Hey friends,
It's been a short week in peds but a couple of highlights include that we were able to diagnose our kid with fevers for 3 months with TB using a PPD skin test. The TB coordinator didn't exactly agree but after Dr Lace talked with the chief medical officer, I think we made our case and the child will be able to get treatment and go home as she is not all that ill with the exception of the fevers. Another interesting case that came in yesterday was a young boy with some sort of movement disorder. We're still not entirely sure what is going on but it is mostly likely a case of rheumatic fever. Maybe we'll have some
answers when we get back and see how he is progressing. Then this morning we saw a rare occurrence: a child with chicken pox. For whatever reason, chicken pox is actually very rare here and the doctors actually weren't quite sure what to do with him!!
We also saw our first case of pediatric HIV. Very sad. He's very ill and has likely progressed to AIDS but we're going to do all we can to get him healthy: anti-retro virals, antifungals, antibiotics and hope that we're able to give him enough of a fighting chance to recover. We still haven't had a chance to visit any of the HIV clinics here but that is definitely on the list before we leave.
As for our mid-trip break, we'll be heading to a Maasai village with Dr Lace tomorrow for a few days to put on a clinic. We get back Saturday afternoon and them we'll leave on Sunday morning to meet our new friends in Zanzibar. We're not entirely sure how long we'll be staying but likely for about 4 or 5 days.
Since we'll be out and about, no guarantees of when I'll be able to post another blog so hang in there and I'll update when I can!!!
Tuesday, July 20, 2010
Sunday, July 18, 2010
An adventure to Arusha National Park
Today was time for another adventure. We got up, ate breakfast, got dressed and packed our things for the day, each of us equipped with our cameras. It was time to try our luck with Arusha National Park.
We loaded onto a dala dala, the local "bus system" here and rode for awhile before paying our fee of 500 Tsh. The driver had us get off at what we thought was our stop but then motioned us to the next dala dala that would take us the rest of the way. Classic. This is usually how our adventures begin. Being shuffled around from one place to the next, not exactly knowing what's going on but we seem to be heading in the right direction and have managed to land on our feet each time.
This time was no different. We got off at our stop and then starte walking but realized after a short ways that we had no idea where we were going. Fortunately a taxi driver caught up to us that spoke English pretty well and helped us find a dala dala to Ngongongare Gate, one of the main entrances to the park. Again, we were hesitant but thankful for the direction.
It took awhile for us to get going as they typically wait to pack the dala dala as full as possible and then we were off. We made a couple stops and then POP!! We're not exactly sure what happened but we think a tire popped. The money collector and the driver got out and started jacking up the car to put on what we assume was a spare tire. We knew it was only a matter of time before we managed to hope on a dala dala before it broke down. No big deal though, we were back on the road heading towards our destination.
On our way to the gate a monkey/baboon ran right in front of our dala dala!! So cool!! Then as we pulled in and paid our fare, there were giraffes right there at the gate!! It was amazing! We were within feet of these huge animals!
We wandered around looking at the giraffes for a little bit, talked to a few people to see if there was space for us to bum a ride with anyone and finally decided to just go in and pay the entrance fee and hopefully be able to hire a guide for a walking safari. When we mentioned that this was what we wanted to do, the guy looked at us like we were insane. He couldn't figure out how we had gotten there or how we expected to take a walking safari from that gate. Apparently we needed to go to the Momella Gate. Would have been nice to know but oh well. We walked out and tried to figure out how we were going to get there and just as we were about to start our way back to Usa River where we could catch a taxi to the right gate, a guy came up and explained that he had overheard that we needed transportation and he happened to have 3 extra seats to go through the park with him and his mom. What?! I'm sorry but there's gotta be a catch...
We proceeded to go through the park and ended up being their photographers since their camera battery had died. We got to see giraffes, warthogs, buffalo, gazelles, more monkeys/baboons and tons and tons of flamingoes. The flamingoes smell really bad by the way.
We went through the park and had a great time. Earlier when we had been trying to figure out what we were doing, our new friends mentioned that they were going to the snake park in Arusha. Since they were headed back our direction anyways, they insisted on taking us back and dropped us off at the same dala dala stop we had left that morning. We offered to at least be able to pay them for gas but they simply refused and insisted that we come to Moshi sometime and they would show us around.
I'm pretty sure we could not have planned this day if we tried.
We loaded onto a dala dala, the local "bus system" here and rode for awhile before paying our fee of 500 Tsh. The driver had us get off at what we thought was our stop but then motioned us to the next dala dala that would take us the rest of the way. Classic. This is usually how our adventures begin. Being shuffled around from one place to the next, not exactly knowing what's going on but we seem to be heading in the right direction and have managed to land on our feet each time.
This time was no different. We got off at our stop and then starte walking but realized after a short ways that we had no idea where we were going. Fortunately a taxi driver caught up to us that spoke English pretty well and helped us find a dala dala to Ngongongare Gate, one of the main entrances to the park. Again, we were hesitant but thankful for the direction.
It took awhile for us to get going as they typically wait to pack the dala dala as full as possible and then we were off. We made a couple stops and then POP!! We're not exactly sure what happened but we think a tire popped. The money collector and the driver got out and started jacking up the car to put on what we assume was a spare tire. We knew it was only a matter of time before we managed to hope on a dala dala before it broke down. No big deal though, we were back on the road heading towards our destination.
On our way to the gate a monkey/baboon ran right in front of our dala dala!! So cool!! Then as we pulled in and paid our fare, there were giraffes right there at the gate!! It was amazing! We were within feet of these huge animals!
We wandered around looking at the giraffes for a little bit, talked to a few people to see if there was space for us to bum a ride with anyone and finally decided to just go in and pay the entrance fee and hopefully be able to hire a guide for a walking safari. When we mentioned that this was what we wanted to do, the guy looked at us like we were insane. He couldn't figure out how we had gotten there or how we expected to take a walking safari from that gate. Apparently we needed to go to the Momella Gate. Would have been nice to know but oh well. We walked out and tried to figure out how we were going to get there and just as we were about to start our way back to Usa River where we could catch a taxi to the right gate, a guy came up and explained that he had overheard that we needed transportation and he happened to have 3 extra seats to go through the park with him and his mom. What?! I'm sorry but there's gotta be a catch...
We proceeded to go through the park and ended up being their photographers since their camera battery had died. We got to see giraffes, warthogs, buffalo, gazelles, more monkeys/baboons and tons and tons of flamingoes. The flamingoes smell really bad by the way.
We went through the park and had a great time. Earlier when we had been trying to figure out what we were doing, our new friends mentioned that they were going to the snake park in Arusha. Since they were headed back our direction anyways, they insisted on taking us back and dropped us off at the same dala dala stop we had left that morning. We offered to at least be able to pay them for gas but they simply refused and insisted that we come to Moshi sometime and they would show us around.
I'm pretty sure we could not have planned this day if we tried.
A week in pediatrics...
My apologies that I haven't been able to update my blog as much. We're down to one laptop and an iPhone making it a bit more difficult for all of us to keep everyone up to date. I spent most of this week in peds with Dr Lace. It has been great to have an American doctor here who actually wants to teach.
