Monday, September 23
Today was a return back to the typical at Nkhoma Mission Hospital. We were all rattled on Friday and then I had a luxurious weekend. Now it was back to reality.
Before I write about today, I do want to add some thoughts about this weekend. First, the hotel where we stayed was amazing and it was a beautiful thing to just feel clean for 24 hours. I know that looks weird as I type it but it is just true. To be in a dust free, trash fire free, hospital germ free zone was a pleasure in itself.
Second, my white skin even in the shade and with SPF of 100 is no match for the African sun. Lots of Rudolf jokes and jokes about my whiteness today. So glad I can add some comic relief to this place. Maybe that is my purpose here.
Lastly, when I came to Malawi I never expected that a benefit would be meeting three women that I would adore. I am amazed by each of them and their sacrifices and honored to call them friends. In the picture (left to right) are Amelia (mom from Georgia adopting Enelise and Jonas), me, Melissa (mom from California adopting Brenda and Brandina-twins), and Nicole (Dutch mom of two adoptive children and director of the Children’s home). Their kids all had a blast swimming and I soaked up the laughter and hugs better than the sun. Teresa and I cuddled in the shade and just worked on growing bigger. She is truly one handful!
Also, I am over halfway through my time here!!!!
So for today….Morning report went very long. Mainly because we had a debriefing of the events of Friday. What went well and what could be improved. Lots of people with things to say. The Vice President did visit the patients in the hospital and did come to a funeral and the hospital. The people are hopeful that it will lead to some much needed road improvements. Overall, I think the group did a good job of identifying areas to improve and new protocols and procedures that need to be put in place to deal with any tragedies in the future, but for the resources Nkhoma has, I think they did an amazing job.
We again have a different group of nursing students on the ward. They will rotate again before I leave. So, some of today was again establishing names and building trust with the nursing staff. This group has a least worked in pediatrics before and seems willing to learn.
We did slow rounds this morning. It amazes me how many patients have drugs that are stopped or not given over the weekend. One factor here is that unlike in the US, when you order a medication you must write for how many days. In the US, you write for a medication and it continues until you stop it. Here, the medications are brought to the ward from the pharmacy by staff, so you write how many days and they bring that many doses. So if you wrote for 5 days of antibiotic and it is day 6, your patient is not longer being treated and unless you are checking medications daily you may not realized it. This occurred to our child with a deep armpit abscess that is still requiring surgical debridement.
Our heart failure patient is not doing well. We requested a palliative care team meeting and they met this afternoon and when I left at 4 were meeting with the family to discuss options. We decided it was best for me not to attend as the discomfort of a foreigner and the need to translate would make it harder for the mom and dad. The cultural aspects make this more difficult but I have been told that the involvement of the palliative care takes the peer pressure from the village off the family if they decide to bring the child home to die.
We again had a few patients that got to go home. One was a little girl in the accident on Friday. She was discharged from KCH on Saturday but was having some pain and fever. She has done well since and orthopedics put on her plaster cast today and she saw the dentist for a broken tooth and was ready to go home. Her father is our radiology technician and people were falling all over themselves to make sure she got the royal treatment (relative in Malawi).
We did have several new admissions and they are mostly puzzling cases. One they thought was rabies although there really was no dog bite history. He had had convulsions and aggression like they often see in those patients. He is improved today which defies that diagnosis. His blood work and spinal flood had no specific clues for us. He is well covered for possible options and we will just observe.
Another patient was in a near comatose state. The assumption was meningitis or cerebral malaria but again his spinal fluid was clear and both malaria tests are negative. He has been unresponsive since Friday night. When I went to the nursery, I was called out because he had low oxygen levels. He appeared to be seizing although with the altered mental state is a little hard to decifer. He was treated but had cold extremities and low oxygen levels. We gave fluid for shock and continued with antibiotics for meningitis as well as an aspiration pneumonia given lung finding and past prolonged seizure. We just couldn’t get his oxygenation up even with oxygen on. Then we realized the oxygen flow was poor and reconfigured the hook up and up it came. It is just difficult with the equipment and nurse familiarity sometimes. Later in the afternoon he seemed to be improving with even some spontaneous movement.
Little Teresa came in today as well. She has an intention in her skull thought to be a congenital abnormality. We did some skull xrays today just to rule out possible trauma and all looks fine. We have found a few articles on this and the resident may write this up as this condition is rare. Hopefully it will self resolve over the next few months.
Additional news is that Melissa did get the official court ruling and the Malawian Judge did a wonderful job in addressing all the US concerns. We are hopeful that documents can be turned in early this week. It takes about 1 ½ weeks to clear the mailroom but maybe in 2 weeks she will have good news.
A busy but good day and I am thankful that most patients are improving. Thank you as always for your prayers.
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