Day 29: Starting on the Malaria Research Ward
Today I started my week on the Malaria Research Ward. Patients who have seizures or a low "Blantyre Coma Score" are admitted to the ward. Kids usual present in bad shape. Most are in a coma, but are able to breathe on their own. Most are comatose due to the malaria parasite, but there are sometimes other reasons for their coma. Sometimes they have meningitis, encephalitis, congenital brain abnormalities, tumors, hydrocephalus, etc. The lady who runs the ward is the one who actually developed the Blantyre Coma Score (BCS) over 20 years ago.
The research team also found that a lot of the kids diagnosed with malaria, were found on autopsy to have died from other causes. They then found that by looking in the eyes there are signs that indicate cerebral malaria vs other causes. Recently, a MRI was installed and they are getting the first series of MRI's that show cerebral malaria. It is exciting to be in the midst of discovery.
A one-year old, little girl, Grace, was admitted for seizures and coma. Her left hand started twitching on the ward and so she was sent to us. Her EEG (brain activity) showed her seizures. Apparently she had been having seizures for ? amount of time because her EEG showed seizures even when she wasn't physically convulsing ("subclinical seizures"). In the afternoon, I did my first pediatric LP on her. We couldn't send her to MRI because she wasn't stable enough.
I also helped admit Fasileni, a 3-year old child who appeared malnourished and hydrocephalic. She was slightly alert when I saw her. She had a fever x 6 months, been convulsing for 5 months. Recently she had lost her eyesight, speech and ability to walk. Mom had tried the outpatient clinics, but finally wanted answers so brought her into Queen's Hospital. We sent her for an MRI, as an LP had already been sent to the lab.
Day 30: Only so much we can do...
To make a long story short, the patient I admitted yesterday, Fasileni, was found to have a massive inoperable brain tumor. Her MRI was unrecognizable.
For the medical ppl: It is likely that she has hydrocephalus (enlarged head) from an ependyoma or choroid plexus tumor that is blocking CSF drainage. The CSF increases and the head swells. In the States, someone may have tried to operate or put in a shunt to drain the CSF, but the patient would still not live long.
Palliative care is all we can give her. When I saw her on rounds in the morning, she had slipped into a coma. Her LP results were lost in the lab, but it was decided not to put mom and the patient through the emotional and physical pain of another LP. Since she had malaria parasites, we continued treating her with Quinine. When I left that night, the Malawian registrar hadn't yet had a chance to sit mom down and tell her that her child would not live long. I spent the day trying to avoid mom's eyes and wishing I spoke enough Chichewa to explain what was going on. I watched the mothers of the ward share food and worry, as they watched us check their children, putting their trust in us, hoping that we could provide a cure.
The other patient that was admitted yesterday, Grace, was again found to have seizures on her EEG even though she wasn't visibly fitting. Throughout the day, all the drugs available on the ward were used to try and stop them. Phenobarb, Phenytoin and Diazepam. It was a balancing act because the drugs would cause her to decrease breathing and we can't intubate here (put a tube down to breathe for them). We had to accept that we just couldn't stop the seizures. Her LP was negative, her parasites had cleared, so it is likely that she also had something wrong with her brain.
Meanwhile, another child started screaming (delirium?). We weren't sure if it was the malaria or something else causing it and had to give her Diazepam to calm her down to sleep. Overnight we were told that she started up again and the Sisters told her that mom would not come back if she kept it up. Mom "left" and the patient never screamed again.
Today's admissions included Mike and Richard. Mike was another child with malaria and fever. But he was posturing (classic opisthotonos). We were able to bring down his fever, but he was still comatos. EEG was negative, and we awaited the MRI. An LP was done (negative). His eyes had classic malaria findings.
The other admission, Richard, had been vomiting, and had diarrhea. He was pale, anemic, jaundiced and hypoglycemic. He had a massive liver and was breathing heavily. HIV status was unknown. As the registrar was telling mom that he looked very sick, he coded. Stopped breathing, turned blue and lost what pulse he had. They bagged him (breathed in oxygen with a bag-valve-mask). After a few minutes with no response, they had to call it. It took a second for mom to realize and then she started to keen. The sisters went over to comfort her and we had to walk away and continue on rounds.
Don't get the wrong impression, it isn't all doom and gloom. It's just that the tough cases are the ones that stick with me. Hamid and Manuel (two older boys, one with meningitis and one with malaria) were able to sit up and eat today. They did a complete 180 degrees from the comatose state they were in before. Soon they will be able to go home. Back to their family and friends and back to their lives. The dads were so happy. Hamid was able to laugh and Manuel was able to see again.
Medicine can do wonders. Unfortunately, sometimes there is only so much we can do. It can be a humbling, fascinating and rewarding profession. It is days like today that remind me of this.
Saturday, January 29, 2011
Friday, January 28, 2011
Day 25: Saw and learned
Med Bay: Saw the same patients with nephrotic syndrome, encephalitis, anemia, hydrocephalus, liver failure, etc. We finished rounding at about 11am so I went down to A&E (ER) to see if there was anything there.
A young girl came in with abdominal pain, fever and vomiting. The differential diagnoses was obstruction vs constipation vs gastroenteritis, as her MPS (malaria parasite blood smear) was negative. I put in my first pediatric IV (it went in her hand) on the first try and started my first drip.
The other patient I saw had a pneumonia that was ok enough to be sent home with oral antibiotics.
During this time I had been speaking a few Chichewa words (which I was butchering, I'm sure). The nurses overheard my feeble attempts and said: "You need to learn. We'll find you a Malawian man so you can learn Chichewa during the day and the night. hahaha."
Apparently nurses are the same here as in the US. I chuckled and was going to tell them that the guy I left back home wouldn't be happy about it, when they asked me if they could take my blood. Seeing the look of confusion on my face they explained that they needed a control sample to compare lab results to for that day. So I held out my arm, watched them use a sterile needle and draw 5mL. Note: If you ever need to have blood drawn, pediatric nurses are awesome. She got me the first try, probably because she's used to itty-bitty veins.
When I got home, the guys had bought 4 chickens. They are hoping for eggs. The rule is that they just have to be gone when we leave (aka chicken dinner). There are a couple of "farm boys" in our group who are up to the task. Going to try and not name them. Although one looks like a Ginger and another a Raven...While the guys were explaining the "chicken facts of life," the eggs were called a "daily ovulation." Which I am going to have to add to the list of "You know you're a medical student when..."
The beard contest continues, as the guys are seeing who can go the longest without shaving. Only 3/5 remain. One of the remaining said that the last time he grew out his beard a little girl went up to him and said, "Do you have a home?" Apparently that was what got him to shave.
Day 26: Hanging on a cliff
After handover in the morning, 6 of us went to go and climb Mt. Mulange for the weekend. We hired 1 guide (Gravy) for the guys. My Scottish girl friend and I hired a separate guide (Eleison) because we knew we would take longer. Also we decided to get a porter each to haul our backpacks and sleeping bags up the mountain and down. Which turned out to be possibly the best $20 I have ever spent. Why? Well you see, I was told that it was a difficult and sometimes dangerous climb if it was raining and if you did not have a guide. I was also told that "older people and heavy people do this all the time."
The first hour was good. We were on your average uphill hiking trail, crossing little streams and were mostly in the shade. Then we stopped for water at a stream and after that it became a real hike. We would step up big boulders that were sometimes high enough that my leg lifted to my thigh. From there it got steeper. And as we got higher, I promised myself that whatever happened I would not look down. Fear of heights, remember? The worst hour for me was an actual climb up slabs of rock with the occasional grassy bits. It wasn't quite vertical, but it was close.
I was on all fours using my arms and legs to climb. I would look ahead for small bits of moss to plant my feet, because when I was on the rock, my feet would slide backwards. I remember thinking, I like rock/wall climbing, but that is when I have a rope to catch me if I slip. What kept me going forward was the knowledge that there was no way I could go back down the way I came up. Then I literally and figuratively hit a wall. I was halfway up this piece of rock when each foot was planted on an outgrowth of moss. I couldn't find another piece of moss within my legs' reach. I tried one too high, but slipped, so went back to where I was. I started slipping as my muscles tired. It was terrifying, especially due to my fear. The guide came back for me, lent me a hand and pulled me up.
After that the rest of the climb got better as we went till finally we reached flat land. My friend and I high-fived each other. I asked our guide which way we would be going back down and if it was steep. And he said a different and less steep way. Our last hour we walked through tall grass on flat land as the sun set. We were just starting to have trouble seeing the path when we saw the light the boys had put on for us. And we met them at CCAP (the cabin) 5 hours after we began the trek. They too apparently thought the climb was difficult (which was validating). I was just pleased to see that everyone made it and no one was injured. They had pasta waiting for us.
We had a nice hot "shower" which was a bucket full of water. Then stayed up sitting on the porch and talking until heading to bed in our bunks.
Day 27: Mt Mulange
(google it for picture)
Woke up, found the bathroom (i.e. an outhouse with a hole in the ground). The cabin was situated in between two peaks on the mountain and the view was striking. The group went to go and climbed one of the peaks. Two of us opted to stay at the cabin to relax our muscles and read. It rained throughout much of the day. Lunch was grilled cheese sandwiches and tomato soup which was made over the fireplace.