I won't go over every detail but here are some thoughts and highlights from the week. On our typical day we start rounds in the pediatric ICU and then move through the rest of the ward. Some days it's quiet and other days there are 2 or 3 moms with kids to a bed.
I've gotten to know the patiets in the ICU pretty well cuz it's mostly the same ones every day. This week we got to send one patient home who's mom was a doctor so we were able to communicate with her. Her little girl had a presumed UTI and we had her on ampicillin and gentamicin and it seemed to do the trick. It's always a good day when we get to send someone home. Our next patient has been at mt meru for a very long time. He has cerebral palsy and is unable to walk, talk, or feed himself. He is being treated for pneumonia and has many bed sores that get washed and dressings changed periodically. Our big achievement this week was that we finally started him on a regular disingenuous schedule of pethidine (opiate not quite as strong as morphine) which has seemed to help him relax and keep him from crying all the time. His prognosis is not good and the basic idea is to make him as comfortable as possible until he passes on.
Our next patient has been in the ICU for probably about 3 weeks and was being treated for TB and wasn't getting much better until we started him on erythromycin for atypical pneumonia. Since then he has improved a ton and is doing much better.
The next is a baby who came in with bacterial meningitis and we were able to do a spinal tap and get some cultures which confirmed the diagnosis. She was started on ceftriaxone and has been steadily getting better.
Our last constant innthe ICU is a Maasai baby who came in with a very distended abdomen and was not doing well. We haven't exactly been able to figure out what's going on with him but we do know that the abdomen became distended after he was given a local herb named Lamande for diarrhea. He has been up and down but basically we've just been treating with antibiotics for presumed peritonitis and using a nasogastric tube to help relieve some of the pressure. He's also on oxygen. He's been draining bile from the NG tube but we're still not sure what to do with him except treat supportively and hope that his body is able to clear the toxin.
Our very interesting case on the other side was a little Maasai boy who was 2 years old and only weighed 9 kgs. He had been having trouble urinating since birth and his mother noticed some masses in his abdomen. We sent him for ultrasound and xray to find out what was going on. His ultrasound showed severly backed up kidneys (hydronephrosis) all the way down the urinary system to a very enlarged, thick walled bladder. His creatinine was also extremely high. The diagnosis was an obstruction in the proximal urethra which needed to be surgically repaired. So he was referred to another hospital.
We have another child who is 7 months old and has ha fevers for 3 months. No other symptoms and no idea what's wrong with her. We gave her a TB test Friday so we'll see what shows up on Monday.
Other than lots of malaria, diarrhea, pneumonia and malnutrition, we've been surprised to learn that there are no less than 4 kids with heart murmurs that we've seen in one week. I don't know what the statistics are in the US but my guess is that it's higher here and might pose an interesting research project for someone in the future. Another interesting topic could be the prevalence of cardiomegaly among children with malnutrition. We've seen at least one chest xray of a child with severe malnutrition and her heart was HUGE!! She probably has had so few nutrients that her heart has been working mega overtime to get nutrients to all her tissues.
We also had a boy with a very large abscess under his chin which Dr Lace opened up and drained and then we had to come back every day for the next 3 and drain more. The poor kid would start crying every time he saw us! Finally on Thursday, when we went to check on him there was nothing more to drain! We had also brought him some peanut M&M's which he was a little unsure about coming from a white coat but hopefully he enjoyed them.
All in all, it's been very interesting being on the peds ward. There are so many needs, it's hard to know here to start. It's hard to know whether to start with education, remodeling, donating supplies, or new equipment. At times I just feel overwhelmed not knowing what to do for many of these kids but also not having the proper diagnostic tools. So many of the Maasai kids come in severely underweight for their age and often because they have to travel so far to come to the hospital, they're in really bad shape by the time they get to us. How can you change cultural traditions, such as the toxic herbs, when they've been in place for hundreds if not thousands of years? One encouraging thing is that genital mutilation, also practised by many Maasai tribes, has become a severe crime and is becoming much less common. It's a totally different world over here and it's hard to know what would help and what would make things worse? What is sustainable and what would crumble as soon as we leave? Is there anythig that we can do for research that would actually benefit these people? Or is it simply the presence of people that are willing to step into the trenches with them and just be there?
I really don't have answers for a lot of the questions that plague me but I do know that like Dr Lace, I want to keep coming back and do whatever I can to help, both here and other countries like Tanzania.
I won't go over every detail but here are some thoughts and highlights from the week. On our typical day we start rounds in the pediatric ICU and then move through the rest of the ward. Some days it's quiet and other days there are 2 or 3 moms with kids to a bed.
I've gotten to know the patiets in the ICU pretty well cuz it's mostly the same ones every day. This week we got to send one patient home who's mom was a doctor so we were able to communicate with her. Her little girl had a presumed UTI and we had her on ampicillin and gentamicin and it seemed to do the trick. It's always a good day when we get to send someone home. Our next patient has been at mt meru for a very long time. He has cerebral palsy and is unable to walk, talk, or feed himself. He is being treated for pneumonia and has many bed sores that get washed and dressings changed periodically. Our big achievement this week was that we finally started him on a regular disingenuous schedule of pethidine (opiate not quite as strong as morphine) which has seemed to help him relax and keep him from crying all the time. His prognosis is not good and the basic idea is to make him as comfortable as possible until he passes on.
Our next patient has been in the ICU for probably about 3 weeks and was being treated for TB and wasn't getting much better until we started him on erythromycin for atypical pneumonia. Since then he has improved a ton and is doing much better.
The next is a baby who came in with bacterial meningitis and we were able to do a spinal tap and get some cultures which confirmed the diagnosis. She was started on ceftriaxone and has been steadily getting better.
Our last constant innthe ICU is a Maasai baby who came in with a very distended abdomen and was not doing well. We haven't exactly been able to figure out what's going on with him but we do know that the abdomen became distended after he was given a local herb named Lamande for diarrhea. He has been up and down but basically we've just been treating with antibiotics for presumed peritonitis and using a nasogastric tube to help relieve some of the pressure. He's also on oxygen. He's been draining bile from the NG tube but we're still not sure what to do with him except treat supportively and hope that his body is able to clear the toxin.
Our very interesting case on the other side was a little Maasai boy who was 2 years old and only weighed 9 kgs. He had been having trouble urinating since birth and his mother noticed some masses in his abdomen. We sent him for ultrasound and xray to find out what was going on. His ultrasound showed severly backed up kidneys (hydronephrosis) all the way down the urinary system to a very enlarged, thick walled bladder. His creatinine was also extremely high. The diagnosis was an obstruction in the proximal urethra which needed to be surgically repaired. So he was referred to another hospital.
We have another child who is 7 months old and has ha fevers for 3 months. No other symptoms and no idea what's wrong with her. We gave her a TB test Friday so we'll see what shows up on Monday.
Other than lots of malaria, diarrhea, pneumonia and malnutrition, we've been surprised to learn that there are no less than 4 kids with heart murmurs that we've seen in one week. I don't know what the statistics are in the US but my guess is that it's higher here and might pose an interesting research project for someone in the future. Another interesting topic could be the prevalence of cardiomegaly among children with malnutrition. We've seen at least one chest xray of a child with severe malnutrition and her heart was HUGE!! She probably has had so few nutrients that her heart has been working mega overtime to get nutrients to all her tissues.
