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.
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