In the late afternoon, the rain cleared and we decided to go and check out the natural pools. On our way there we hit a river. I slipped on my "arse" (as my Scottish friend says) and went right in the water. We saw a beautiful view and I realized how far up we actually were. Then we found a pool of water next to a waterfall that looked out onto the countryside. Another surreal view of Africa. Not sure how we can keep topping them.
Went back, had rice and beans for dinner. Met another group who made the climb to the cabin. Stayed up talking around a single candlestick.
Day 28: What goes up, must come down
Climbed down, which was easier than going up. There were a lot of rocks that we had to step off of, but other than that we didn't have too much difficulty. AWhen we reached the bottom, the guys had a flatbed truck waiting for all of us. We piled in the back and drove around the mountain back to our car. Ate some lunch, then went back to the house where we heard the others' stories of their trip to Majete (spelling?). We were then told by our host that they took us up the steep way and that there is another way up that most people use instead. Figures. Still glad I had the experience, but don't think that I could ever do it again.
Med Bay: Saw the same patients with nephrotic syndrome, encephalitis, anemia, hydrocephalus, liver failure, etc. We finished rounding at about 11am so I went down to A&E (ER) to see if there was anything there.
A young girl came in with abdominal pain, fever and vomiting. The differential diagnoses was obstruction vs constipation vs gastroenteritis, as her MPS (malaria parasite blood smear) was negative. I put in my first pediatric IV (it went in her hand) on the first try and started my first drip.
The other patient I saw had a pneumonia that was ok enough to be sent home with oral antibiotics.
During this time I had been speaking a few Chichewa words (which I was butchering, I'm sure). The nurses overheard my feeble attempts and said: "You need to learn. We'll find you a Malawian man so you can learn Chichewa during the day and the night. hahaha."
Apparently nurses are the same here as in the US. I chuckled and was going to tell them that the guy I left back home wouldn't be happy about it, when they asked me if they could take my blood. Seeing the look of confusion on my face they explained that they needed a control sample to compare lab results to for that day. So I held out my arm, watched them use a sterile needle and draw 5mL. Note: If you ever need to have blood drawn, pediatric nurses are awesome. She got me the first try, probably because she's used to itty-bitty veins.
When I got home, the guys had bought 4 chickens. They are hoping for eggs. The rule is that they just have to be gone when we leave (aka chicken dinner). There are a couple of "farm boys" in our group who are up to the task. Going to try and not name them. Although one looks like a Ginger and another a Raven...While the guys were explaining the "chicken facts of life," the eggs were called a "daily ovulation." Which I am going to have to add to the list of "You know you're a medical student when..."
The beard contest continues, as the guys are seeing who can go the longest without shaving. Only 3/5 remain. One of the remaining said that the last time he grew out his beard a little girl went up to him and said, "Do you have a home?" Apparently that was what got him to shave.
Day 26: Hanging on a cliff
After handover in the morning, 6 of us went to go and climb Mt. Mulange for the weekend. We hired 1 guide (Gravy) for the guys. My Scottish girl friend and I hired a separate guide (Eleison) because we knew we would take longer. Also we decided to get a porter each to haul our backpacks and sleeping bags up the mountain and down. Which turned out to be possibly the best $20 I have ever spent. Why? Well you see, I was told that it was a difficult and sometimes dangerous climb if it was raining and if you did not have a guide. I was also told that "older people and heavy people do this all the time."
The first hour was good. We were on your average uphill hiking trail, crossing little streams and were mostly in the shade. Then we stopped for water at a stream and after that it became a real hike. We would step up big boulders that were sometimes high enough that my leg lifted to my thigh. From there it got steeper. And as we got higher, I promised myself that whatever happened I would not look down. Fear of heights, remember? The worst hour for me was an actual climb up slabs of rock with the occasional grassy bits. It wasn't quite vertical, but it was close.
I was on all fours using my arms and legs to climb. I would look ahead for small bits of moss to plant my feet, because when I was on the rock, my feet would slide backwards. I remember thinking, I like rock/wall climbing, but that is when I have a rope to catch me if I slip. What kept me going forward was the knowledge that there was no way I could go back down the way I came up. Then I literally and figuratively hit a wall. I was halfway up this piece of rock when each foot was planted on an outgrowth of moss. I couldn't find another piece of moss within my legs' reach. I tried one too high, but slipped, so went back to where I was. I started slipping as my muscles tired. It was terrifying, especially due to my fear. The guide came back for me, lent me a hand and pulled me up.
After that the rest of the climb got better as we went till finally we reached flat land. My friend and I high-fived each other. I asked our guide which way we would be going back down and if it was steep. And he said a different and less steep way. Our last hour we walked through tall grass on flat land as the sun set. We were just starting to have trouble seeing the path when we saw the light the boys had put on for us. And we met them at CCAP (the cabin) 5 hours after we began the trek. They too apparently thought the climb was difficult (which was validating). I was just pleased to see that everyone made it and no one was injured. They had pasta waiting for us.
We had a nice hot "shower" which was a bucket full of water. Then stayed up sitting on the porch and talking until heading to bed in our bunks.
Day 27: Mt Mulange
(google it for picture)Woke up, found the bathroom (i.e. an outhouse with a hole in the ground). The cabin was situated in between two peaks on the mountain and the view was striking. The group went to go and climbed one of the peaks. Two of us opted to stay at the cabin to relax our muscles and read. It rained throughout much of the day. Lunch was grilled cheese sandwiches and tomato soup which was made over the fireplace.
In the late afternoon, the rain cleared and we decided to go and check out the natural pools. On our way there we hit a river. I slipped on my "arse" (as my Scottish friend says) and went right in the water. We saw a beautiful view and I realized how far up we actually were. Then we found a pool of water next to a waterfall that looked out onto the countryside. Another surreal view of Africa. Not sure how we can keep topping them.
Went back, had rice and beans for dinner. Met another group who made the climb to the cabin. Stayed up talking around a single candlestick.
Day 28: What goes up, must come down
Climbed down, which was easier than going up. There were a lot of rocks that we had to step off of, but other than that we didn't have too much difficulty. AWhen we reached the bottom, the guys had a flatbed truck waiting for all of us. We piled in the back and drove around the mountain back to our car. Ate some lunch, then went back to the house where we heard the others' stories of their trip to Majete (spelling?). We were then told by our host that they took us up the steep way and that there is another way up that most people use instead. Figures. Still glad I had the experience, but don't think that I could ever do it again.
Wednesday, January 26, 2011
Home sick with what I hope is just the flu. Slept for about 14hrs, so decided to catch up on some blogging...
Day 23: Malawian Women
Today, I started in the Medical Bay ward, which is where they send kids from the Pediatric Special Care ward that need more chronic care. Saw Memory there (the girl recovering from meningitis) and she was up walking on her own. No hearing loss or any other residual neurological effects. She looked great! Saw the usual plethora of medical problems, but wanted to reflect on the women of Malawi.
The way the hospital is set up, there are usually only 1-3 Sisters (nurses) per ward even if there are a lot of patients. The Sisters are responsible for distributing medications and giving shots. They will also start IVs, but a lot of the time Registrars or 5th year medical students usually start them (students go straight from high school to medical school, which is 5 years here).
The families (usually mom, grandma or other female guardian) do the majority of patient care. They are the ones who clean the patients, feed the patients, take the patients to the toilet and alert us or the sisters to problems. We see the occasional dad when mom has a little one or a lot of kids to tend to at home, but for the most part, the ward is filled with women.
The women carry children on their backs ranging from the newborn to the older sick child. They take a big, thick piece of cloth, put the child in a piggyback position and wrap the cloth around the back of the child, tying one end to the front end of her chest and another at her hips. It's fascinating (and more practical than strollers) because it leaves her hands free. In fact the only stroller I have seen was a nanny pushing a Caucasian kid down the street. Also, to keep her hands free she will carry anything on her head. I've seen the usual food baskets to suitcases to anything that will fit up there.
If the child is still breastfeeding, sometimes the mom will put the child in a sling on her side, so that she can whip the kid around and let him/her feed. Compared to the States, breastfeeding is natural here. The women have no embarrassment about pulling a breast out of their shirts and feeding their babies. Which seems to me the way it should be, but I know that when I have kids, if I were ever to try it, I would be socially shunned if I didn't "modestly cover up."
The women bond in the hospital, as a lot of time they don't have as much family support at there. It is expensive for people from surrounding villages to take a minibus to the hospital, and I'm always impressed by how long a mom will journey with a sick child to get to one. Ladies share their meals, watch each other's children when mom has to go to the toilet or buy food. They eat together, talk together, celebrate and mourn together. They are strong.
In public, couples (including husbands and wives) do not show physical affection for each other. In some villages they even have separate huts where the wife will sneak into the man's hut at night and be back in her own by morning. Yet, friends show public affection. You hold hands with same sex friends and give them hugs. It threw one of the guys here for a loop when he made a friend with a Malawian guy who later grabbed his hand while they were walking together. Fortunately, he was able to overcome the American social stigma and didn't pull away and offend his new friend.
Cultures are fascinating and just thought I'd share a bit about the Malawian culture, even if this ended up being a little longer than anticipated.
Day 24: Medical Bay
On the ward, we saw a lot of neurological cases. One 7 year old was diagnoses with encephalitis with ? cause. Her brain is atrophied. She is not talking or walking. We were trying to set up outpatient care by getting her a CP chair (cerebral palsy chair which here is a wheelchair base with a white plastic patio chair for the seat). Also were trying to get mom taught on how to move her limbs. We gave her Baclofen to help loosen her muscles, but there was not much else we could do.