We also had a boy with a very large abscess under his chin which Dr Lace opened up and drained and then we had to come back every day for the next 3 and drain more. The poor kid would start crying every time he saw us! Finally on Thursday, when we went to check on him there was nothing more to drain! We had also brought him some peanut M&M's which he was a little unsure about coming from a white coat but hopefully he enjoyed them.
All in all, it's been very interesting being on the peds ward. There are so many needs, it's hard to know here to start. It's hard to know whether to start with education, remodeling, donating supplies, or new equipment. At times I just feel overwhelmed not knowing what to do for many of these kids but also not having the proper diagnostic tools. So many of the Maasai kids come in severely underweight for their age and often because they have to travel so far to come to the hospital, they're in really bad shape by the time they get to us. How can you change cultural traditions, such as the toxic herbs, when they've been in place for hundreds if not thousands of years? One encouraging thing is that genital mutilation, also practised by many Maasai tribes, has become a severe crime and is becoming much less common. It's a totally different world over here and it's hard to know what would help and what would make things worse? What is sustainable and what would crumble as soon as we leave? Is there anythig that we can do for research that would actually benefit these people? Or is it simply the presence of people that are willing to step into the trenches with them and just be there?
I really don't have answers for a lot of the questions that plague me but I do know that like Dr Lace, I want to keep coming back and do whatever I can to help, both here and other countries like Tanzania.
Sunday, July 11, 2010
Happy Feet
I know, I know, it’s been awhile since I’ve written. My apologies. Fortunately we’ve been busy with quite a few fun things in addition to our work at the hospital. Tuesday, following a sad start to the week, was much slower and offered me the opportunity to step into the OR and observe Dr Lee repairing a broken femur.
A brutal and somewhat less sophisticated procedure than what would happen in the states, it was still fascinating nonetheless. Dr Lee cleaned and prepped the upper half of the right leg and then began cutting into the flesh. I’ve started to get used to seeing the blood drip down the leg instead of the smelling burning flesh as I’m accustomed to in the states. He cut through the skin, fat and muscle layers, all the way down to the bone. Once down to the bone, he took a pair of large locking pliers and pulled on the bone until it was at an angle where he could clean up the break and insert a thin guide rod into the bone to make space for the rod that would stabilize and help the break heal. Once finished with the lower half, he moved on to do basically the same thing with the upper half. It’s pretty crazy to see half a bone sticking out of a man’s thigh. Oh yeah, and did I mention that he was awake? Apparently they hardly ever use anesthesia here. What they use instead is something that they call a spinal. From what I could tell, it sounded like it’s basically a nerve block at the level of the spinal cord where they’ll be operating. So for this patient, they likely gave the spinal somewhere around L4. The guy was awake during the entire procedure and all of the crazy, brutal manipulation that was going on, but he didn’t flinch or scream. Point for Mt Meru.
Once the two bone halves were prepped and cleaned, Dr Lee used the probe to go all the way through upper half of the femur until the probe broke the skin near his hip. They made an incision and poked the probe through. Once they were certain of a clean path, they used the probe as a guide for the rod that Dr Lee hammered in from the top, all the way down to the bottom of the femur. The entire procedure took maybe 90 minutes tops. Crazy.
We found out while we were there on Tuesday that Wednesday is a national holiday, something to the effect of a peasants’ day. Meaning that none of the doctors would be in. This worked out well since Lindsay’s friend who works teaching English in southern Tanzania got in really late on Tuesday night. It was great to have him around since he’s conversationally fluent in Swahili. We went to the craft market and had a pretty lazy day, which was nice.
Thursday was back to the hospital, and amazingly enough we were informed by the chief medical officer that Dr Lace, a pediatrician from Salem, was going to be there and he wanted to teach us. Now, in case you haven’t figured this out by now, communication is not a strong point for Tanzanians. So the fact that the chief medical officer was able to get us that message was either a total coincidence or she actually was keeping an eye out for us to let us know. My guess is the former.
We went up to the labor ward after looking around unsuccessfully for the tall mzungu. No one had seen him. Again the labor ward was fairly quiet. Lindsay’s friend also came along with us as he’s thinking about a career in medicine himself. T, Lindsay and I have all been pretty desensitized to the human body and had already had a chance to get used to all the naked women who lay around in the labor ward. It was a little overwhelming for Andrew and he stepped outside for a bit. It was also pretty quiet, so I decided to take the opportunity to try again to find Dr Lace.
We indeed found him just as they’d started rounding in the Pediatric ICU. Pretty sad to see so many sick kids. There was one child with pretty severe cerebral palsy that has pneumonia and it sounds like they’re trying to keep him as comfortable as possible, but he can’t speak, walk or feed himself and his life expectancy is not good. There was also a younger child with a similar diagnosis that seemed to be able to function a little better, but I thought to myself how difficult it would be to have a child with such a condition in a place like this. The life expectancy is not good even in the states with all of our resources and technology. So hard.
We saw several children with diarrhea, a couple with malaria, one small child that likely has down syndrome, one with diabetes that they were having difficulties controlling his blood sugar and lots of distended tummies. There was a pretty large crowd around the new face so it was difficult to hear a lot of what was going on, so after awhile, Andrew and I headed back up to the labor ward to find T and Lindsay. T had been with a woman for an hour or so, in a similar situation as Monday. T and Lindsay had been doing an excellent job of keeping her comforted and encouraging her as well as staying on the nurses like hawks to keep a close eye on this woman and encourage them to do the episiotomy early and get the baby out.
My stomach churned as the watched the final moments of her delivery, unsure of whether or not the baby was going to start crying. I was more than relieved to hear the cries of a healthy baby girl. I don’t think I could have handled a repeat of Monday. The labor ward was still pretty quiet, so after Lindsay learned how to start an IV, she and I headed back down to the pediatric unit to catch the end of rounds. It was so refreshing to have someone like Dr Lace that is actually interested in teaching. I just shook my head sometimes as he would ask the interns some of the most obvious questions such as, “Is the patient on any medications?” and then if they were instructing them to make sure that they stayed on those meds while in the hospital. Isn’t that common sense? But then again, this is Africa… a saying that we’ve come to embrace and seems to sum up many situations that just seem to make no sense.
So you may be wondering why I titled this blog “Happy Feet”. Well, my feet FINALLY got to play some soccer with the local kids. We took Friday off to go visit our Canadian friends in Nkoaranga where they were helping out at the local hospital. They were busy in surgery and pulling teeth. While we were dropping off some goodies for them at their house, one of the girls came running up looking for headlamps and flashlights. “They’re in the middle of a surgery and the power just went out!!!” Surprising? Maybe when we had first started at Mt Meru, but that’s a pretty common scenario. So no, we weren’t surprised.
