Day 42: Happiness

Decided to try a full day in A&E. Mondays are the busiest because they are right after the weekend, so it was already in full swing when I got there. The resuscitation room was overflowing. I started seeing one patient, but when I was ready to present to the attending, when more serious patients came in, she was deemed stable enough to be admitted through the regular room.

While parents were waiting patiently in a line out the door (any of these kids would have been a priority 1 in the States), we noticed one kid who went floppy with her eyes rolling into the back of her head.

She was placed on a table, given oxygen via a bag valve mask while IV lines were placed. Mom grabbed me, frantic and crying while asking "Is she dead?!" I said that she was alive but that she was very sick.

The glucose was checked and blood was drawn. I drew up some glucose which was given. A NG tube was placed. Meds were given and she started to come back. After she stabilized, we learned her story. This was a 9 month old girl named Happiness who was having intermittent seizures. One of the Scottish students kept an eye on her while the rest of us went back to the others.

I went with the attending to help with a 4 month old named Happiness (we will call her Wee Happiness and the 9month old Big Happiness). Wee Happiness had a bad case of gastroenteritis that left her severely dehydrated. She had no good veins because she was so dehydrated and cold. The attending tried in the feet, hands, arms, femoral, the scalp and the neck while I held her down. She barely even whimpered throughout this ordeal she was so weak. Finally the attending was able to use a regular needle to drill into her shin bone (interosseous). Then we could pump some fluids into her. After a few boluses, the attending was able to get a line in her neck and she warmed and perked up.

Another memorable patient from that day was the 3 year old that I saw in the triage room. He was wheezing and coughing. I drew up Salbutamol (opens the airways) and placed him on a breathing treatment (like a humidifier). We gave him some meds for his pneumonia (here they use X-penicillin and gentamicin) and admitted him.

The rest of the patients in the resucitation room were diagnosed with cerebral malaria and we transferred them to the malaria research ward. When A&E "closed" for the evening (the ER is moved to a different area), we piled 4 sick kids on a stretcher. The stretcher included Big Happiness, Wee Happiness, a cerebral malaria child and a 1 month old child with oxygen tanks. We grabbed a bag-valve-mask and wheeled them to their respective wards.

After the walk home, I arrived just in time to see 2 students and 1 of the guards chasing chickens around the yard. They caught and killed two of them. It is true that chickens do run around without their heads after death. Kind of creepy.

They then plucked and removed the insides and we had a fantastic meal with steak, chicken, mashed potatoes, green beans and brownies. Two of the other guys arrived back late that evening from their Victoria Falls trip.


Day 43: Chatinka Nursery

In the morning, I said goodbye to 3 of the crew as they left to continue their travels (they had taken extra time off).

I went to Chatinka Nursery, which is where infants go right after birth if they have any complications or are just a low birth weight. They also have something called Kangaroo care where the moms wrap the baby to their chest to keep them warm, stimulated and to have a place to sleep. It's cool to see. The mom with twins wraps both of them up to her front. There are a lot of twins here because the pregnancies are considered more complicated, so they are sent to Queen Elizabeth Hospital.

I was able to see spina bifida, learn about feeding, guessing babies’ gestational age, and treating jaundice. We also monitored the premature babies for hypothermia, hypoglycemia and infection.

After the day at the hospital, I took a minibus to Shoprite and Game, which are grocery and department stores. It was such a relief to not have to barter. Then I took a minibus to the wood market and purchased my last souvenirs. Ironically I saw one my school’s club t-shirts on one of the guys that someone had used to barter with. It made me smile 

That night I said goodbye to two more members as they headed off to Zambia or Tanzania.



Day 44: Twins

I went to Chatinka nursery again, as I had such a good experience there. I was able to write notes and examine the kids. Helped out in a “jaundice study” where they are determining how accurate the bilirubin monitor is to what the actual number is in the babies’ serum. There have been numerous studies, but very few dealing with darker skin children, which could give false readings on the machine.

At handover in the morning, I heard a story about a mum with post-partum depression who had brought her newborn in. The child was very sick and should have been brought to a hospital sooner. Whether or not the mum delayed care due to her post-partum depression was debatable. The infant was too sick and passed away shortly after arrival. The mum had a very flat affect; she was expressionless. The worry was that she had another infant (twin) at home and what could happen if she wasn’t treated for her depression.

However, I learned that her lack of sorrow at the death of her child may also be due to cultural reasons. Apparently, when there are twins, if one dies, then the mum may not mourn, as it is considered bad luck for the surviving twin. Which I found interesting, for obvious reasons. Still they were going to try and treat her.

They also mentioned a child who was involved in a minibus accident where he was walking and was hit. He was unable to move half of his body and they were going to get a MRI on him to look for any brain damage.

That evening I went to the market and bought fabric, as I was trying to use up all of my kwatcha (Malawian money) before the weekend.


Day 45: Exams

I was awakened at 3am by the other 2 guys coming back from Victoria Falls. I heard all about their travels, including their bungee jumps. Watched the video and it was insane. They wrapped their ankles with a towel each and then a towel between. Then there was one safety harness. They had to jump straight out and head first, looking at the rapids below. Crazy.

I went to the neuro clinic in the morning, where I saw Seraphina, a girl I had seen my first week. She was still having some behavioral problems and developmental delay, which is common here. Another girl who was very similar to Seraphina, actually ran away from home and was missing for 2 weeks. She was then found in Mulange (1 hr drive away) where she had been abused. The developmentally challenged are difficult to treat, especially in underdeveloped areas. The neurologist was trying any medication he could think of, but not one of them did much.

Another child was having seizures, nystagmus (eye movement) with right-sided paralysis. They were still doing a work-up on him.

And finally, one of the girls I have seen on some other ward came in for a follow-up on her craniopharyngioma. She still had a shunt in her head to keep her from getting hydrocephalus, but was going to South Africa to be evaluated for surgery. The parents were quite religious and were insistent to the neurologist to take the shunt out and let them visit a “South African priest who does miracles.” The neurologist had a long discussion with them about believing in the power of prayer with the surgery, but said that she would have a poor outcome if they removed the shunt and didn’t remove the craniopharyngioma. That being said, both the priests and surgeons are in South Africa, so who knows what the family will do.

That afternoon I was volunteered to be a timer for the Malawian med students exam. It was interesting how they do it here (makes sense) because they have stations that have you show your clinical exam skills, resuscitation skills, history taking skills, and physical exam skills. For the history taking and talking to a “mom” about giving oxygen, there were actors. They had a dummy for the resuscitation room and then real patients for the physical exam room. The babies kept crying so much that they had to keep rotating them out. One of the “patients” was actually the patient who I removed his peritoneal tap, when I was on the Medical Bay ward. He waved as he walked past. It was nice because I got to see all of the med students that I worked with over the past 6 weeks.