Another 1 year old came in because she stopped walking. She didn't bear weight on her left leg and her foot dropped. Come to find out, she previously had meningitis and whoever gave her her Ceftriaxone (antibiotic) shot must have nicked her sciatic nerve one day.
Memory was discharged. Other patients had everything from anemia (? etiology) to nephrotic syndrome (the kids are swollen and they pee protein), to advanced HIV, L knee effusion, etc.
One boy had an extremely large abdomen that was distended with fluid, likely due to liver failure. He had so much fluid that he had a reducible hernia in his scrotum. The registrar showed us how to do a therapeutic peritoneal tap (needle in belly to drain fluid) and asked if anyone could remove it after 1.5 liters had been drained. None of the med students volunteered, so I stayed behind. Pulled the tube out and placed a cotton ball with tape over it. About 5 minutes later the kid started crying and grabbing his abdomen. My first thought was, "Oh, shit! Could I have done something wrong???" My next thought was "You just removed a tube. It's not like it's a difficult procedure." I talked to the Sister on duty and she gave him Paracetamol (Tylenol). I checked on him later and he was back to his usual self.
When I got home, I found out that all the interns are on strike. Apparently they haven't been paid since they started. Pediatrics wasn't hit as bad, but OB/GYN was. So two of the students went in that night on call to help out. From what I heard, they helped with vaginal deliveries, but no one went in to a c-section. It's a shame because it is the patients who could possibly suffer from the strike, but at the same time interns need to have funds to eat and pay rent. The strike is still going on a week later. No one is sure when it is going to end.
Day 23: Malawian Women
Today, I started in the Medical Bay ward, which is where they send kids from the Pediatric Special Care ward that need more chronic care. Saw Memory there (the girl recovering from meningitis) and she was up walking on her own. No hearing loss or any other residual neurological effects. She looked great! Saw the usual plethora of medical problems, but wanted to reflect on the women of Malawi.
The way the hospital is set up, there are usually only 1-3 Sisters (nurses) per ward even if there are a lot of patients. The Sisters are responsible for distributing medications and giving shots. They will also start IVs, but a lot of the time Registrars or 5th year medical students usually start them (students go straight from high school to medical school, which is 5 years here).
The families (usually mom, grandma or other female guardian) do the majority of patient care. They are the ones who clean the patients, feed the patients, take the patients to the toilet and alert us or the sisters to problems. We see the occasional dad when mom has a little one or a lot of kids to tend to at home, but for the most part, the ward is filled with women.
The women carry children on their backs ranging from the newborn to the older sick child. They take a big, thick piece of cloth, put the child in a piggyback position and wrap the cloth around the back of the child, tying one end to the front end of her chest and another at her hips. It's fascinating (and more practical than strollers) because it leaves her hands free. In fact the only stroller I have seen was a nanny pushing a Caucasian kid down the street. Also, to keep her hands free she will carry anything on her head. I've seen the usual food baskets to suitcases to anything that will fit up there.
If the child is still breastfeeding, sometimes the mom will put the child in a sling on her side, so that she can whip the kid around and let him/her feed. Compared to the States, breastfeeding is natural here. The women have no embarrassment about pulling a breast out of their shirts and feeding their babies. Which seems to me the way it should be, but I know that when I have kids, if I were ever to try it, I would be socially shunned if I didn't "modestly cover up."
The women bond in the hospital, as a lot of time they don't have as much family support at there. It is expensive for people from surrounding villages to take a minibus to the hospital, and I'm always impressed by how long a mom will journey with a sick child to get to one. Ladies share their meals, watch each other's children when mom has to go to the toilet or buy food. They eat together, talk together, celebrate and mourn together. They are strong.
In public, couples (including husbands and wives) do not show physical affection for each other. In some villages they even have separate huts where the wife will sneak into the man's hut at night and be back in her own by morning. Yet, friends show public affection. You hold hands with same sex friends and give them hugs. It threw one of the guys here for a loop when he made a friend with a Malawian guy who later grabbed his hand while they were walking together. Fortunately, he was able to overcome the American social stigma and didn't pull away and offend his new friend.
Cultures are fascinating and just thought I'd share a bit about the Malawian culture, even if this ended up being a little longer than anticipated.
Day 24: Medical Bay
On the ward, we saw a lot of neurological cases. One 7 year old was diagnoses with encephalitis with ? cause. Her brain is atrophied. She is not talking or walking. We were trying to set up outpatient care by getting her a CP chair (cerebral palsy chair which here is a wheelchair base with a white plastic patio chair for the seat). Also were trying to get mom taught on how to move her limbs. We gave her Baclofen to help loosen her muscles, but there was not much else we could do.
Another 1 year old came in because she stopped walking. She didn't bear weight on her left leg and her foot dropped. Come to find out, she previously had meningitis and whoever gave her her Ceftriaxone (antibiotic) shot must have nicked her sciatic nerve one day.
Memory was discharged. Other patients had everything from anemia (? etiology) to nephrotic syndrome (the kids are swollen and they pee protein), to advanced HIV, L knee effusion, etc.
One boy had an extremely large abdomen that was distended with fluid, likely due to liver failure. He had so much fluid that he had a reducible hernia in his scrotum. The registrar showed us how to do a therapeutic peritoneal tap (needle in belly to drain fluid) and asked if anyone could remove it after 1.5 liters had been drained. None of the med students volunteered, so I stayed behind. Pulled the tube out and placed a cotton ball with tape over it. About 5 minutes later the kid started crying and grabbing his abdomen. My first thought was, "Oh, shit! Could I have done something wrong???" My next thought was "You just removed a tube. It's not like it's a difficult procedure." I talked to the Sister on duty and she gave him Paracetamol (Tylenol). I checked on him later and he was back to his usual self.
When I got home, I found out that all the interns are on strike. Apparently they haven't been paid since they started. Pediatrics wasn't hit as bad, but OB/GYN was. So two of the students went in that night on call to help out. From what I heard, they helped with vaginal deliveries, but no one went in to a c-section. It's a shame because it is the patients who could possibly suffer from the strike, but at the same time interns need to have funds to eat and pay rent. The strike is still going on a week later. No one is sure when it is going to end.
Tuesday, January 25, 2011
Pictures take hours to upload, so I'll have to do those when I get back in the States.
Day 19: To the lake we go
The gang decided to head to Lake Malawi for the weekend. We hired a minibus and driver for the weekend and the 8 of us (+1 Scottish girl) piled in it on Friday. The route was scenic, as always, in Africa. We did run into a problem when the front tire popped. Everyone was okay. As we pulled off the road, a whole group of children greeted us: "Mz-ooon-goo!!!!" Which means white person in Chichewa. One of the girls from our group pulled out some sparkly nail polish and all the kids swarmed around her to get the glitter on their fingers. A couple of cameras came out and they posed and giggled as they saw themselves on the digital screens.
Meanwhile, the guys (including the driver and navigator) were having difficulty loosening the bolts. One of the guys ( a former MSU safety football player) even bent the tire iron trying to get them to budge. After pouring oil and having a bit of luck, they were able to change the tire. We went back to the last town we passed and picked up a new spare tire.
On the road again, the sun set as we started to go up and down hills and around sharp corners. It was like a roller coaster ride where you can only see just in front where the lights hit. Without seatbelts and where the next corner could be a catastrophe.
Fortunately, we made it to Lake Malawi and to the Gecko Lodge where we were staying. We made it there just before the kitchen closed. Eating pizza, we spent the night talking with our 5 peers from Scotland, Ireland and England.
Day 20: Lake Malawi
Lake Malawi is one of the most beautiful places I have ever been, if not the most beautiful. Gecko Lodge was set up so that we stayed in a Chalet (cabin) that had a kitchen and bathroom with electricity and running water. Our patio looked out onto the lake and the island in the middle (what my main blog picture is). You walk out onto a grassy area where there were hammocks out front and a small beach with a volleyball net.
We woke up and made breakfast and then split up for the day. I spent the day relaxing in the hammock reading "House of God" and napping in the warm breeze, hearing the sounds of the water. I said "hi" to the other group and hung out with them on the lounges on the beach. Then we watched as one of the guys swam to the island and back (which is pretty far). The group played volleyball with some of the law students from Virgina.
It was one of the girl's birthdays and we did a BBQ on the beach. The locals cooked fish, spinach, tomato, potatoes and rice over the fire. The kids from the town sang and danced and surprisingly did some familiar tunes, like "Who let the dogs out." Then they sang "Happy Birthday" and a cake was brought out. The cake was made with crumbled digestive crackers, broken up snickers and evaporated milk that was mixed and heated together. Yum. As I crawled into my bunk that night, I could still hear the waves. I fell asleep soundly thinking about summers near Lake Michigan.
Day 21:
One of my Scottish friends and a guy from our group and I rented Kayaks and paddled to the island. On the island we were able to snorkel and see all the the beautiful freshwater fish. We swam in the warm water and soaked in our surroundings. The island had blue and green geckos and a variety of birds.
We paddled back to the lodge and joked about getting Schistosomiasis from the shallow water. I picked up the treatment for it at the local pharmacy in case I need it when I get back to the States. Because in the States if I were to start peeing blood or getting fevers or back pain, that isn't something that would come to most physician's mind. But it is found here and especially at Lake Malawi.