We then took the opportunity to go for a hike and explore the area a bit. We found a gorgeous trail up a hillside past a few houses and some kids playing outside. On the way back down, Andrew grabbed the kids and started organizing them for a soccer match. YESSSSSSS. I’d been wanting to kick a ball around with the locals since we arrived. The kids are so good and it was hilarious watching and playing with them. Oops, watch out for the cow. Is the laundry line out of bounds? Nope, apparently not. Is that cow dung on the ball? Oh yeah, better wipe that off real quick. And beware of all the shoes lying in the middle of the “field”. Hilarious, but so much fun. A much needed break from the chaos and reality of the hospital.
Saturday we joined another one of our Canadian friends on a trip to Majiya Chai where there is a program called Children for Children’s Future (CCF) that takes children off the street and clothes them, feeds them, houses them and schools them. From what we could tell it seemed like there was a primary school there and then they fundraised to pay for them to go to secondary or other trade schools. One of the boys wanted to go to acrobatic school. I wasn’t entirely sure what that was until our friend DeePal asked him to show us his “talent”. He took off his flip flops and did a round-off, back tuck on the grass. Gymnastics. My kind of kid. =) We asked how he learned how to do that and his response was simply, “my muscles tell me what to do”. Amazing.
After a bit of a tour and chatting with the kids a bit, we broke out the soccer ball and started some juggling with whoever wanted to join in. For those of you who don’t know what juggling is, you keep the soccer ball in the air using your head, chest, knees and feet to keep it from touching the ground and pass it around to one another. For me, there is no better way to bond with kids than playing soccer. Especially in a place like this. They all spoke pretty good English, especially compared to our limited Swahili, but sports like soccer go beyond language barriers. There was also a dance party that broke out. Music is another great ice breaker we’ve discovered.
After some yummy ugali and greens for lunch, we headed out to the soccer field for a little scrimmage. So much fun, but I totally got put in my place by kids that were more than half my age and played without shoes. Incredible. I told DeePal that I wanted to send back a box full of soccer shoes for the kids. Sadly the administration is going through a rough time and would likely confiscate the shoes to make the kids look more desolate and get more money. A very sad truth.
Once we got back and showered, we headed over to one of our favorite local hangouts for some food and live music. A wonderfully relaxing evening after a fun-filled, jam packed last few days. Sunday we were hoping to head to Arusha National Park to get our first look at some of the animals, but after looking into it a bit, it was more expensive than we were anticipating. So Sunday became a day for taking care of all the little things like laundry, food, cleaning and relaxing to prepare for the week. We also headed to another favorite hang out to watch Spain beat Holland to win the World Cup. So fantastic.
And so the week begins again and we’ll be spending most of our time in Pediatrics while Dr Lace is here.
Hope that catches everyone up!
A brutal and somewhat less sophisticated procedure than what would happen in the states, it was still fascinating nonetheless. Dr Lee cleaned and prepped the upper half of the right leg and then began cutting into the flesh. I’ve started to get used to seeing the blood drip down the leg instead of the smelling burning flesh as I’m accustomed to in the states. He cut through the skin, fat and muscle layers, all the way down to the bone. Once down to the bone, he took a pair of large locking pliers and pulled on the bone until it was at an angle where he could clean up the break and insert a thin guide rod into the bone to make space for the rod that would stabilize and help the break heal. Once finished with the lower half, he moved on to do basically the same thing with the upper half. It’s pretty crazy to see half a bone sticking out of a man’s thigh. Oh yeah, and did I mention that he was awake? Apparently they hardly ever use anesthesia here. What they use instead is something that they call a spinal. From what I could tell, it sounded like it’s basically a nerve block at the level of the spinal cord where they’ll be operating. So for this patient, they likely gave the spinal somewhere around L4. The guy was awake during the entire procedure and all of the crazy, brutal manipulation that was going on, but he didn’t flinch or scream. Point for Mt Meru.
Once the two bone halves were prepped and cleaned, Dr Lee used the probe to go all the way through upper half of the femur until the probe broke the skin near his hip. They made an incision and poked the probe through. Once they were certain of a clean path, they used the probe as a guide for the rod that Dr Lee hammered in from the top, all the way down to the bottom of the femur. The entire procedure took maybe 90 minutes tops. Crazy.
We found out while we were there on Tuesday that Wednesday is a national holiday, something to the effect of a peasants’ day. Meaning that none of the doctors would be in. This worked out well since Lindsay’s friend who works teaching English in southern Tanzania got in really late on Tuesday night. It was great to have him around since he’s conversationally fluent in Swahili. We went to the craft market and had a pretty lazy day, which was nice.
Thursday was back to the hospital, and amazingly enough we were informed by the chief medical officer that Dr Lace, a pediatrician from Salem, was going to be there and he wanted to teach us. Now, in case you haven’t figured this out by now, communication is not a strong point for Tanzanians. So the fact that the chief medical officer was able to get us that message was either a total coincidence or she actually was keeping an eye out for us to let us know. My guess is the former.
We went up to the labor ward after looking around unsuccessfully for the tall mzungu. No one had seen him. Again the labor ward was fairly quiet. Lindsay’s friend also came along with us as he’s thinking about a career in medicine himself. T, Lindsay and I have all been pretty desensitized to the human body and had already had a chance to get used to all the naked women who lay around in the labor ward. It was a little overwhelming for Andrew and he stepped outside for a bit. It was also pretty quiet, so I decided to take the opportunity to try again to find Dr Lace.
We indeed found him just as they’d started rounding in the Pediatric ICU. Pretty sad to see so many sick kids. There was one child with pretty severe cerebral palsy that has pneumonia and it sounds like they’re trying to keep him as comfortable as possible, but he can’t speak, walk or feed himself and his life expectancy is not good. There was also a younger child with a similar diagnosis that seemed to be able to function a little better, but I thought to myself how difficult it would be to have a child with such a condition in a place like this. The life expectancy is not good even in the states with all of our resources and technology. So hard.
We saw several children with diarrhea, a couple with malaria, one small child that likely has down syndrome, one with diabetes that they were having difficulties controlling his blood sugar and lots of distended tummies. There was a pretty large crowd around the new face so it was difficult to hear a lot of what was going on, so after awhile, Andrew and I headed back up to the labor ward to find T and Lindsay. T had been with a woman for an hour or so, in a similar situation as Monday. T and Lindsay had been doing an excellent job of keeping her comforted and encouraging her as well as staying on the nurses like hawks to keep a close eye on this woman and encourage them to do the episiotomy early and get the baby out.
My stomach churned as the watched the final moments of her delivery, unsure of whether or not the baby was going to start crying. I was more than relieved to hear the cries of a healthy baby girl. I don’t think I could have handled a repeat of Monday. The labor ward was still pretty quiet, so after Lindsay learned how to start an IV, she and I headed back down to the pediatric unit to catch the end of rounds. It was so refreshing to have someone like Dr Lace that is actually interested in teaching. I just shook my head sometimes as he would ask the interns some of the most obvious questions such as, “Is the patient on any medications?” and then if they were instructing them to make sure that they stayed on those meds while in the hospital. Isn’t that common sense? But then again, this is Africa… a saying that we’ve come to embrace and seems to sum up many situations that just seem to make no sense.
