Hi everyone- sorry for the delay...internet was down for a while and we were crazy busy at the hospital, so were unable to post about our last 3 days finally working! I also apologize for the numerous typos in this post. It is our lunch break so I am typing quickly and will not have time to proofread...
Oh, and Happy belated Valentine's Day!
WOW. The hospital is incredible- as in very few resources. What a sight to see... hopefully we can post some pictures. Where to start? I guess I will describe the hospital first, then give you a glimpse of what we've seen/done each day.
Ekwendeni is a primitive, resource-poor place.
BYOB: Bring your own blood donor.
BYOCT: Bring your own caretaker
BYOEverything: Bring your own bed sheets, clothes, food, drinks... Patients have family members or friends here 24/7 to help take care of them. Nurses strictly take vitals, put in IVs, and administer medications and fluids (many of which they have mixed themselves). Family members do everything else for the patient. In between all the buildings there are people lounging, wandering around, hanging laundry to dry. Patients sometimes go down the street to the makret themselves. There is a building for families to store their own grain and maize. There is a porridge factory, but is often not functional (like right now). MDs do everything - they are the internist, surgeon, pediatrician, obstetrician all in one. There is a female ward, male ward, both with beds in the back porches for TB patients, a maternity ward (w/ private birthing rooms- very luxurious), neonatal "ICU" where there are basically just beds for mothers to lay and kangaroo the premies for warmth, since there are no incubators. All babies sleep in bed with mother. There is also a building for expecting mothers 8 months+ preganant. They can come here prior to labor because if they go into labor in their home village, they may not make it to the hospital in time. There is a pediatric ward, which is the most busy, especially now during malaria season. There are 2 operating theaters (major room for C-sections, another for minor surgeries like hernia repairs and Incision & Drainage of abscesses; all surgeries are done by any physician or medical officers (malawian physician assistants). There is an outpatient department adn several clinics, such as Antiretroviral CLinic, Palliative Care, Family Medicine. The Emergency Department is basically a room of supplies that is kept unlocked so people can access some supplies if absolutely necessary. No medicines are kept there. Most of the time, patients are carried directly into their respective ward. There is a small pharmacy and a lab that can process only Hgb, Hct, urine dipstick, CSF studies, stool studies, blood films, VDRL, HIV, TB, and CD4 counts. There is 1 ultrasound machine and one CXR machine, but currently there are no films to take XRs.
Staff: 3 physicians; Dr. Carol is from Scotland and has been here 2 years, Dr. Martha who is from Amercia but away this week so we have not met, and Dr. Annika from Holland who we have been spending the most time with. She is here for 4 years with her husband and threee children (ages 1, 4, and 6). There is 1 nurse per ward and about 3 medical officers that share call (and surgeries) with physicians.
Day 1: After a tour of the hospital, Ijoined Medical Officer Albert for Adult Ward rounds: 2 women with TB, and men with enlarged prostate (was transferred to Mzuzu), 2 drunks, psychogenic heart palpitations, shin lac, astham exacerbation, and 2 very sick HIV/TB patients. Then I joined JUlie and Dr. Annike in the pediatric unit where rounds were taking place. This occurs in one large room, where parents sit in a circle with their sick child on the lap and we literaly go around the circle (ROUNDS, haha) one at a time. Some interesting cases, but mostly children with malaria. The sickest ones have malaria that has gone to their brains. There was one child with sickle cell crisis who probably had a stroke becasue she couldn't move the left side of her body. At one point, a child came in convulsing, most likely a complication of malaria. Annika did a crazy fast perfect LP. They actually took oxygen off a sick child to give to this sicker child. Then the power went out and no one had oxygen until the generators kicked in!
Minutes after that chaos, Annika was called to perform a C-section on a 17 yo girl for breach presentation. US surgeons would scoff at the procedure- so primtive. It is much like I would imagine an ED physician performing an emergency C/S. Plus everything in the theater is re-used including sterile equipment. Scrubbing means washing your hands with a abr of soap. In the theater we adorn a scrub-like dress, welly boots, a plastic apron that is wiped "clean" after every surgery, a cap, mask, glasses, and double gloves. Everything but the gloves are washed again and re-used. She used every last centimeter of suture before opening another. Only used 2 packs for the entire surgery. Instead of a time-out, Annika said a quick prayer. 2 quick incisions, pulled the baby out (quite difficultly, might I add. The incision was a bit small and they ranked that baby so much at its neck I was glad to see it could move all its limbs after birth). Then sutured the uterus and belly right back up.
This was all before noon. The rest of the day we checked on all of the patients, helped with vitals in the pediatric ward. Then passed out in bed early that night.
Highlights from Day 2: Valentine's Day! I saw lot's of patients with TB. Julie performed a successful lumbar puncutre on a 2 yo with convulsions, probably complication of malaria. We went to round on the maternity ward and walked in two find one girl who had lost 2 liters of blood overnight after giving birth. She was taken to the theater and 2 cervical lacs repaired. Around 5pm, Julie and I admitted an 81 yo lady (very rare in Malawi, considering the average lifespan is 46 years!) with severe watery diarrhea and0wT%du0Q_ntus. Probably hypoglycemia and dehydration secondary to dysentery... but had to rule out... you guessed it!.. MALARIA. The nurse started her on fluids. I don't think she was seen by a physician until the next morning.
Now it is the afternoon of Day 3. Julie and I rounded together in the female ward (many admissions last night, mostly malaria or pregnancy complications) then prewented to Dr. |Annika. A nurse was not available to translate, but I think we did quite well using our limited vocabulary sheet and many hand gestures. When the nurse returned, she scarily started implementing our plans on all the patients before Annika could even sign off on them! This morning was also a crazy morning in the pediatric ICU (1 table where the sickest children receive fluids & blood). 2 children came in with severe malaria- one convulsing, one in respiratory distress & severely dehydrated. This time I got to do the LP on a 26 month old (champagne tap, might I add- well... it was clear and one stick- there's no CSF cell count available). Julie constantly ran back and forth from the lab with blood and the single glucometer in the hospital. The pharmacist was on lunch break and not responding to Dr. Annika's calls. I was filling fluid bags and adding quinine or dextrose, literally approximating IV drips. One child still needs blood, but hopefully the lab tech will return and the child will be ok when we check on him this afternoon. I've certainly started to experience dealing wtih really really sick children. Its really scary. These extremely lethargic children would definitely be admitted to the ICU at home, but instead, here, they lay on a single table together, receving fluids and/or blood, quinine for malaria, and get their vitals and blood sugars checked.
PHEW! Has it only been 2.5 days?
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