We made a big dinner with vegetables the other girls found at the market earlier in the day and the fish the guys bartered for. It's amazing what you can cook over a fire and with 2 heating plates.
Day 22:
Monday was a holiday. We took the long road back to the house on the minibus. About halfway home, the car started chugging up the mountains and we realized we blew a cylinder. We arrived at the house a little later than expected. Everyone was a little nauseated and we arrived on whatever parts were left in the minibus.
Day 19: To the lake we go
The gang decided to head to Lake Malawi for the weekend. We hired a minibus and driver for the weekend and the 8 of us (+1 Scottish girl) piled in it on Friday. The route was scenic, as always, in Africa. We did run into a problem when the front tire popped. Everyone was okay. As we pulled off the road, a whole group of children greeted us: "Mz-ooon-goo!!!!" Which means white person in Chichewa. One of the girls from our group pulled out some sparkly nail polish and all the kids swarmed around her to get the glitter on their fingers. A couple of cameras came out and they posed and giggled as they saw themselves on the digital screens.
Meanwhile, the guys (including the driver and navigator) were having difficulty loosening the bolts. One of the guys ( a former MSU safety football player) even bent the tire iron trying to get them to budge. After pouring oil and having a bit of luck, they were able to change the tire. We went back to the last town we passed and picked up a new spare tire.
On the road again, the sun set as we started to go up and down hills and around sharp corners. It was like a roller coaster ride where you can only see just in front where the lights hit. Without seatbelts and where the next corner could be a catastrophe.
Fortunately, we made it to Lake Malawi and to the Gecko Lodge where we were staying. We made it there just before the kitchen closed. Eating pizza, we spent the night talking with our 5 peers from Scotland, Ireland and England.
Day 20: Lake Malawi
Lake Malawi is one of the most beautiful places I have ever been, if not the most beautiful. Gecko Lodge was set up so that we stayed in a Chalet (cabin) that had a kitchen and bathroom with electricity and running water. Our patio looked out onto the lake and the island in the middle (what my main blog picture is). You walk out onto a grassy area where there were hammocks out front and a small beach with a volleyball net.
We woke up and made breakfast and then split up for the day. I spent the day relaxing in the hammock reading "House of God" and napping in the warm breeze, hearing the sounds of the water. I said "hi" to the other group and hung out with them on the lounges on the beach. Then we watched as one of the guys swam to the island and back (which is pretty far). The group played volleyball with some of the law students from Virgina.
It was one of the girl's birthdays and we did a BBQ on the beach. The locals cooked fish, spinach, tomato, potatoes and rice over the fire. The kids from the town sang and danced and surprisingly did some familiar tunes, like "Who let the dogs out." Then they sang "Happy Birthday" and a cake was brought out. The cake was made with crumbled digestive crackers, broken up snickers and evaporated milk that was mixed and heated together. Yum. As I crawled into my bunk that night, I could still hear the waves. I fell asleep soundly thinking about summers near Lake Michigan.
Day 21:
One of my Scottish friends and a guy from our group and I rented Kayaks and paddled to the island. On the island we were able to snorkel and see all the the beautiful freshwater fish. We swam in the warm water and soaked in our surroundings. The island had blue and green geckos and a variety of birds.
We paddled back to the lodge and joked about getting Schistosomiasis from the shallow water. I picked up the treatment for it at the local pharmacy in case I need it when I get back to the States. Because in the States if I were to start peeing blood or getting fevers or back pain, that isn't something that would come to most physician's mind. But it is found here and especially at Lake Malawi.
We made a big dinner with vegetables the other girls found at the market earlier in the day and the fish the guys bartered for. It's amazing what you can cook over a fire and with 2 heating plates.
Day 22:
Monday was a holiday. We took the long road back to the house on the minibus. About halfway home, the car started chugging up the mountains and we realized we blew a cylinder. We arrived at the house a little later than expected. Everyone was a little nauseated and we arrived on whatever parts were left in the minibus.
Thursday, January 20, 2011
Day 17: Needles and Cuts
After so many days on pediatrics, I am starting to see a theme. The big three disease here are HIV, TB and malaria. Additionally, lots of patients come in dehydrated, in shock and/or convulsing. We followed up with some of the same patients today. Trying to keep all of the different types of fluid resuscitation straight because it is different if the kid is malnourished, HIV positive, in shock, or if they have all three.
One patient was noticed to have extremely cold hands and feet (was in shock), and needed fluids. The registrar (aka resident) couldn't get access via the hands/arms or feet, so the attending did a line in the right femoral vein (groin). One hr later, the line had moved. After trying her left femoral vein and missing, then trying her scalp, they finally did a jugular (in the neck). During this time the patient was not focusing her eyes. She was 5+ for malaria and having total body convulsions any time she was stimulated. She got transferred to the malaria ward.
In the afternoon, I saw 3 LPs (lumbar punctures). They don't numb them here before putting the needle in the back and sterility is minimal (note: LPs are used to diagnose meningitis). The 3rd LP was a young 3 year-old who was thrashing around so much that the registrar and I could not hold him down. Another registrar came over, waved us aside, and got up on the table. She put the kid's legs between hers and hugged him while laying on top of him to hold him still.
It was procedure day because I also was able to see them do a pleural tap (in the chest to drain fluid from around the lungs). The patient had consolidation in her entire left chest, so they stuck a needle and tube to drain the pus. Then they converted the tube into a chest tube and made their own drainage system with a plastic bottle. They use what they have available here.
When I got home, more stories were told. One girl had seen them do a breech delivery where they had to break the baby's humerus (arm bone) to get him out. She also saw a baby born blue and floppy and was able to stimulate (rub hard and shake) him back into life.
Another group member had an injury while playing basketball, when an opponent's chin landed into his head, leaving a large cut. The group gave him whiskey, put ice on it and stapled it back together with surgical staples back at the house. Never a dull moment in a house full of med students.
Day 18: Rough day
Still on PSCW. In the morning, we heard a wail and turned to see that one of the ICU patients had passed away. The child had severe hydrocephalus (lots of fluid in brain) which a shunt had previously been placed. The shunt had become clogged, which was why he had been admitted.
During this time, another mom waved me over and I grabbed a Chichewa-speaking medical student and headed over. Mom was requesting for the NG tube to be removed (NG is a nagogastric tube that goes through the nose and into the esophagus to feed a patient). Her son had been admitted for vomiting and diarrhea, but she said he had stopped and was eating on his own. She wanted the tube to be removed because he had difficulty breathing. The med student explained that the DIB was likely due to his distended abdomen and that an NG tube doesn't cause difficulty breathing because it doesn't enter the trachea. We looked the child over, told the registrar and then went to grab a quick lunch before lecture.
At the lecture, one of the other Malawian med students told me that the child had been found dead 10 minutes after we had seen him. I was shocked, and so was the registrar when I told him later on at movie night (Thurs nights are movie nights at our house). We still do not know how or why the child passed away. Both of us still feel guilty/responsible in some way and were surprised by the the lack of a reaction from the natives.
When a child dies, it is even more difficult than an adult's death. I've come to realize that part of my coping mechanism or way of reaching an okay place is if I know how/why the child died. I guess it is because I think that what I learn from that death may help prevent other's. So when I don't know what/if something went wrong, it makes it all the more difficult to come to terms with the situation. All I can do is keep learning and seeing patients and hope that one day I'll be a better pediatrician for it.
Tuesday, January 18, 2011
Internet has been down...
Day 13: Weekend Trip to Zomba Plateau and Lake Chilwa
Woke up reasonably early and left with 2 of the guys from MSU, an ortho resident from Boston and a female med student from London. The other 5 MSU students had left for the plateau the day before. Using the orthopedic resident's car, one of the guys drove, as it is a manual. I really should learn to drive stick shift when I get back to the States. My old driver's training instructor told me that if I wanted to live to the age of 25, I wouldn't drive a stick. Well, I'm 25 now, so perhaps it is time to try again.
We drove through the countryside until we saw Zomba Plateau in the distance. When we reached the plateau, we drove up many switchbacks until we reached our destination: Trout Farm. Going up the mountain was slightly terrifying, due to my little fear of heights, especially as some of the roads didn't have guard rails.
Trout farm is a lodging area and we were able to get a beautiful, hand crafted, wooden lodge for the 5 of us. The place had running water, but no electricity. We didn't waste any time getting a guide to begin our trek to the top of the plateau. Our guide's name was Friday and he led the group barefoot up the mountain. My body was definitely not used to the altitude or climbing steep inclines (Michigan is quite flat). Soon I was huffing and puffing. I was definitely the least athletic out of our group of cyclists and marathon runners. It was a struggle to get to the top. But with a little encouragement, determination and quick stops to catch my breath, I made it to the top. The view was worth it, as we could look out over towns and the rest of the landscape. We were up in the clouds.
Our trek down was not as strenuous, but more mentally taxing and balance taxing, as it was slippery. Friday took us to more look out points where when we looked down, all we could see were clouds. He also took us to a waterfall. Once we made it back after our 6hr hike, we made egg sandwiches on the gas stove and watched the sun set from the porch. Candles were it and a fire was made outside. We looked up at the stars and joked about our near future as interns.