So you may be wondering why I titled this blog “Happy Feet”. Well, my feet FINALLY got to play some soccer with the local kids. We took Friday off to go visit our Canadian friends in Nkoaranga where they were helping out at the local hospital. They were busy in surgery and pulling teeth. While we were dropping off some goodies for them at their house, one of the girls came running up looking for headlamps and flashlights. “They’re in the middle of a surgery and the power just went out!!!” Surprising? Maybe when we had first started at Mt Meru, but that’s a pretty common scenario. So no, we weren’t surprised.
We then took the opportunity to go for a hike and explore the area a bit. We found a gorgeous trail up a hillside past a few houses and some kids playing outside. On the way back down, Andrew grabbed the kids and started organizing them for a soccer match. YESSSSSSS. I’d been wanting to kick a ball around with the locals since we arrived. The kids are so good and it was hilarious watching and playing with them. Oops, watch out for the cow. Is the laundry line out of bounds? Nope, apparently not. Is that cow dung on the ball? Oh yeah, better wipe that off real quick. And beware of all the shoes lying in the middle of the “field”. Hilarious, but so much fun. A much needed break from the chaos and reality of the hospital.
Saturday we joined another one of our Canadian friends on a trip to Majiya Chai where there is a program called Children for Children’s Future (CCF) that takes children off the street and clothes them, feeds them, houses them and schools them. From what we could tell it seemed like there was a primary school there and then they fundraised to pay for them to go to secondary or other trade schools. One of the boys wanted to go to acrobatic school. I wasn’t entirely sure what that was until our friend DeePal asked him to show us his “talent”. He took off his flip flops and did a round-off, back tuck on the grass. Gymnastics. My kind of kid. =) We asked how he learned how to do that and his response was simply, “my muscles tell me what to do”. Amazing.
After a bit of a tour and chatting with the kids a bit, we broke out the soccer ball and started some juggling with whoever wanted to join in. For those of you who don’t know what juggling is, you keep the soccer ball in the air using your head, chest, knees and feet to keep it from touching the ground and pass it around to one another. For me, there is no better way to bond with kids than playing soccer. Especially in a place like this. They all spoke pretty good English, especially compared to our limited Swahili, but sports like soccer go beyond language barriers. There was also a dance party that broke out. Music is another great ice breaker we’ve discovered.
After some yummy ugali and greens for lunch, we headed out to the soccer field for a little scrimmage. So much fun, but I totally got put in my place by kids that were more than half my age and played without shoes. Incredible. I told DeePal that I wanted to send back a box full of soccer shoes for the kids. Sadly the administration is going through a rough time and would likely confiscate the shoes to make the kids look more desolate and get more money. A very sad truth.
Once we got back and showered, we headed over to one of our favorite local hangouts for some food and live music. A wonderfully relaxing evening after a fun-filled, jam packed last few days. Sunday we were hoping to head to Arusha National Park to get our first look at some of the animals, but after looking into it a bit, it was more expensive than we were anticipating. So Sunday became a day for taking care of all the little things like laundry, food, cleaning and relaxing to prepare for the week. We also headed to another favorite hang out to watch Spain beat Holland to win the World Cup. So fantastic.
And so the week begins again and we’ll be spending most of our time in Pediatrics while Dr Lace is here.
Hope that catches everyone up!
Monday, July 5, 2010
A Mother's Pain...
I’m struggling to find the words to describe what I experienced today… My heart is absolutely broken for the woman whose baby I attempted to help deliver. The day started off pretty slow and Lindsay, T and I all took notice of a young woman who appeared to be close to giving birth. As they ran off, I decided it was my turn to dive in and I gloved up just to be ready. I was anticipating a quick delivery as that is how most of the ones we’ve witnessed so far have gone. That definitely was not the case with this woman. It was her first pregnancy and as such, it was expected that it might take longer. As the nurse came over, I let her know that I’d never done this before and I’d like to help her. The nurse first had to break the membrane to help the labor progress. Once that was done, you could see the baby’s head and we all assumed that the actually delivery would soon take place.
Initially the nurse was there to help coach her as I couldn’t communicate, but after a few pushes and no progress, she left to attend to other women. A Tanzanian medical student, Lindsay and I were left to attend to this woman. The nurse checked back a couple times but didn’t really do much. After about 20 minutes or so, Dr Ishmael appeared. We all knew something wasn’t going right and tried to solicit his help, but he just told us that she likely needed an episiotomy and then he basically disappeared. For about the next hour, I continued to stay by her side amidst the chaos that continued across the rest of the labor ward. I tried to continue to encourage her to push and help her progress as much as I could and relax when she wasn’t having contractions.
Something clearly wasn’t right when she wasn’t making any progress and was getting progressively more tired. And yet, I couldn’t communicate with her, I lacked the experience to know what to do and the nurses and doctors were nowhere to be found. Finally, one of the nurses came over and gave her the attention that she needed. She encouraged her to push and tried to loosen and expand the birth canal to get this baby out. After waiting yet another 5-10 minutes, the nurse finally performed the episiotomy and pushed on her belly to help with pushing during contractions.
As the baby’s head finally came out, I tried to clean it up as quickly as I could. Then with one more push, the entire baby was out. Blue and lifeless. The nurses worked quickly attempting to resuscitate the lifeless infant. The cord was cut and tied and the baby was carried back to the newborn room where they could attempt to expand the lungs and try to illicit a response.
As the nurses attended to the baby, I continued to stay with the mother. She still needed to deliver the placenta. A shot of oxytocin and about 15 minutes later, everything was out. The intentional tear still needed to be repaired. I knew things weren’t going well for her baby so I continued to stay with her and do what I could to comfort her. As the nurse came over with sutures, I held the mother’s hand and tried to rub her shoulders and continue to comfort her. They gave her a shot of lidocaine to numb the area, but it clearly wasn’t enough as the mother writhed in pain at every stitch. Once the procedure was finished, I put a few more of her kangas on her to keep her warm and got her phone for her. Still no news of her baby.
I decided to give her some privacy as she started to dial on her phone. I assumed she was calling her husband. I walked to the other side of the ward and when I came back, she was leaning against one of beds sobbing hysterically. Someone had finally told her that her baby didn’t make it. I went over to rub her back. “Pole sana, mama.” So sorry. Even as I said the words in my meek attempt to comfort her, I knew they were not enough. Nothing could heal her broken heart at that moment for the baby that she had nurtured inside of her for nine months. It was to be her first. I prayed a silent prayer over her asking God to bless her with many more children and uncomplicated pregnancies and deliveries with healthy babies. Although something told me that this child would never be forgotten and her heart will always carry the scar of her first.
After that, we all needed a breather. Hearing the broken-hearted sobs of this woman was more than we could bear. We stepped out and took a walk to attempt to deliver some surgical supplies to Dr Lee. When we couldn’t find him, we decided to give them to one of the doctors standing near the Ob/Gyn operating theater. They needed supplies too. Everywhere needs supplies.
We tried to talk through what had just taken place. Sadness for the mother and her baby that didn’t make it. Frustration that the nurses hadn’t paid more attention to her. Questioning whether or not there’s something we could have done. Maybe with more training, we could have done more. Maybe if one of the nurses had actually paid attention to our pleas for help, the baby would have made it. So many ifs and no answers. But what if we hadn’t been there? Would she have been worse off? What about the other mother’s? Would there have been more complications of other births?
