronchiolitis (respiratory infection), pneumonia and gastroenteritis (vomiting and diarrhea), along with the usual hydrocephalus, etc. Many come through and only stay for a few days, but others are in the more intensive care unit. Rounds are relatively short here and we got out early.
I've been reading a lot more books since being here. So far have finished:
"The Girl who Played with Fire" (interesting, although frustrating because the book leaves you hanging. I don't have book 3 with me)
"House of God" (a must read for future doctors, albeit scary to think about),
"Darkfall" (a good old fashioned mystery).
Right now I'm in the middle of "To Kill a Mockingbird," which is an interesting read considering the cultural dynamics here.
If anyone has any book recommendations for when I get back, let me know :)
Day 37: Asthma, a formidable foe
Morning rounds went as usual. Learned a bit about murmurs, as we have a child with a loud VSD. The hole in his heart is actually quite small, but the smaller the hole, the louder the murmur.
Got out early again so went down to A&E. I was in the triage admission room working up patients best I could with my limited number of Chichewa words. I worked with a 3rd year med student, who helped translate as I helped him take a complete history and come up with differential diagnoses.
One child came in profusely bleeding from his lip. He had been born with a hemangioma (blood vessel malformation), which had recently been treated with sclerotherapy. It had gotten infected so he had come back in. HIV status was unknown and he was covered with blood. We kept having to change his dressings because any time he would cry, the clot would bust open and he would soak through the gauze.
Meanwhile, the intern had placed an 11-year old girl with a nebulizer in the corner, as she had come in with difficulty breathing. Asthma is actually not that common here, but if the patient has it, it is usually severe because it is rarely controlled. In the middle of working up a patient with pneumonia, the nurse called me over to the girl. The nebs weren't working. The 3rd year grabbed the intern while I listened to her chest. She had wheezes bilaterally, but a lot of her chest was silent (not a good sign). The intern and I hauled her over to the resuscitation room. I went back to the triage room.
After about 15 minutes, I realized that the 3rd year and intern had disappeared and I couldn't do anymore without getting a proper history. No other medical people were in the room. I went to the resuscitation room, and there were 2 registrars, a Scottish 5th year, the 3rd year and the intern holding the girl down while they were sticking a NG tube and IV lines in her. She was screaming, and I don't blame her. I switched with the intern and held down her legs so he could go back to the triage room and move patients along. Additionally, a younger boy had passed away on the bed next to us and his mom was keening. There was a lot going on at once.
I found out that the girl had gone severely hypoxic (no oxygen) and had become agitated. She "shat" all over herself and every human bodily fluid was on the floor. While the attending was putting in the NG tube, gastric juices and blood sprayed out and covered the registrar's arm and white shirt. They then gave the girl Ketamine, bag-valve-masked her and intubated her. The Scottish student took over the breathing and we all stopped holding her down, as she was sedated.
I remember several discussions about asthma that I had back in the States. Intubation is always the last resort. Also, what most pediatricians fear is an acute asthma attack, because those kids can go down quickly. Now, I see why.
The girl was sent to the HDU (ICU) and was to be ventilated for 48hours. Last I heard they were able to give her nebulizers through the tube and she was looking better.
Day 38: Failure to thrive
A 5th year medical student and I were seeing patients together. The one patient that stuck out was a small, wrinkly-looking child. She wasn't dehydrated (good skin turgor, moist mucous membranes, capillary refill <2seconds, no sunken eyes, alert), but something wasn't right. The diagnosis was gastroenteritis, but there seemed to be more. We found out that she had been losing weight and when the attending came over, we learned that she was a twin. She weighed 2.9kg and her sister weighed 4.1kg. At birth they weighed 2.5kg and 2.6kg respectively. We ordered a chest x-ray and an HIV test and were doing a full work-up on failure to thrive.
The other one I remember was a 5-month old with pneumonia, but who also had Down syndrome. I was told it isn't very common in the hospital to see Down's, but that you do see individuals out in the villages with Down's. I wonder how common it actually is here versus the incidence in the States.
Other children we saw that day had hydrocephalus, hemangiomas, and cleft palates.
Day 39: Figuring out what's wrong
I walked into the ward and saw a 5-month old gasping for breath with her eyes rolling in back of her head. I grabbed the registrar and while she got the bag-valve mask, I extended the neck and thrust her jaw forward. After she gave her breaths for a couple of minutes, the girl came back and was breathing on her own. She was placed on ceftriaxone and that was it. I still don't know why she had an episode of apnea.
I also saw the child with the VSD and checked up on him. He was more active and alert, but still appeared frail looking. He was on TB, PCP and pneumonia treatment due to some lung findings and questionable sepsis, but his HIV test was negative. Since he looked more stable, he was sent to get a chest x-ray. It showed an enlarged heart and some hilar adenopathy (white stuff in the middle). We didn't know what is causing him to be so sick.
Day 40: Where did the LA go?