The next morning we packed up and drove to Lake Chilwa, which was nearby. We were told the road was "off the beaten path" and sure enough with all of us piled in the car, we had about a 3 inch clearance from the ground and potholes. Needless to say, it took awhile to get there. But as we passed through villages, we got even more of a look at the culture of Malawi. When we hit the lake, we got out, stretched, took pictures, and hopped right back in. It was a very hot day and by that point in time the trunk would not latch. Yay for rope. We didn't do the boat ride on the lake, because we didn't want to leave the trunk and stuff unattended. We drove back and compared notes on our different experiences with the other 5 when we got home.
Day 15: Starting a week in the Special Care Ward
After sniffing our clothes and smelling something rank, the men took apart the dryer intake and found a dead snail! They fixed it up and our clothes are back to normal smells.
On Monday, I started on the Special Care Ward, which is where acute pediatric cases go after A & E (accident and emergency). We started rounding in the High Dependency Unit (aka ICU) and saw gastroenteritis (viral illness causing vomiting and diarrhea), a girl with hemiplegia awaiting an MRI (half side of her body wouldn't work), vocal cord papilloma, dehydration and shock, etc.
In the afternoon, I went to A&E again to the Resuscitation room. They pack as many kids in as they can onto the 4 beds, usually with two patients per bed. One patient was unconscious with a 3rd nerve palsy (one of her eyes pointed down and out), decreased reflexes and history of convulsion (seizure). I checked her sugars, which were normal. We weren't sure if it was due to malaria, a lesion in the brain, meningitis or something else. She was sent to the Malaria Research Ward. A couple days later, I found out that she had meningitis and came back around with antibiotics. Everything else was negative.
Other children had SMA (severe malaria anemia) and needed blood transfusions. To diagnose anemia fast, we compared the hands of the child with the hands of the mom. We felt for enlarged livers and spleens, which seem to be quite common here.
When kids don't cry when examining them or resist IVs and shots, then you know they are exhausted and pretty sick. These are the kind of kids that end up in the Resuscitation room.
Another girl was lying against the wall coming in and out of consciousness and coherent thoughts. She had her eyes closed and was curled up, refusing to be moved. We sent her to the Special Care Ward, where I found out the next day that her LP (lumbar puncture) was positive for strep pneumonia. She looked completely different since she had received her antibiotics. I almost didn't recognize her because she looked so much better. But I remembered her name: Memory.
Went to a palliative care lecture that night, which was informative. Still trying to get used to the different drugs names here. (Paracetamol = acetaminophen (Tylenol)).
Day 16: Wow...just wow.
Following up on some of the patients, the girl with hemiplegia was found to have a craniopharyngioma on her MRI. Basically this means she had a growth in her brain that was able to be removed.
We saw a 5 year old with enlarged lymph nodes everywhere. They were under her chin, on the back of her head, in her armpits, on her back and in her groin. She was later diagnosed with HIV. Questionable TB.
Another child that had HIV had a CD4 count of 1. Normal is between 500-1600. Additionally, I saw a 5 month old with Transposition of the great arteries (the aorta and pulmonary arteries are switched from where they are supposed to be). Most kids with this die almost immediately, but this one was able to live because of a hole where the blood could be mixed. We think he had a PDA that remained open after birth, but his chest sounded like he had a VSD.
When I got home, I learned that one of the others had an even more eventful day. He had previously seen a very poorly done c-section where the interns were operating without an attending supervision. The colon had been accidentally cut a couple of times, the patient bled and died later that night. After seeing this, one of the med students from our group (who wants to go into OB/Gyn and has had several rotations of it), took charge of a c-section because he couldn't stand the poorly done procedures. And in all honesty, he had more experience than the interns who were operating. So with the intern at his side, he cut, delivered and finished an entire c-section without any complications.
They don't resuscitate infants properly here (i.e. no suction of the airways, and no rigorous stimulation to arouse the infant. So he looked for the other student on (who knows pediatrics) and she was unavailable because she had passed out from the heat of the OR.
The story continued when he told us that the ORs don't have suctions to suction blood out of the operating field of vision (the incision and womb). When he was done, he realized that blood had seeped through his scrubs and onto his leg and groin. The patient was known to be HIV +. The student is now on HIV prophylaxis meds, although it is extremely unlikely that he would contract HIV in that manner. It was a good reminder to us to be careful while being here. And the medical supply box finally made it to Malawi.
Woke up reasonably early and left with 2 of the guys from MSU, an ortho resident from Boston and a female med student from London. The other 5 MSU students had left for the plateau the day before. Using the orthopedic resident's car, one of the guys drove, as it is a manual. I really should learn to drive stick shift when I get back to the States. My old driver's training instructor told me that if I wanted to live to the age of 25, I wouldn't drive a stick. Well, I'm 25 now, so perhaps it is time to try again.
We drove through the countryside until we saw Zomba Plateau in the distance. When we reached the plateau, we drove up many switchbacks until we reached our destination: Trout Farm. Going up the mountain was slightly terrifying, due to my little fear of heights, especially as some of the roads didn't have guard rails.
Trout farm is a lodging area and we were able to get a beautiful, hand crafted, wooden lodge for the 5 of us. The place had running water, but no electricity. We didn't waste any time getting a guide to begin our trek to the top of the plateau. Our guide's name was Friday and he led the group barefoot up the mountain. My body was definitely not used to the altitude or climbing steep inclines (Michigan is quite flat). Soon I was huffing and puffing. I was definitely the least athletic out of our group of cyclists and marathon runners. It was a struggle to get to the top. But with a little encouragement, determination and quick stops to catch my breath, I made it to the top. The view was worth it, as we could look out over towns and the rest of the landscape. We were up in the clouds.
Our trek down was not as strenuous, but more mentally taxing and balance taxing, as it was slippery. Friday took us to more look out points where when we looked down, all we could see were clouds. He also took us to a waterfall. Once we made it back after our 6hr hike, we made egg sandwiches on the gas stove and watched the sun set from the porch. Candles were it and a fire was made outside. We looked up at the stars and joked about our near future as interns.
The next morning we packed up and drove to Lake Chilwa, which was nearby. We were told the road was "off the beaten path" and sure enough with all of us piled in the car, we had about a 3 inch clearance from the ground and potholes. Needless to say, it took awhile to get there. But as we passed through villages, we got even more of a look at the culture of Malawi. When we hit the lake, we got out, stretched, took pictures, and hopped right back in. It was a very hot day and by that point in time the trunk would not latch. Yay for rope. We didn't do the boat ride on the lake, because we didn't want to leave the trunk and stuff unattended. We drove back and compared notes on our different experiences with the other 5 when we got home.
Day 15: Starting a week in the Special Care Ward
After sniffing our clothes and smelling something rank, the men took apart the dryer intake and found a dead snail! They fixed it up and our clothes are back to normal smells.
On Monday, I started on the Special Care Ward, which is where acute pediatric cases go after A & E (accident and emergency). We started rounding in the High Dependency Unit (aka ICU) and saw gastroenteritis (viral illness causing vomiting and diarrhea), a girl with hemiplegia awaiting an MRI (half side of her body wouldn't work), vocal cord papilloma, dehydration and shock, etc.
In the afternoon, I went to A&E again to the Resuscitation room. They pack as many kids in as they can onto the 4 beds, usually with two patients per bed. One patient was unconscious with a 3rd nerve palsy (one of her eyes pointed down and out), decreased reflexes and history of convulsion (seizure). I checked her sugars, which were normal. We weren't sure if it was due to malaria, a lesion in the brain, meningitis or something else. She was sent to the Malaria Research Ward. A couple days later, I found out that she had meningitis and came back around with antibiotics. Everything else was negative.
Other children had SMA (severe malaria anemia) and needed blood transfusions. To diagnose anemia fast, we compared the hands of the child with the hands of the mom. We felt for enlarged livers and spleens, which seem to be quite common here.
When kids don't cry when examining them or resist IVs and shots, then you know they are exhausted and pretty sick. These are the kind of kids that end up in the Resuscitation room.
Another girl was lying against the wall coming in and out of consciousness and coherent thoughts. She had her eyes closed and was curled up, refusing to be moved. We sent her to the Special Care Ward, where I found out the next day that her LP (lumbar puncture) was positive for strep pneumonia. She looked completely different since she had received her antibiotics. I almost didn't recognize her because she looked so much better. But I remembered her name: Memory.
Went to a palliative care lecture that night, which was informative. Still trying to get used to the different drugs names here. (Paracetamol = acetaminophen (Tylenol)).
Day 16: Wow...just wow.
Following up on some of the patients, the girl with hemiplegia was found to have a craniopharyngioma on her MRI. Basically this means she had a growth in her brain that was able to be removed.
We saw a 5 year old with enlarged lymph nodes everywhere. They were under her chin, on the back of her head, in her armpits, on her back and in her groin. She was later diagnosed with HIV. Questionable TB.
Another child that had HIV had a CD4 count of 1. Normal is between 500-1600. Additionally, I saw a 5 month old with Transposition of the great arteries (the aorta and pulmonary arteries are switched from where they are supposed to be). Most kids with this die almost immediately, but this one was able to live because of a hole where the blood could be mixed. We think he had a PDA that remained open after birth, but his chest sounded like he had a VSD.
When I got home, I learned that one of the others had an even more eventful day. He had previously seen a very poorly done c-section where the interns were operating without an attending supervision. The colon had been accidentally cut a couple of times, the patient bled and died later that night. After seeing this, one of the med students from our group (who wants to go into OB/Gyn and has had several rotations of it), took charge of a c-section because he couldn't stand the poorly done procedures. And in all honesty, he had more experience than the interns who were operating. So with the intern at his side, he cut, delivered and finished an entire c-section without any complications.