So many questions that lay unanswered and yet we know that all we can do is continue to be present; to comfort the mothers as much as possible. One pair of hands is still one more than they have without us. Even if it’s just one mother that we get to help, comfort or console, it is enough and our presence is worthwhile.
Initially the nurse was there to help coach her as I couldn’t communicate, but after a few pushes and no progress, she left to attend to other women. A Tanzanian medical student, Lindsay and I were left to attend to this woman. The nurse checked back a couple times but didn’t really do much. After about 20 minutes or so, Dr Ishmael appeared. We all knew something wasn’t going right and tried to solicit his help, but he just told us that she likely needed an episiotomy and then he basically disappeared. For about the next hour, I continued to stay by her side amidst the chaos that continued across the rest of the labor ward. I tried to continue to encourage her to push and help her progress as much as I could and relax when she wasn’t having contractions.
Something clearly wasn’t right when she wasn’t making any progress and was getting progressively more tired. And yet, I couldn’t communicate with her, I lacked the experience to know what to do and the nurses and doctors were nowhere to be found. Finally, one of the nurses came over and gave her the attention that she needed. She encouraged her to push and tried to loosen and expand the birth canal to get this baby out. After waiting yet another 5-10 minutes, the nurse finally performed the episiotomy and pushed on her belly to help with pushing during contractions.
As the baby’s head finally came out, I tried to clean it up as quickly as I could. Then with one more push, the entire baby was out. Blue and lifeless. The nurses worked quickly attempting to resuscitate the lifeless infant. The cord was cut and tied and the baby was carried back to the newborn room where they could attempt to expand the lungs and try to illicit a response.
As the nurses attended to the baby, I continued to stay with the mother. She still needed to deliver the placenta. A shot of oxytocin and about 15 minutes later, everything was out. The intentional tear still needed to be repaired. I knew things weren’t going well for her baby so I continued to stay with her and do what I could to comfort her. As the nurse came over with sutures, I held the mother’s hand and tried to rub her shoulders and continue to comfort her. They gave her a shot of lidocaine to numb the area, but it clearly wasn’t enough as the mother writhed in pain at every stitch. Once the procedure was finished, I put a few more of her kangas on her to keep her warm and got her phone for her. Still no news of her baby.
I decided to give her some privacy as she started to dial on her phone. I assumed she was calling her husband. I walked to the other side of the ward and when I came back, she was leaning against one of beds sobbing hysterically. Someone had finally told her that her baby didn’t make it. I went over to rub her back. “Pole sana, mama.” So sorry. Even as I said the words in my meek attempt to comfort her, I knew they were not enough. Nothing could heal her broken heart at that moment for the baby that she had nurtured inside of her for nine months. It was to be her first. I prayed a silent prayer over her asking God to bless her with many more children and uncomplicated pregnancies and deliveries with healthy babies. Although something told me that this child would never be forgotten and her heart will always carry the scar of her first.
After that, we all needed a breather. Hearing the broken-hearted sobs of this woman was more than we could bear. We stepped out and took a walk to attempt to deliver some surgical supplies to Dr Lee. When we couldn’t find him, we decided to give them to one of the doctors standing near the Ob/Gyn operating theater. They needed supplies too. Everywhere needs supplies.
We tried to talk through what had just taken place. Sadness for the mother and her baby that didn’t make it. Frustration that the nurses hadn’t paid more attention to her. Questioning whether or not there’s something we could have done. Maybe with more training, we could have done more. Maybe if one of the nurses had actually paid attention to our pleas for help, the baby would have made it. So many ifs and no answers. But what if we hadn’t been there? Would she have been worse off? What about the other mother’s? Would there have been more complications of other births?
So many questions that lay unanswered and yet we know that all we can do is continue to be present; to comfort the mothers as much as possible. One pair of hands is still one more than they have without us. Even if it’s just one mother that we get to help, comfort or console, it is enough and our presence is worthwhile.
Friday, July 2, 2010
Reality Check...
I’m not sure what it was today, the weather, a lack of sleep or simply a different day with different demands, but I hit my max of what I can handle. We started the day as we typically do showing up around 8:30, which is earlier than most of the doctors and students, and we couldn’t find any doctors for a good hour. We later found out that they have continuing education on Friday mornings. Oh, good to know.
We ended up shadowing a physical therapist that we met yesterday while hanging out in the surgery area. Today he showed us what he does in terms of checking on patients healing from fractures and helping them get the strength and mobility back. So we spent about 45 minutes rounding with him on patients in the surgical ward and the pediatric ward. Hearing a child’s blood curdling screams as the PT slowly rotated his foot so that his bones will heal right was not exactly the most pleasant way to start the day.
Once we were finished we headed back up to the labor ward and things were just starting to pick up. A couple admissions, a woman had just delivered a baby and more were on the way. It absolutely baffles me that women will be screaming in agony and no one even flinches. Every time I hear someone scream, I think to myself, “Shouldn’t someone check on her?” And yet it never happens. And then, Dr. Ishmael (who is basically still a student himself) comes over to us as we’re finished an admission exam and informs us that one of the women is about to deliver. We walk down and see one woman having a tear repaired after giving birth, but don’t really see anyone else who looks like they’ve been prepped to give birth.
WARNING – explicit details of birth to follow.
Oh, just kidding. There’s a baby’s head about to pop out. As Lindsay starts gloving up, Dr. Ishmael just continues to tell her to hurry. Comforting right? Lindsay runs over as soon as she’s prepped just in time to realize that the umbilical cord is wrapped around the baby’s neck twice. “Uh, we’ve got a cord wrapped around the neck!” Lindsay exclaims while trying not to panic. Dr Ishmael simply replies, “Just unwrap it.” Oh right, of course. Fortunately Lindsay was able to quickly remove the cord and deliver the baby without any more problems. As she continued I ran to get some sterile wipes to clean out the baby’s eyes and mouth. We’d heard a few weak cries, but once Lindsay was able to wipe out the mouth the baby started crying nice and strong. While we were busy doing that, Dr Ishmael instructs Thu to get some pitocin. Oh, right, cuz she knows where that’s at and loads needles all the time.
Well we finally got her the pitocin shot and Thu was able to carry the baby over to the baby area to be warmed, cleaned and weighed. Lindsay delivered the placenta and then had to go wash up as her arm had gotten splashed in the process. With Thu and Lindsay somewhat occupied, I was left to clean up the mother. Wipe up the blood around the outside and around the vaginal canal… ok, check. Now make sure you get all the way up to the cervix and clear out any clots. Ok, I’m trying, but mom is scared and in pain. Dr Ishmael keeps yelling at me that I should be all the way in up to my knuckles and the gauze in there too. Ok, ok, I’m trying! How would you feel if someone was shoving gauze up your genital area?