On morning handover it was announced that the whole hospital is out of LA (a medicine used to treat malaria). So they were going to have to use a more complicated malaria regime using 2 different medications. There are many rumors circulating around the hospital about a lost shipment, but no one really knows what happened.
I checked in on my VSD patient. The attending was out of ideas as to why he was not improving, so he consulted another attending. She recommended re-testing for HIV as he is now over 6months and infants can seroconvert to being HIV positive. They were going to place him back on Cotrimazole and anti-virals were discussed. The epinephrine didn't do anything. Although he was on day 4 of a fever, they are going to give him steroids and see if that will open up his airways.
The other patient I rounded on was less responsive than the day before. She had had no new episodes of apnea, but she had lost interest in anything, including eating. We placed her on IV fluids and stuck a NG tube to keep her fed. The skin on her stomach felt like dough and the attending thought that she may be in hypernatremic dehydration (too much salt because of losing so much water from her vomiting and diarrhea). Not that we have any way to check sodium here. I'm just going to have to wait and see what happens to these two over the weekend and hope for the best.
Thursday, February 3, 2011
Day 34: Majete
Those of us that didn't leave for Lake Malawi (2 guys and one ortho resident) made the drive to Majete. We went to the park where there were animals. The guys weren't with us when we went to Kruger, so this was their first wildlife experience. If we could have done Majete differently, we would have brought with us a car that had 4-wheel drive. Before we knew it we were deep in the woods driving along a "path" that looked as if no one had driven on it in months. There were times when we would bottom out and feel the rocks hitting the liner of the car under our feet. Laughing, we would have to get out while a driver drove through the harder parts (this park you are allowed to walk, as their are no lions or things that will go after you...unless you count water buffalo)
I'm amazed that car made it up some of those hills and over those rocks. Of course with the noises the car made being gunned up the terrain, it is no wonder how scarce the animals were. Except the insects that managed to find their way into the car. I was kept amused by the girlish screams given by my male companions when a grasshopper jumped on them or a particularly large spider. If one of those enormous spiders had jumped on me, I'm sure I would have shrieked as well. Anyways it was an experience.
We still managed to see a water buck, some impala, hippos and water buffalo. Just as we had given up (after driving through the park for the full 5 hour loop), there was an elephant waiting for us at the exit gate. Of course.
On the drive back we were worried about breaking down, as we were nearly out of gas. The first gas station we saw driving out of Majete was a BP station. They informed us that they had been out of petrol for 2 weeks. So we continued driving and miraculously made it to a gas station in Blantyre that had fuel even during the shortage.
Day 35: Wood
The guys headed to another mountain in Blantyre, while I stayed back to rest, read and go to the open market. Got some fabric. When the guys came back we went to the wood market. Being the last customers of the day, we were ambushed. There were too many sellers around me that I just started saying no because I couldn't think straight. A couple followed us out and I was able to barter them down and got some wooden elephants and a safari theme on silkscreen. Even after so many weeks here, I still am not used to bartering. It will be different to go back to the States and just walk into a store and pay the price on the sticker.
Those of us that didn't leave for Lake Malawi (2 guys and one ortho resident) made the drive to Majete. We went to the park where there were animals. The guys weren't with us when we went to Kruger, so this was their first wildlife experience. If we could have done Majete differently, we would have brought with us a car that had 4-wheel drive. Before we knew it we were deep in the woods driving along a "path" that looked as if no one had driven on it in months. There were times when we would bottom out and feel the rocks hitting the liner of the car under our feet. Laughing, we would have to get out while a driver drove through the harder parts (this park you are allowed to walk, as their are no lions or things that will go after you...unless you count water buffalo)
I'm amazed that car made it up some of those hills and over those rocks. Of course with the noises the car made being gunned up the terrain, it is no wonder how scarce the animals were. Except the insects that managed to find their way into the car. I was kept amused by the girlish screams given by my male companions when a grasshopper jumped on them or a particularly large spider. If one of those enormous spiders had jumped on me, I'm sure I would have shrieked as well. Anyways it was an experience.
We still managed to see a water buck, some impala, hippos and water buffalo. Just as we had given up (after driving through the park for the full 5 hour loop), there was an elephant waiting for us at the exit gate. Of course.
On the drive back we were worried about breaking down, as we were nearly out of gas. The first gas station we saw driving out of Majete was a BP station. They informed us that they had been out of petrol for 2 weeks. So we continued driving and miraculously made it to a gas station in Blantyre that had fuel even during the shortage.
Day 35: Wood
The guys headed to another mountain in Blantyre, while I stayed back to rest, read and go to the open market. Got some fabric. When the guys came back we went to the wood market. Being the last customers of the day, we were ambushed. There were too many sellers around me that I just started saying no because I couldn't think straight. A couple followed us out and I was able to barter them down and got some wooden elephants and a safari theme on silkscreen. Even after so many weeks here, I still am not used to bartering. It will be different to go back to the States and just walk into a store and pay the price on the sticker.
Subscribe to:
Posts (Atom)