They don't resuscitate infants properly here (i.e. no suction of the airways, and no rigorous stimulation to arouse the infant. So he looked for the other student on (who knows pediatrics) and she was unavailable because she had passed out from the heat of the OR.
The story continued when he told us that the ORs don't have suctions to suction blood out of the operating field of vision (the incision and womb). When he was done, he realized that blood had seeped through his scrubs and onto his leg and groin. The patient was known to be HIV +. The student is now on HIV prophylaxis meds, although it is extremely unlikely that he would contract HIV in that manner. It was a good reminder to us to be careful while being here. And the medical supply box finally made it to Malawi.
Monday, January 10, 2011
Day 10: General Clinic
Went to the General Clinic where I saw how Diabetes and epilepsy are treated and monitored in Malawi. Definitely different than back home. What was even more interesting to me was how medical records are kept. Each child has a "health passport" in which physician's write in whenever they go to a clinic or are admitted to the hospital. It helps with keeping track of medical decisions, but is not perfect because sometimes what is written in the book is not what mom has been giving the kid.
When we got home two of the guys encountered Leprosy on their ward, which is quite rare, even by Malawi standards.
Day 11: To market, to market
Decided to check out the Neurology clinic, where I got to see even more pathology. A child seized in front of us and we ended up diagnosing him with Lennox-Gastaut Syndrome. I had to look it up. Apparently it is when a child presents with different kinds of seizures (grand mal/tonic-clonic, to partial seizure, to absence seizures) due to diffuse neuronal injury. In normal people terms: something affected the whole brain and which is why different types of seizures show up. Additionally, we got to see a child who was having convulsions after eating pork and getting the pork tapeworm, Taenia Soleum.
In the afternoon, I headed over to the A & E (accident and emergency) ward. Saw a child who had severe pneumonia to the point that she would stop breathing. The registrar (resident) would bag-valve mask (breathe for her with the pump) to bring her back around. The only other thing to be done would be to place the kid on a CPAP. In the US, a kid like this would be placed on a ventilator to help her breathe. There are no ventilators at this hospital, only a "sort-of" way to help aid her breathing, which is CPAP here. Mom and grandmother refused, as it was too invasive of a procedure. I left with the registrar to see other kids, and do not know what happened to Honour. Things are definitely different down here.
The next place we went was a triage area, where they were giving out Quinine shots. In all honesty, it almost sounded like a torture chamber. The child would be held down for his/her shot and be screaming the whole time. The next kid in line would see what was coming and start screaming and crying, which became a ripple effect down the line.
On the way home, one of the girls and I stopped at a market, as I needed to pick up items since the luggage hadn't come in yet. I was able to get a shirt with "Who's your Paddy on it" for St. Patrick's day, along with a white skirt, shorts, a watch and a notebook. One of the conversations at the market:
lady: "I help find your size. This your size."
me: "No, thank-you. That's not my size."
lady: "What your size?"
me: "Closer to 8"
lady: "You not 8, you too fat for 8."
me: "Thaaanks."
I wasn't too offended, as she meant it as a compliment. Larger people are more desired and have more wealth and money for food. It's interesting to think that in the US, their selling line is "oh, but you look so skinny." A great example of the different values in cultures.
Day 12: Luggage?
Got extremely lost trying to find the HIV clinic in the hospital. Asked people and got lost for about an hour before I gave up. People gave me different directions or told me the clinic didn't exist, etc.
However, luggage came in! It felt like Christmas because I couldn't remember what I had packed :)
Unfortunately, box of medical supplies were still lost in Africa somewhere.
Went to the General Clinic where I saw how Diabetes and epilepsy are treated and monitored in Malawi. Definitely different than back home. What was even more interesting to me was how medical records are kept. Each child has a "health passport" in which physician's write in whenever they go to a clinic or are admitted to the hospital. It helps with keeping track of medical decisions, but is not perfect because sometimes what is written in the book is not what mom has been giving the kid.
When we got home two of the guys encountered Leprosy on their ward, which is quite rare, even by Malawi standards.
Day 11: To market, to market
Decided to check out the Neurology clinic, where I got to see even more pathology. A child seized in front of us and we ended up diagnosing him with Lennox-Gastaut Syndrome. I had to look it up. Apparently it is when a child presents with different kinds of seizures (grand mal/tonic-clonic, to partial seizure, to absence seizures) due to diffuse neuronal injury. In normal people terms: something affected the whole brain and which is why different types of seizures show up. Additionally, we got to see a child who was having convulsions after eating pork and getting the pork tapeworm, Taenia Soleum.
In the afternoon, I headed over to the A & E (accident and emergency) ward. Saw a child who had severe pneumonia to the point that she would stop breathing. The registrar (resident) would bag-valve mask (breathe for her with the pump) to bring her back around. The only other thing to be done would be to place the kid on a CPAP. In the US, a kid like this would be placed on a ventilator to help her breathe. There are no ventilators at this hospital, only a "sort-of" way to help aid her breathing, which is CPAP here. Mom and grandmother refused, as it was too invasive of a procedure. I left with the registrar to see other kids, and do not know what happened to Honour. Things are definitely different down here.
The next place we went was a triage area, where they were giving out Quinine shots. In all honesty, it almost sounded like a torture chamber. The child would be held down for his/her shot and be screaming the whole time. The next kid in line would see what was coming and start screaming and crying, which became a ripple effect down the line.
On the way home, one of the girls and I stopped at a market, as I needed to pick up items since the luggage hadn't come in yet. I was able to get a shirt with "Who's your Paddy on it" for St. Patrick's day, along with a white skirt, shorts, a watch and a notebook. One of the conversations at the market:
lady: "I help find your size. This your size."
me: "No, thank-you. That's not my size."
lady: "What your size?"
me: "Closer to 8"
lady: "You not 8, you too fat for 8."
me: "Thaaanks."
I wasn't too offended, as she meant it as a compliment. Larger people are more desired and have more wealth and money for food. It's interesting to think that in the US, their selling line is "oh, but you look so skinny." A great example of the different values in cultures.
Day 12: Luggage?
Got extremely lost trying to find the HIV clinic in the hospital. Asked people and got lost for about an hour before I gave up. People gave me different directions or told me the clinic didn't exist, etc.
However, luggage came in! It felt like Christmas because I couldn't remember what I had packed :)
Unfortunately, box of medical supplies were still lost in Africa somewhere.
Sunday, January 9, 2011
Day 9: First day at Queen Elizabeth Central Hospital
The house that we are staying at has the perfect set-up for rotating students. There is one big spacious family room where socializing, movies and reading occur. We can eat breakfast or lunch out on the porch if we like. The rooms are set-up with bunk beds (4 in each room). One guy drew the unlucky/lucky straw and gets to share a room with the 3 girls. Probably a little more unlucky because we all talk in our sleep. The outside of the house is surrounded by a brick wall and an entrance gate. Security guards are present if needed. The only major rule for us is to be home before dark.
Since it was our first day, our host took us to the hospital, where the 2 of us on "Paediatrics" sat in our morning "hand-off." Morning hand-off here is when they go over the total number of patients in each of the wards. All members of the department are present as serious cases and mortalities from the previous day are discussed. After that we went to register and learned some of the layout of the hospital after getting lost a few times. The hospital is set up with multiple corridors that connect, which makes it easy for us new students to get turned around. People are scattered on the lawn outside the wards eating, washing sheets, sleeping or just waiting.
We went to the pediatric cardiology clinic and were thrown right in. Learned a few words real fast in the language of Chichewa. For example:
How are you? = Muli bwanji?
Thank-you/Good-bye = Zicomo
Pain = kupweteka
The hardest to remember is that "yes = eee" and "no = aye."
After a little hesitation, we started attempting the words to get a history, and examining the kids. It was an AMAZING learning experience. All the things that we read about in the past, we were able to see. We got to hear heart murmurs, and see post-viral cardiomyopathy, Ventricular Septal defect (hole in heart), Rheumatic Heart Disease, Mitral Regurgitation, Follow-up on Valvuloplasty, Atrial Septal defect, etc. I saw more in 1 hr than I probably would have in an entire month in the US. Everything made me want to learn more about what I'd seen.
The pathology here is incredible. We couldn't find the PMI on one girl. The PMI is basically where you can feel the heart beat the most on a chest. Instead of being on the front left of her chest, we found it on her left side close to her back. Her heart and spine (scoliosis) were rotated inside her body.
In the afternoon we sat in on an excellent cardiology lecture, which tied everything together. We met a few of the Malawian medical students and then found our way back to the house for supper. It was interesting hearing what the others saw during their day (how surgeries work here and delivering babies) and I was excited to go back the next day. It is crazy that I'm finally here.
The house that we are staying at has the perfect set-up for rotating students. There is one big spacious family room where socializing, movies and reading occur. We can eat breakfast or lunch out on the porch if we like. The rooms are set-up with bunk beds (4 in each room). One guy drew the unlucky/lucky straw and gets to share a room with the 3 girls. Probably a little more unlucky because we all talk in our sleep. The outside of the house is surrounded by a brick wall and an entrance gate. Security guards are present if needed. The only major rule for us is to be home before dark.
