Nick’s on call today. But right now, he’s up at the hospital giving blood. He got called in a few hours ago for an admission. He ended up having five patients come in. One of them was a kid who died from anemia waiting for blood. His hematocrit was 5 - probably means a hemoglobin of around 1. Normal hemoglobin is somewhere about 12-17. In the United States we usually give a blood transfusion once it gets down to 7. Death and suffering is so commonplace here. We usually end up talking about his day by focusing on what he’s learning or something new he was able to do with ultrasound. Here’s a few snippets he wrote in an email about life at the hospital. The email was to the director of the fellowship and the other fellows going abroad in January so it's pretty technical.
"They were really hurting for help when we got here and were really glad to have us. In looking back they were really gracious to let us have a couple days and the weekend to catch up before really getting thrown in. There is one pediatrician and one med/peds post residency fellow who had been the only medical doctors here for basically 2 months while one family was on furlogh. They were getting burned out seeing every kid and adult in both the outpatient and inpatient areas.
I started out for the first week in the PMI which is their outpatient ward for kids <5 yrs. It is lots of empiric treatment of disease which has been a little difficult for me as we really rely on history and have very few definitive diagnostic studies. Labs we can get: CBC, HCT, ALT/AST, Na, K, Cr, CO2, urine dip, urine micro, thick smear (no thin smears), peripheral smear (for sickle cells and once they saw filaria!), sputums for TB, and HIV 1/2. They do stool exams but I think they are few and far between and there are no cultures done and little to no gram stains of anything. They have medical screeners that treat basic medical problems that are straight forward and then send everyone that is sick or complicated to us. Probably 60% of what we are seeing now is malaria in kids and it isn't even malaria season yet!! There are also lots of superficial skin infections with bullous impetigo, sickle cell crises, pneumonias, diarrhea/dysentery, dehydration (that gets really severe), and really crazy malnutrition. Any people that we admit from the clinic or while on call we take care of until we discharge them, which usually means rounding on 6-12 patients in the AM.
Cerebral malaria and seizures here are a conundrum. IV/IM diazepam and oral phenobarb are the only seizure meds that we have available currently. I had a kid seize for almost 24 hrs straight and couldn't get them to abort even with huge doses of diazepam and trying to give phenobarb by NG. It was the most frustrating thing that I have encountered here and I think took me from the "everything is interesting and fun" to "this sucks" pretty quickly. It was a good spot to be in to have to rely on the Lord and for Him to be sufficient for both me and the child. If you have any extra IV anti-convulsants around in the US, send them this way as malaria season is coming...
The second week I moved to the OPD (adults and kids >5 yrs) and Parker moved to the PMI. The OPD is ultrasound heaven. I have loved learning and have really improved my skills in the one week I have been here. I have diagnosed with ultrasound: pneumonias, pneumothorax, pleural effusions, constrictive TB pericarditis, CHF, metastatic liver masses, perforated typhoid, gangrenous large bowel, bowel obstructions with perforation, ascites and liver failure, intussecption, splenomegaly, ovarian cysts, neurogenic bladder, hydronephrosis, BPH, Bladder masses, extremity abscesses, and probably more. I really love it and have enjoyed being able to have more of a definitive diagnosis for things in the OPD that I can diagnose with ultrasound. I have been surprised by the variety that we see there from hypertension and diabetes (?), filariasis, lots of TB, lots of typhoid, lots of malaria, some HIV, skin infections, one case of cutaneous leishmaniasis, asthma (that has nearly no treatment options here), etc. The x-rays I have seen here have been like none other too!!
We have not got into the OB side of things yet but probably will soon now that we are getting more comfortable with the Med/Peds part."
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