Yewo

(The best word in Malawi, used for "yes, ok, thanks, hello", and pretty much anything else. Its our go-to response- hope no one catches on to us)

So the really sick children Julie and I were praying for pulled through and made it through the night. For severe malaria, the first 24 hours are the most critical, so its a good sign. Unfortunately, the peds ward was crazy busy again this afternoon- another cerebral malaria (Julie did a very difficult LP on this little bucking bronco) and a septic child... I guess we will be getting more comfortable dealing with really sick kids. Don't ever want to get too comfortable though...

One man with HIV & TB in the male ward is deteriorating quickly and they say there is nothing we can do. "He's terminal".

On the other hand, it was a party in the female ward this morning as Julie and I conducted rounds ON OUR OWN. We have one vocab sheet and lots of hand gestures, but we get by. Luckily, most of the women were feeling better and going home. They enjoyed laughing at (with?) us during each patient encounter. At least we could bring them cheer. We did have to remind the nurse that someones hand to sign off on our plans before he started processing our orders.

The shocker this morning was that our 81 yo with diarrhea passed away about a half hour before we arrived at the hospital this morning. It really surprised us, but then again, she was really sick, probably (actually, definitely) septic, although there was really no way of telling for sure.  Who knows if she actually received the fluids we ordered. Its funny- doctors at home get called by nurses for the tiniest details, but no one called a physician overnight when her temperature dropped to 33C... the only progress note in the chart after our morning rounds note was acknowledging her death, followed by "Sorry" and a signature. Not much else we really could have done for her. It made Julie and I stop and think though. The protocol for caring for this woman would have been completely different back home. It's easy to get lazy/comfortable just rolling with what's only available. Maybe we could have been more aggressive that she received fluids, given her hypotension? Or maybe we could've suggested starting antibiotics... but just for what seemed like a simple case of diarrhea, which had improved over her first day here? Who knows what was actually going on with her body. We are in no way blaming ourselves, but it was a reality check that we shouldn't just forget our training because its not what they do here. Maybe we can help people get creative with the resources available. Now were are not going to forget to use our fresh minds.

On a lighter note, we are making plans for the weekend at Lake Malawi in Nhkata Bay. Going with Dr. Carol, Rhianna (a Dutch homeschool teacher), and 2 midwifery students from Northern Ireland- should be a good time! THe highlight of the trip will be grocery shopping in Mzuzu on the way back on Sunday. If Julie and I are lucky, the store will be stocked with some sort of dairy product, preferably cheese... any kind of cheese, really... even if it comes out of a can. Noodles/rice/nsima and chicken for every meal are starting to get old. We are avoiding the goat's feet.