Since it was our first day, our host took us to the hospital, where the 2 of us on "Paediatrics" sat in our morning "hand-off." Morning hand-off here is when they go over the total number of patients in each of the wards. All members of the department are present as serious cases and mortalities from the previous day are discussed. After that we went to register and learned some of the layout of the hospital after getting lost a few times. The hospital is set up with multiple corridors that connect, which makes it easy for us new students to get turned around. People are scattered on the lawn outside the wards eating, washing sheets, sleeping or just waiting.
We went to the pediatric cardiology clinic and were thrown right in. Learned a few words real fast in the language of Chichewa. For example:
How are you? = Muli bwanji?
Thank-you/Good-bye = Zicomo
Pain = kupweteka
The hardest to remember is that "yes = eee" and "no = aye."
After a little hesitation, we started attempting the words to get a history, and examining the kids. It was an AMAZING learning experience. All the things that we read about in the past, we were able to see. We got to hear heart murmurs, and see post-viral cardiomyopathy, Ventricular Septal defect (hole in heart), Rheumatic Heart Disease, Mitral Regurgitation, Follow-up on Valvuloplasty, Atrial Septal defect, etc. I saw more in 1 hr than I probably would have in an entire month in the US. Everything made me want to learn more about what I'd seen.
The pathology here is incredible. We couldn't find the PMI on one girl. The PMI is basically where you can feel the heart beat the most on a chest. Instead of being on the front left of her chest, we found it on her left side close to her back. Her heart and spine (scoliosis) were rotated inside her body.
In the afternoon we sat in on an excellent cardiology lecture, which tied everything together. We met a few of the Malawian medical students and then found our way back to the house for supper. It was interesting hearing what the others saw during their day (how surgeries work here and delivering babies) and I was excited to go back the next day. It is crazy that I'm finally here.
Day 8: Just how many countries can we fit in one week?
Woke up, ate pastries and left. Walked about 2km before finding the "bus station," which consisted of a location where minibuses pick up passengers. One of the perks with traveling with the guys was that they liked to barter, so there were able to get the price down to about $2 per person. On the way out of Tete, the minibus and another car collided. Luckily, we were only going about 5mph because of traffic. However, we had to wait on the bus while they got an estimate for a minor dent and paint chipping. As a side note, Tete is known as the hottest place in Mozambique, in case anyone decides to go there. It definitely lived up to it's name. Once the minibus started again, the breeze came back through the windows.
The bus ride from Tete to the Mozambique border was about 2 hrs. With 4 of us in the back seat with our packs on our knees, we got the full minibus experience. Most of the populace uses minibuses to get around. There were about 20 people in our bus and we watched as people got on and off in small villages. Young and old boarded the bus, and once we even had a live chicken on board. The buses usually have to be push started as the batteries are bad, and there are not seatbelts to be found. At each village, people came up to the minibus selling fruits and drinks. We stuck to our bottled water, for obvious health reasons, but had they been selling mangoes, litches (spelling?) or granidillos (sp?), we probably would have grabbed some.
At the Mozambique checkpoint, they checked our passport. We then had to take a "taxi"another 5km to the border. It is unusual for the checkpoints to be so far apart. Anyways, we walked across the border into Malawi. It was then that we realized that we had been in 5 countries in about a week (US, France, South Africa, Mozambique, & Malawi). We hopped on our last minibus for another 1.5 hrs and were dropped off in Blantyre, Malawi. We were finally able to find a cellphone at the gas station and called our host, where she found us. She welcomed us with open arms, and after the past week's adventures, we felt like we were finally home.
Woke up, ate pastries and left. Walked about 2km before finding the "bus station," which consisted of a location where minibuses pick up passengers. One of the perks with traveling with the guys was that they liked to barter, so there were able to get the price down to about $2 per person. On the way out of Tete, the minibus and another car collided. Luckily, we were only going about 5mph because of traffic. However, we had to wait on the bus while they got an estimate for a minor dent and paint chipping. As a side note, Tete is known as the hottest place in Mozambique, in case anyone decides to go there. It definitely lived up to it's name. Once the minibus started again, the breeze came back through the windows.
The bus ride from Tete to the Mozambique border was about 2 hrs. With 4 of us in the back seat with our packs on our knees, we got the full minibus experience. Most of the populace uses minibuses to get around. There were about 20 people in our bus and we watched as people got on and off in small villages. Young and old boarded the bus, and once we even had a live chicken on board. The buses usually have to be push started as the batteries are bad, and there are not seatbelts to be found. At each village, people came up to the minibus selling fruits and drinks. We stuck to our bottled water, for obvious health reasons, but had they been selling mangoes, litches (spelling?) or granidillos (sp?), we probably would have grabbed some.
At the Mozambique checkpoint, they checked our passport. We then had to take a "taxi"another 5km to the border. It is unusual for the checkpoints to be so far apart. Anyways, we walked across the border into Malawi. It was then that we realized that we had been in 5 countries in about a week (US, France, South Africa, Mozambique, & Malawi). We hopped on our last minibus for another 1.5 hrs and were dropped off in Blantyre, Malawi. We were finally able to find a cellphone at the gas station and called our host, where she found us. She welcomed us with open arms, and after the past week's adventures, we felt like we were finally home.
So behind on posts...
Day 7: We meet again
From there we wanted to go to Costa do Sol. The minibus driver said it would be 5 Meticals. (To break down the math conversions we have been doing in our heads: 10 Meticals = 1 dollar, 8 Rand = 1 dollar). So we said "ok" and climbed in the Chapa (aka minibus). More passengers had gotten off until only 1 other was left. He and the driver started arguing about why he was taking us further out of his way for cheaper than the norm. After listening to a flurry of Portuguese,
the passenger turned to us to explain what was going on. When he said that the driver may be intending to take advantage of us tourists and "rob us," we got off at the next stop and took a taxi instead.
Woke up with mosquito nets in face, I was still trying to get used to them. The nets are used to decrease the amount of times you get bit by mosquitoes, and thus, decrease your chances of getting malaria. Already being on doxycycline, I'm tempted to say to hell with it, but I'm getting used to them. In Maputo, after staying the night at Fatima's, we went to the outdoor market and drooled over all the beautiful fruits displayed. We even bought a few mangoes to scrub off and eat. Then we headed to Mozambique's train station (our guidebook pointed it out as being ranked #10 in Newsweek's most beautiful train stations). The station is about 100yrs old and was ironically designed by the same guy who built the Eiffel tower.
From there we wanted to go to Costa do Sol. The minibus driver said it would be 5 Meticals. (To break down the math conversions we have been doing in our heads: 10 Meticals = 1 dollar, 8 Rand = 1 dollar). So we said "ok" and climbed in the Chapa (aka minibus). More passengers had gotten off until only 1 other was left. He and the driver started arguing about why he was taking us further out of his way for cheaper than the norm. After listening to a flurry of Portuguese,
the passenger turned to us to explain what was going on. When he said that the driver may be intending to take advantage of us tourists and "rob us," we got off at the next stop and took a taxi instead. The restaurant Costa do Sol was closed, but we were able to get a taste of the culture at the Mozambique beaches. It was like 
one big BBQ party. People were grilling fish, swimming and drinking over the holiday weekend. We had previously been told not to swim in the water at Maputo, so we found some shade and shared a mango and coke between us. Then we started to look for some transportation to take us back, but there wasn't any. On foot again, about half a mile up the road we were able to get the bus to take us to the hospital near where we were staying. I'm still not sure if he said yes because we told him we needed to go to the hospital, but away we went. We made it back just in time to pick up our stuff and hit up the airport.
one big BBQ party. People were grilling fish, swimming and drinking over the holiday weekend. We had previously been told not to swim in the water at Maputo, so we found some shade and shared a mango and coke between us. Then we started to look for some transportation to take us back, but there wasn't any. On foot again, about half a mile up the road we were able to get the bus to take us to the hospital near where we were staying. I'm still not sure if he said yes because we told him we needed to go to the hospital, but away we went. We made it back just in time to pick up our stuff and hit up the airport.
We met the guys at the airport and I think we were as glad/relieved to see them as they were to see us, because there were hugs all around. It's amazing how quickly a group can bond in so little time under these kinds of circumstances. It was like seeing long lost brothers. We boarded the plane and flew from Maputo, Mozambique to Tete, Mozambique.
In Tete, a nice man gave us a ride through the outskirts of town and dropped us off at the
bridge. So our group of 5 walked with packs across the suspension bridge, as I tried not to look down. By this point in time we had gotten used to the starring and pointing and car honking. It was 3km to "Motel Tete." Needless to say, there were definitely some perks to AirFrance holding my suitcase and the med supplies hostage. And that's what I reminded myself of every night while washing out my clothes by hand. Anyways, back to Tete...
When we arrived at Motel Tete, it had apparently been converted to a motel for a Brazilian mineral bulldozing company. We talked with them for awhile and became the night's entertainment as everyone came out of their rooms to say "hello." From there we took a minibus to a different hostel, which was extremely expensive. All of the other hotels were already booked, except for one (can't remember the name), so we checked in there and went out for pizza.
In Tete, a nice man gave us a ride through the outskirts of town and dropped us off at the
bridge. So our group of 5 walked with packs across the suspension bridge, as I tried not to look down. By this point in time we had gotten used to the starring and pointing and car honking. It was 3km to "Motel Tete." Needless to say, there were definitely some perks to AirFrance holding my suitcase and the med supplies hostage. And that's what I reminded myself of every night while washing out my clothes by hand. Anyways, back to Tete...When we arrived at Motel Tete, it had apparently been converted to a motel for a Brazilian mineral bulldozing company. We talked with them for awhile and became the night's entertainment as everyone came out of their rooms to say "hello." From there we took a minibus to a different hostel, which was extremely expensive. All of the other hotels were already booked, except for one (can't remember the name), so we checked in there and went out for pizza.
