Obstructions

Thursday, September 19

Today was a busy day but that made it go by very quickly.  The toddler who drank the kerosene did well overnight and had no symptoms at all this morning. He was able to head home and his mother was so happy!

I was called to the NICU directly from morning report. We had another baby that had not passed stool since birth and this morning her abdomen was distended and had no bowel sounds. I contacted the Lilongwe nursery and got transport ready to go. Bowel obstructions can be quickly emergent. It is just unusual to have two similar recently. It is nice that this referral process has become more comfortable.

We actually were able to discharge many kids today. One of our puffy kids, Zacharius, who has nephrotic syndrome was stable enough to go home.  His grandmother used a nurse to ask me if I could help with her bill. The boy’s father had left the family years ago which is not uncommon here. The mother has now remarried but the new husband does not accept the boy as his and does not allow him to live with the family.  Again, a fairly common practice here. So the abandoned boy lives with the grandmother. She had sold all she had to have enough money to bring him to the clinic and pay the appt fee. She had no idea it would result in a hospital admission and now has no money to pay and she doesn’t know anyone locally to ask for help.  I obviously agreed to help but asked her not to tell other patients. No one else asked for help so I think she kept her word. 

The practice of mothers remarrying even if it means abandoning children from their previous marriage is just fascinating. It is easy to get judgmental and think things like, “I could never.” However, it is just such a different world. One where women who are left often don’t survive. One in which the majority of your children don’t live into adulthood. We really can’t begin to understand or know how we would handle the situation.

I think we may have sent 5-6 kids home today which is wonderful. Two had recovered from bronchiolitis and two had malaria and required blood transfusions.  The nurses seemed to enjoy rounds and it was nice for us to feel some progress of kids getting better and going home well.

A few of the kids are just getting bored with being here and their parents as well. One who has meningitis will be with us a full 14 days. One with TB will be around for at least 2 weeks and the sweet one with heart failure will be with us til the end. I got the older ones coloring books and crayons- it was met with hesitancy at first but later they were coloring.

We have had one with us for a few days with bloody stools. He had looked bad, then better, then not good, and then better this morning. Nuances of the history are hard when you work through a translator and some questions just simply don’t gather the info you are looking for. Dysentery is fairly common here and the child has been on good antibiotics to cover the most concerning causes. However, right before lunch, he just seemed worse. His belly was distended and tense and he was uncomfortable. We took him for X-ray and an ultrasound. They were both concerning for an intussusception or another form of bowel obstruction.  This is were the bowel telescopes on itself and can lead to ischemia and death of a section of bowel. It needs urgent treatment.

Our surgeons here were not able to help as the machines in our operating theatre do not support young children. I called my contact at KCH, Treasure (he and I are getting to be close friends) and he okayed the transfer and coordinated getting all the info and pictures from me to the surgeons. We had some trouble organizing ambulances but got him on his way soon. A bonus was that since he had been transferred from another district the ambulance was covered. Small victory!

Lunch was late and short given our obstruction issues. In the afternoon we had 4 new admissions. It was good we had reduced our numbers in the morning.  We admitted one with a minor head injury from falling into the latrine pit (ouch and gross), one with malnutrition that is crazy cute, and two with seizures and possible meningitis. Four in a row with no malaria. That is out of the ordinary. shocking because the mosquitos have definitely worsened.

On the home front, Melissa and the girls got a court date for tomorrow for the judge to basically update the adoption decree to reflect more fully the family situation. Hopefully, this will help to secure Visas from the USCIS. We are praying for ease and a positive outcome.  The children’s home director goes to meet with the consular on Monday regarding Amelia’s case. Hopefully that will lead to a quick conclusion for that family as well.

We had a good evening with everyone cooking and eating. Stan is grilling some crocodile tail while I type. The girls are showering to “look beautiful for the judge”. My laundry was done today and I am enjoying a clean smelling jacket after a fairly malodorous day in pediatrics. God is good!