So I finish up, and she’s still got some active bleeding going on somewhere. Obviously I’m not an expert by any means and if he asks me to stitch her up I’m gonna be through the roof. Fortunately she’s going to be moved to the other side and one of the nurses is going to suture her tear. Once she’s headed over to the other side, Dr Ishmael decides it’s a good time to teach me how to examine a placenta to make sure it’s intact. Hasn’t it already been examined 5 times? So as he’s trying to teach me this through broken English, he has no gloves on and can’t really explain to me what I’m supposed to be checking for. Awesome. I finally figure it out and the placenta is clearly intact.
Maybe this scenario wouldn’t be so bad for someone who actually has some background in OB, but for me, the whole situation was incredibly frustrating. Lindsay, Thu and I have absolutely no idea what we’re doing and yet we’re basically handling the entire thing. No one else is around or gloved up in case something goes wrong, none of the nurses came over to offer help or guidance, and we’re basically being talked through this by someone who’s barely even done it himself. I so wish that I had more training. I wish that I had more experience. Maybe if I’d seen this a hundred times before it would just be going through the motions. Maybe if I knew where to find things, there wouldn’t be such a panic. BUT the fact that the health and well being of this mother and her baby was essentially left up to 3 bumbling medical students was more than I could handle today. The fact that a woman can be in labor with no one supervising and nothing ready to support her or the child is something that I just cannot even begin to fathom.
I think what’s most frustrating is that a woman can be in labor and no one turns a head or quickens their step to assist her. We’ve definitely caught on to the fact that nothing get done quickly here, but one would think that a hospital might be an exception to that. Nope. Apparently not. I don’t think I’ll ever get over that frustration but hopefully by the time we leave, I’ll at least be able to do my part to help.
We ended up shadowing a physical therapist that we met yesterday while hanging out in the surgery area. Today he showed us what he does in terms of checking on patients healing from fractures and helping them get the strength and mobility back. So we spent about 45 minutes rounding with him on patients in the surgical ward and the pediatric ward. Hearing a child’s blood curdling screams as the PT slowly rotated his foot so that his bones will heal right was not exactly the most pleasant way to start the day.
Once we were finished we headed back up to the labor ward and things were just starting to pick up. A couple admissions, a woman had just delivered a baby and more were on the way. It absolutely baffles me that women will be screaming in agony and no one even flinches. Every time I hear someone scream, I think to myself, “Shouldn’t someone check on her?” And yet it never happens. And then, Dr. Ishmael (who is basically still a student himself) comes over to us as we’re finished an admission exam and informs us that one of the women is about to deliver. We walk down and see one woman having a tear repaired after giving birth, but don’t really see anyone else who looks like they’ve been prepped to give birth.
WARNING – explicit details of birth to follow.
Oh, just kidding. There’s a baby’s head about to pop out. As Lindsay starts gloving up, Dr. Ishmael just continues to tell her to hurry. Comforting right? Lindsay runs over as soon as she’s prepped just in time to realize that the umbilical cord is wrapped around the baby’s neck twice. “Uh, we’ve got a cord wrapped around the neck!” Lindsay exclaims while trying not to panic. Dr Ishmael simply replies, “Just unwrap it.” Oh right, of course. Fortunately Lindsay was able to quickly remove the cord and deliver the baby without any more problems. As she continued I ran to get some sterile wipes to clean out the baby’s eyes and mouth. We’d heard a few weak cries, but once Lindsay was able to wipe out the mouth the baby started crying nice and strong. While we were busy doing that, Dr Ishmael instructs Thu to get some pitocin. Oh, right, cuz she knows where that’s at and loads needles all the time.
Well we finally got her the pitocin shot and Thu was able to carry the baby over to the baby area to be warmed, cleaned and weighed. Lindsay delivered the placenta and then had to go wash up as her arm had gotten splashed in the process. With Thu and Lindsay somewhat occupied, I was left to clean up the mother. Wipe up the blood around the outside and around the vaginal canal… ok, check. Now make sure you get all the way up to the cervix and clear out any clots. Ok, I’m trying, but mom is scared and in pain. Dr Ishmael keeps yelling at me that I should be all the way in up to my knuckles and the gauze in there too. Ok, ok, I’m trying! How would you feel if someone was shoving gauze up your genital area?
So I finish up, and she’s still got some active bleeding going on somewhere. Obviously I’m not an expert by any means and if he asks me to stitch her up I’m gonna be through the roof. Fortunately she’s going to be moved to the other side and one of the nurses is going to suture her tear. Once she’s headed over to the other side, Dr Ishmael decides it’s a good time to teach me how to examine a placenta to make sure it’s intact. Hasn’t it already been examined 5 times? So as he’s trying to teach me this through broken English, he has no gloves on and can’t really explain to me what I’m supposed to be checking for. Awesome. I finally figure it out and the placenta is clearly intact.
Maybe this scenario wouldn’t be so bad for someone who actually has some background in OB, but for me, the whole situation was incredibly frustrating. Lindsay, Thu and I have absolutely no idea what we’re doing and yet we’re basically handling the entire thing. No one else is around or gloved up in case something goes wrong, none of the nurses came over to offer help or guidance, and we’re basically being talked through this by someone who’s barely even done it himself. I so wish that I had more training. I wish that I had more experience. Maybe if I’d seen this a hundred times before it would just be going through the motions. Maybe if I knew where to find things, there wouldn’t be such a panic. BUT the fact that the health and well being of this mother and her baby was essentially left up to 3 bumbling medical students was more than I could handle today. The fact that a woman can be in labor with no one supervising and nothing ready to support her or the child is something that I just cannot even begin to fathom.
I think what’s most frustrating is that a woman can be in labor and no one turns a head or quickens their step to assist her. We’ve definitely caught on to the fact that nothing get done quickly here, but one would think that a hospital might be an exception to that. Nope. Apparently not. I don’t think I’ll ever get over that frustration but hopefully by the time we leave, I’ll at least be able to do my part to help.
Thursday, July 1, 2010
Taking a step back in time...
It’s almost the end of our first week at Mt Meru and it’s difficult to describe what it’s like here. If you’d like a detailed blow by blow of what our days have been like, Lindsay has been keeping track of our every move and everything we’ve seen in the hospital. However, in general, we’ve already seen a lot of pretty gnarly stuff in a matter of 3 days. We’ve seen an amputation, a packed gynecology ward, mom’s get up and WALK out of the labor ward just minutes after deliver a baby and even repairing a tear, and learned how to do a cervical exam.
Medical care is very different here. Patients are treated more like a machine than a person who has thoughts, feelings and can be hurt by what you’re doing to them. It’s a bit difficult to swallow, especially when they’re teaching us many of the same techniques and we have no way of communicating with the patient to tell them that we’re about to examine their cervix and that we’ll be as gentle as we can. I think that’s been the hardest part for me. We’ve had “talk before touch” pounded into us since day 1 of med school and when you can’t communicate with the patient or it’s through another person it makes it very difficult. So we’re working on our Swahili to learn some key phrases to let them know what we’re doing and to tell them to relax.