Tuesday, January 4, 2011
And I would walk 500 miles...
Day 6: Happy New Year! Crossing the border
Woke up early. The 3 of us girls made breakfast (mmm eggs, sausage and fresh mango) and did dishes and in exchange the 2 guys were to drop off the rental car. Both groups were going to cross the border and the plan was to meet on the other side in Mozambique. Well things sometimes don't go as planned...
Us girls were going to walk to the border from the hostel, while the guys were going to drop the car off in Nespruit and take a minibus there. So we slathered on sunscreen, but our bags on our bags, filled our water and off we went. We were told that it was 4km to the border. 10km later we reached the border, hot and sweaty, but happy to get out of the heat. Ankle fortunately had healed over the previous 2 days. After crossing from South Africa into Mozambique, the guys weren't there. We hopped a bus (looked similar to a Greyhound) and headed for Maputo, Mozambique, as our back-up plan was to meet at the next hostel.
While on the bus, I was musing about what my grandmother always says about New Years Day: "Whatever you do on that day, you will be doing the rest of the year." Apparently I will be traveling into new borders this year (both figuratively and literally).
In Maputo, after some navigational skills (Thank-you LonelyPlanet for your map), we arrived at Fatima's hostel. The guys weren't there, but apparently had been there earlier. We booked dorm rooms for the night, then got an e-mail from them saying that they had gone someplace else if we wanted to meet up otherwise to meet them at the airport the next day.
We took a taxi out to dinner at "Fierra Popular." Which turned out to be a fair with surrounding restaurants. We picked one (can't remember the name), and we shared calamari, prawns and cod. The menu was entirely in Portuguese, with a National Geographic video playing on the wall. Fortunately, one of the girls speaks Spanish fluently, which made it easier to make words out. It made me want to take Spanish again. We had an excellent time and then headed back to our hostel before another long day ahead.
Woke up early. The 3 of us girls made breakfast (mmm eggs, sausage and fresh mango) and did dishes and in exchange the 2 guys were to drop off the rental car. Both groups were going to cross the border and the plan was to meet on the other side in Mozambique. Well things sometimes don't go as planned...
Us girls were going to walk to the border from the hostel, while the guys were going to drop the car off in Nespruit and take a minibus there. So we slathered on sunscreen, but our bags on our bags, filled our water and off we went. We were told that it was 4km to the border. 10km later we reached the border, hot and sweaty, but happy to get out of the heat. Ankle fortunately had healed over the previous 2 days. After crossing from South Africa into Mozambique, the guys weren't there. We hopped a bus (looked similar to a Greyhound) and headed for Maputo, Mozambique, as our back-up plan was to meet at the next hostel.
While on the bus, I was musing about what my grandmother always says about New Years Day: "Whatever you do on that day, you will be doing the rest of the year." Apparently I will be traveling into new borders this year (both figuratively and literally).
In Maputo, after some navigational skills (Thank-you LonelyPlanet for your map), we arrived at Fatima's hostel. The guys weren't there, but apparently had been there earlier. We booked dorm rooms for the night, then got an e-mail from them saying that they had gone someplace else if we wanted to meet up otherwise to meet them at the airport the next day.
We took a taxi out to dinner at "Fierra Popular." Which turned out to be a fair with surrounding restaurants. We picked one (can't remember the name), and we shared calamari, prawns and cod. The menu was entirely in Portuguese, with a National Geographic video playing on the wall. Fortunately, one of the girls speaks Spanish fluently, which made it easier to make words out. It made me want to take Spanish again. We had an excellent time and then headed back to our hostel before another long day ahead.
Lions, Zebras and Elephants
Day 4: The Hunt for the lion
Still staying in Kruger (Nelspruit, South Africa), we were able to go into Kruger National Park on an African safari. The way the park is set-up is so you can drive through with the windows down and see all the wildlife the area has to offer. The park is enormous with many endangered species. That day we woke up at 4:30am (sun was actually up) to get in line for the park. Inside the park, we saw impala, warthogs, zebra, giraffe, wildebeasts, exotic birds, rhinos, hippos, etc. Pretty much everything that is in "The Lion King." It was indescribable. The scenery was everything you would expect from the tall green grass, trees and kilometers of land.
While driving and pointing out the smaller animals, we see an elephant in the middle of the road up ahead. No other car was around, and he was walking slowly toward us. Now when you are in a car low to the ground and see a big elephant walking toward you, it is a bit unnerving, but we turned off the engine and stayed put. It just continued stomping around the car and continued on it's way like we weren't even there. Later, another elephant crossed in front of us and we watched as he scratched his back on a tree (nearly knocking it over). We also saw a big group of elephants pass by. It was definitely elephant day.
Still staying in Kruger (Nelspruit, South Africa), we were able to go into Kruger National Park on an African safari. The way the park is set-up is so you can drive through with the windows down and see all the wildlife the area has to offer. The park is enormous with many endangered species. That day we woke up at 4:30am (sun was actually up) to get in line for the park. Inside the park, we saw impala, warthogs, zebra, giraffe, wildebeasts, exotic birds, rhinos, hippos, etc. Pretty much everything that is in "The Lion King." It was indescribable. The scenery was everything you would expect from the tall green grass, trees and kilometers of land.
Lions, leopards and cheetahs are hard to find and by 4pm we still hadn't seen one. Then, out of nowhere, a leopard crossed the road in front of us. A kilometer later, we saw a male lion sitting near a bridge. Although he was down below, I was still shocked to see someone actually get out of their car to get a better picture. A park ranger happened to be driving behind him and yelled at him to get back in the car, otherwise who knows what could have happened. Especially as we knew that there were two others roaming around unseen nearby.
But the real excitement was on the way out of the park. A big herd of impala ran in front of the jeep and it wasn't until we looked around us that we saw the pride. One lioness was approaching a hyena and 2 were cornering him from behind. We heard roaring, saw movement and a scuffle, until the hyena somehow managed to escape. A total of 6 lioness were seen in the one patch of land. They were impressive, and slightly terrifying (ok, if I'm honest, more than slightly), as they were so close. It was a great way to end the day.
But the real excitement was on the way out of the park. A big herd of impala ran in front of the jeep and it wasn't until we looked around us that we saw the pride. One lioness was approaching a hyena and 2 were cornering him from behind. We heard roaring, saw movement and a scuffle, until the hyena somehow managed to escape. A total of 6 lioness were seen in the one patch of land. They were impressive, and slightly terrifying (ok, if I'm honest, more than slightly), as they were so close. It was a great way to end the day.
Day 5: Please don't stomp on us or the car!
For our second day in the park, we went on our own in the rental car. Right when we entered the park, we saw part of the same pride. A lion and at least 3 lioness were sleeping after a long night of hunting.
With the smaller and quieter car, we were able to see a lot of the birds of South Africa, including some of the rarer ones. We found a rare stork (can't remember the name right now) who is one of the remaining 50 mating pairs in the world.
For our second day in the park, we went on our own in the rental car. Right when we entered the park, we saw part of the same pride. A lion and at least 3 lioness were sleeping after a long night of hunting.
With the smaller and quieter car, we were able to see a lot of the birds of South Africa, including some of the rarer ones. We found a rare stork (can't remember the name right now) who is one of the remaining 50 mating pairs in the world.
While driving and pointing out the smaller animals, we see an elephant in the middle of the road up ahead. No other car was around, and he was walking slowly toward us. Now when you are in a car low to the ground and see a big elephant walking toward you, it is a bit unnerving, but we turned off the engine and stayed put. It just continued stomping around the car and continued on it's way like we weren't even there. Later, another elephant crossed in front of us and we watched as he scratched his back on a tree (nearly knocking it over). We also saw a big group of elephants pass by. It was definitely elephant day.
During breakfast and lunches, we would stop at look-out points. We ate the fruit and bread that we had and enjoyed the peace and quiet of the area. It was (and still is) hard to believe that places like this exist.
There was more stress later when we realized the bus we were planning on taking only leaves on Thursdays. We found out on Friday. After looking through all our other options and having most of them unavailable, there was only one decent option left. So for the next part of our journey we had to head to Mozambique. The next morning, ASAP.
It was New Year's Eve and so we went to a local restaurant, got a bottle of wine and ate fish. I had an amazing "butter fish" with a baked potato and their fresh vegetables of the day. It was delicious. We arrived back to Kruger View Lodge just before 11:30 pm and I am ashamed to say that I was so tired, that I fell asleep listening to the fireworks go off, celebrating the New Year.
There was more stress later when we realized the bus we were planning on taking only leaves on Thursdays. We found out on Friday. After looking through all our other options and having most of them unavailable, there was only one decent option left. So for the next part of our journey we had to head to Mozambique. The next morning, ASAP.
It was New Year's Eve and so we went to a local restaurant, got a bottle of wine and ate fish. I had an amazing "butter fish" with a baked potato and their fresh vegetables of the day. It was delicious. We arrived back to Kruger View Lodge just before 11:30 pm and I am ashamed to say that I was so tired, that I fell asleep listening to the fireworks go off, celebrating the New Year.
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