This post begins with our voyage atop Chinongu Mountain Sunday evening. It is really just a large, bouldery hill, but my super graceful climbing skills (ha) made it much more difficult than necessary- I now have minor battle wounds to show for it. Free souvenirs! Hope you enjoy the view we posted :)
So far this rainy week we've had a very busy time at the hospital:
Hearing about the weekend events at the hospital on Monday morning was quite shocking. We learned that on Saturday there had been a double mini-bus accident on the main road when one mini-bus tried to overtake another right by Chinongu (which isn't surprising considering the driving we've witnessed here!). Sadly, 4 people died in the wreck- one a mother of a 3-mos child. Luckily, the child was unharmed in the accident. Someone also saw a man covered in blood running from the scene of the accident, assumingly the driver of the bus. However, the staff of Ekwendeni Hospital on-call and at home came together and worked very well through the trauma, allowing no deaths in any passengers brought here. Also, we learned that a child died in the ward on Friday evening. This was upsetting because we had rounded on her in the morning and, in fact, her case was not very rememberable because she had no issues at the time and no hint of decompensation. Two tragedies.
Seeing new patients this weekend has been very interesting. On Monday we US scanned a woman 20-weeks pregnant, diagnosed with malaria, who had been having vaginal bleeding and contractions for 2 days. Although we found a fetal heart rate, it was slow. There were no fetal movements and no amniotic fluid, indicating that a miscarriage was inevitable. We just had to wait. However, the heart was still beating (with decelerations) on Tuesday and she had actually stopped having contractions, but when we scanned her again today (Wednesday), there was no longer a fetal heartbeat. It was difficult news to deliver (and to receive, I'm sure). Now labor would be induced to avoid any septic complications.
In the children's ward this week have been some more sad cases. One child with cerebral palsy was diagnosed with malaria and malnutrition- he is 4 years old and weight 8 kg! It has been very difficult to assess his feeding ability both orally and through his NG tube. Its funny- at home we worry about levels of functioning in children with cerebral palsy, but the largest issue here is simple nutrition. We also discovered that another child we have been following for the past week was HIV positive (we simply screened him because there were tests available, not for any reason in particular), as well as his mother. I can't imagine what him and his mother have been going through. Just imagine- bringing your child to hospital because he is deathly ill with sepsis, but watching him improve over the course of the week until he is ready to nearly go home, then discovering that both you and him are HIV positive and that your three-year-old son will need to start antiretroviral therapy now, which he will continue for life, and you may need to start medication soon as well. It breaks our hearts. We actually discovered two HIV positive children through routine screening this week.
On Tuesday there was fuel for the mobile clinic! At 9:15am we were told they would be leaving at any minute, so Julie and I rushed over, ready to go. But typical Africa time, we were FINALLY on the (very bumpy) road to Luhomero village by 11am (after stopping once for a live chicken - lunch! - and once for vegetables and rice at the market). The "clinic" was really an empty building with 4 empty rooms, but was crowded with mothers and their babies waiting to be seen. Children were weighed (by hanging them on a hook with fabric pieces), screened, and received various immunizations. Unfortunately, Julie and I were not extremely helpful talking to the young mothers (in the villages hardly anyone knows English, and we only know how to ask a few questions in Chitambuka which are only helpful with yes or no answers). However, we did perform the antenatal exams on the expecting mothers- weight, blood pressure, gestational age, fundal height, and listened for fetal heart tones- with a hollow hourglass contraption, not Doppler! Its definitely a learned skill, but we are just starting the get the hang of it. We also were able to give a couple vaccinations, so we weren't totally un-useful! It was a great experience and we were very glad there was fuel to go that day!
Now this morning was the most interesting day so far. After rounding in the children's ward with Anneke, a man came into the rounding room and sat down in front of Julie and proceeded to hand her a small package with what looked like teeth in it and then began to take off his pants. Something was wrong with him (drunk? mentally ill?) and we quickly rushed him AWAY from the children and to the outpatient department. Then a man was brought in who had been hit by a taxi as he was walking alongside the road. He was clearly bleeding internally, so we did what we could and sent him to the larger surgery-capable hospital in Mzuzu... by taxi! (The ambulance had left, but no worries, Dr. Jack accompanied him to Mzuzu in the taxi and stayed with him until they took him to the OR for a splenic laceration). Then we US scanned the pregnant woman described earlier, then another pregnant woman for gestational age, although she "guessed" (correctly) she was about 9 months, and then another patient who had been diagnosed with pancreatic cancer and had some operation, but was now experiencing abdominal pain again. Julie and I thought we had been becoming more comfortable with ultrasound throughout this year, but due to the operation and cancer, this gentleman's abdomen was a mess. It was very difficult to identify normal structures and landmarks. It was possible that the cancer had metastisized to the liver and that there was a large cyst near the pancreas- anotehr case in which a CT or PET scan would be more than helpful! Lastly, we returned to Children's ward to check on one child who was quite sick and nearly unconscious during rounds, but she had not improved with fluids, so we started antibiotics and I did an LP to rule out (hopefully) meningitis. There are no more glucose strips available to test her blood sugar, but hopefully the dextrose in her IV fluids will help. Another day where the lack of resources are just so pronounced. But I mention only the interesting cases, which are often the sickest cases. Over just the course of two and a half weeks, we've seen hundreds of patients get well again. Mickie is not an exception! While we can constantly comment on Malawi health care, one of the poorest of the resource-poor countries, we can also celebrate the healing that occurs in hospitals like this one. Everyone is just doing their job with what they have- and very well!
Oh, and one last disappointing (albeit humorous) comment to leave you with, Julie and I ONCE AGAIN bought "mangoes" at the market only to discover that, yes, they were, in fact, avocadoes. Fool us twice, shame on us. Maybe we are lacking some mental resources here...
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