Puffy Kids

Thursday, September 12

So today, my cough and scratchy voice is much better.  Not to normal but I make sound when I speak. However, the GI situation is not the best.  In morning report, I had to make a swift exit and return and there is a lot of toilet paper in my pockets just in case.  No need to go any further.

We had a lot of admissions last night and since I was in clinic a lot of yesterday, many of the patients on the ward were new to me.  Sam was around for a little while and did some teaching and quizzing of the nursing students. I was really glad to see that. We rounded quite a bit together.  I stilll love doing that because I can ask questions, offer ideas, and we make a plan with all heads together. He disappeared toward the end but I was thankful for the help.  Susan was on call last night and already texted that she needed rest and would be in late.  

The patients in the ward are not straight forward.  Many are tricky and require some research and decisions on rounds.  A few kids were able to go home. One that had meningitis with neck rigidity 14 days ago that was unlike anything I had seen.  She was happily crawling around and back to her baseline today. The antibiotics and hospital care can be effective! One with abdominal pain has also done well and is heading home.  A few of our TB kids are improving and I got surgery to come and see one with a large abscess and they cleaned it out this afternoon.  

The worst on the ward right now are our puffy kids.  There are certainly no chubby kids in Malawi. The only ones with round faces are those with nephrotic syndrome and congestive heart failure.  They just are simply fluid filled with edema everywhere. In the states, these cases are rare with our quick treatment of infections and our specialists.  Here they are not uncommon. One is a boy that looks like the Michelin man. His kidneys are letting out so much protein that his fluids don’t stay in the vessels but just leak out.  We will treat with steroids and hope that he improves. The other is a little girl that has heart failure secondary to a previous untreated strep infection. Rheumatic heart disease is the most common form of acquired heart disease for children in developing countries.  In simplified terms, the valves can be affected such that the heart muscle eventually is not able to pump well and this creates a back up of fluid in the lungs and body. This looks like a little girl who is edematous all over who is struggling to breathe because of the fluid on her lungs.  Just miserable. We will slowly try to help her urinate the extra fluid and help her heart pump better. The prognosis for these puffy kids is not good.

I even had one in the nursery who was not puffy but has had a distended abdomen and ascites that is not improving.  I was able to communicate with a surgeon at the hospital in the capital and transferred this patient to them this afternoon.  It was nice to be able to take care of that without assistance. Slowly, I am learning my way around. It was also nice because the clinical officer in the NICU came to me directly to help with a plan and I was able to take care of it for her.  

Relationships with nurses and clinical officers continue to make progress.  Slow steps of earning trust. Between the code the other day and the transfer today, I have spent some time with Olive a very senior nurse and she has been kind and helpful and seems very appreciative of my asking for her input and giving her respect and appreciation.  She is the type that when I am saying “I think we need to repeat that medicine in 3-5 minutes” she just shakes her head in affirmation and then makes eye contact to confirm that it jives with her porotocols. Some things are still crazy frustrating like finding no one on the ward when I come back from a meeting of the NICU, but maybe progress.

Back at the inn, Melissa is making some progress with her case and has heard from other families who got intent to deny letters but then were cleared for visas.  They should complete the paperwork tomorrow.  

Tonight I am thankful for many things.  None of my patients died today. I have sweet people surrounding me here and it is fun to look around at people that I care for and did not know a month ago.  We have had electricity all day. Victor at the cafeteria made pizza. Our 5:30 delivery time occurred at 8, but hey, it made us all visit for an extra 2 hours.

Malawi is a tough place to live, and it is teaching me to be so aware of all the blessings I have in my life.  God teaches me. God sustains me when the lessons are rough. God is most evident when I am at my end. God is very evident in Malawi.  And I rejoice in that!