And for all of you mothers out there… remember what labor pains felt like? Contractions for hours, pushing sometimes for hours, often resorting to an epidural to ease the pain? Yeah, none of that exists here. The only medications that are given during pregnancy are penicillin if the water has broken, AZT if the patient is HIV positive and that’s pretty much it. If there’s a tear they’ll numb it with lidocaine before stitching it back up, but there’s not much in the way of comfort for a woman in labor. The labor ward is a long room split in two by the “administration area”. One side is for women who are having contractions and are dilated more than 4 cm and the other side is for when they actually give birth. There is no such thing as a birthing suite, no privacy and no husband present to hold your hand or wipe your brow while you push. Fortunately, these babies seem to be quite a bit smaller than what we’re used to. Pushing typically lasts only a few minutes and then it’s over. One woman that we saw give birth yesterday delivered so fast that no one even had time to glove up once we saw the baby crowning. Lindsay has already had the chance to basically deliver a baby herself and both that time and the other one I just mentioned we were standing on the delivery side watching something on one side only to turn around and see a baby’s head crowning and no one supervising.
It really is unbelievable here. Sterile technique seems to be a bit of a foreign concept and it’s somewhat relative given that windows are open and outside air is blowing in during an operation. Today was quite possibly one of the most grotesque injuries I’ve ever seen and may ever see. The Ob/Gyn ward was pretty slow and not much to do for the 3 of us so we wandered over to the operating theater when Dr Lee was to see what was going on. He was just finishing setting a cast on someone when we walked in. After waking up from anesthesia, the patient sat up, they wrapped his blankets back around him and then he WALKED out of the OT barefoot! I’m not even sure whether or not they opened up his arm, it may have just been setting it, but that ground in there is absolutely filthy!!
(This is the grotesque part so those with uneasy stomachs beware!!)
So then they put a new sheet over the operating table and wheeled in the next patient. As they transferred her to the operating table, her bandaged leg flopped around like gumby. When Dr Lee cut through and unwrapped the bandage, her entire shin was practically exposed and the tibia fractured all the way through. As Dr Lee tried to examine the foot, bone and muscle, the woman screamed in pain at every movement. They finally gave her some anesthetic (ketamine) and Dr Lee went to work chipped away at some of the bone to see what was still viable. After awhile, it became quite apparent that the entire lower portion of the tibia was dead and unsalvageable. Her options? Amputation, which would be the most sterile, or somehow using the fibula to become the main support of the leg. Although I’m not sure either option would ever allow her to walk again.
More than anything, the last few days have made me very grateful for what services we have in the states. It’s difficult for me to make a judgement about the way that they do things here even if I do think it is often not exactly sterile or seemingly barbaric. It’s really like taking a step back in time and I know that they do the best that they can with what they have. I’ve noticed that patients are responsible for purchasing a lot of their own materials. Women are required to bring in a couple pairs of surgical gloves and cotton gauze for their examinations. They have to purchase their own bandages. In some ways, it makes sense, but on the other hand, it’s very possible that a woman could be ready to give birth and there are no sterile gloves around if they’re out and the woman forgot to bring her own.
A lot of the supplies that we brought are disposable, such as suction bulbs to clear out the newborns’ mouths when they are born and sometimes that’s not a whole lot of use to them. The things that they need are things that can be sterilized and re-used.
When you step back and think about it, it’s heartbreaking to walk around and see what happens in the hospital every day. But regardless, these are patients that desperately need care and they do the best they can with what’s available.
Medical care is very different here. Patients are treated more like a machine than a person who has thoughts, feelings and can be hurt by what you’re doing to them. It’s a bit difficult to swallow, especially when they’re teaching us many of the same techniques and we have no way of communicating with the patient to tell them that we’re about to examine their cervix and that we’ll be as gentle as we can. I think that’s been the hardest part for me. We’ve had “talk before touch” pounded into us since day 1 of med school and when you can’t communicate with the patient or it’s through another person it makes it very difficult. So we’re working on our Swahili to learn some key phrases to let them know what we’re doing and to tell them to relax.
And for all of you mothers out there… remember what labor pains felt like? Contractions for hours, pushing sometimes for hours, often resorting to an epidural to ease the pain? Yeah, none of that exists here. The only medications that are given during pregnancy are penicillin if the water has broken, AZT if the patient is HIV positive and that’s pretty much it. If there’s a tear they’ll numb it with lidocaine before stitching it back up, but there’s not much in the way of comfort for a woman in labor. The labor ward is a long room split in two by the “administration area”. One side is for women who are having contractions and are dilated more than 4 cm and the other side is for when they actually give birth. There is no such thing as a birthing suite, no privacy and no husband present to hold your hand or wipe your brow while you push. Fortunately, these babies seem to be quite a bit smaller than what we’re used to. Pushing typically lasts only a few minutes and then it’s over. One woman that we saw give birth yesterday delivered so fast that no one even had time to glove up once we saw the baby crowning. Lindsay has already had the chance to basically deliver a baby herself and both that time and the other one I just mentioned we were standing on the delivery side watching something on one side only to turn around and see a baby’s head crowning and no one supervising.
It really is unbelievable here. Sterile technique seems to be a bit of a foreign concept and it’s somewhat relative given that windows are open and outside air is blowing in during an operation. Today was quite possibly one of the most grotesque injuries I’ve ever seen and may ever see. The Ob/Gyn ward was pretty slow and not much to do for the 3 of us so we wandered over to the operating theater when Dr Lee was to see what was going on. He was just finishing setting a cast on someone when we walked in. After waking up from anesthesia, the patient sat up, they wrapped his blankets back around him and then he WALKED out of the OT barefoot! I’m not even sure whether or not they opened up his arm, it may have just been setting it, but that ground in there is absolutely filthy!!
(This is the grotesque part so those with uneasy stomachs beware!!)
So then they put a new sheet over the operating table and wheeled in the next patient. As they transferred her to the operating table, her bandaged leg flopped around like gumby. When Dr Lee cut through and unwrapped the bandage, her entire shin was practically exposed and the tibia fractured all the way through. As Dr Lee tried to examine the foot, bone and muscle, the woman screamed in pain at every movement. They finally gave her some anesthetic (ketamine) and Dr Lee went to work chipped away at some of the bone to see what was still viable. After awhile, it became quite apparent that the entire lower portion of the tibia was dead and unsalvageable. Her options? Amputation, which would be the most sterile, or somehow using the fibula to become the main support of the leg. Although I’m not sure either option would ever allow her to walk again.
More than anything, the last few days have made me very grateful for what services we have in the states. It’s difficult for me to make a judgement about the way that they do things here even if I do think it is often not exactly sterile or seemingly barbaric. It’s really like taking a step back in time and I know that they do the best that they can with what they have. I’ve noticed that patients are responsible for purchasing a lot of their own materials. Women are required to bring in a couple pairs of surgical gloves and cotton gauze for their examinations. They have to purchase their own bandages. In some ways, it makes sense, but on the other hand, it’s very possible that a woman could be ready to give birth and there are no sterile gloves around if they’re out and the woman forgot to bring her own.
A lot of the supplies that we brought are disposable, such as suction bulbs to clear out the newborns’ mouths when they are born and sometimes that’s not a whole lot of use to them. The things that they need are things that can be sterilized and re-used.
When you step back and think about it, it’s heartbreaking to walk around and see what happens in the hospital every day. But regardless, these are patients that desperately need care and they do the best they can with what’s available.
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