Sweaty Palms

Thursday, August 29

I worry today that my posts are becoming repetitive, and I understand that reading the minutia of my day may be getting old. I do really appreciate the comments and support as it makes me feel less alone. Additionally, I know this is also for me to document my days here as time will erase from my mind the stories and images. So, here I go.

Morning report was typical with nothing really new. There were a lot of concerns about delays in transporting emergencies. There have been deaths during transport lately. Still seems to be a problem of a  make payment before you go philosophy and a lack of urgency. The ambulances and quick ERs we have are such luxuries that we don’t even appreciate.  

I walked to the Pedi ward with some dread. I was aware that 2 clinical officers were gone and the one remaining is rarely present. Patrick, the Malawian resident, seems distracted. As soon as I stepped into the ward, my palms were sweaty.  The child with stridor last night is worse. He holds a sniffing position with loud and desperate breaths. His neck is swollen and he appears tired. I was worried about a retropharyngeal abscess or epiglotitis. I started calling and texting the medical officer- super slow response. I explained my concerns to the nurses. I started filling out transport forms and had the nurse call the ambulance. The clinical officer finally showed and agreed with my concerns. We did some x rays that only increased our concerns and did not offer an easier diagnosis.  Then, we had no extra nurse to go on the ambulance and I had to beg the resident to go. After an eternity they left.  

The medical officer was then called out to an emergency in the outpatient department. This left me as the only one on the ward. So with a medical student and a great nurse, Sibo, we started rounds. We had 13 and had another 4 were admitted as we rounded. Truly a dive into the deep end without floaties,  Even the ever available, Dr. Catherine was not here today. We slowly plodded along seeing malaria, abscesses, horrid malnutrition and dehydration, and a severe meningitis case. Mostly things that are so preventable and yet here kids are dying. The meningitis is scary but so interesting.  This one is due to a bacteria that US kids all are vaccinated against and so I have never seen, but it looks just as the textbooks describe.

It continued on until after 2pm when the resident returned and I stepped out for lunch.  I returned quickly and reviewed all the charts and made adjustments and reminded nurses of things that had been forgotten.  The positives, and there are some, don’t let the details of this record paint a gloomy picture: Being alone with the nurse and nursing students was good for my relationship with them.  When I explain concerns, they learn that I care, that I am trying, and that I am doing the work with them. They come and ask questions and seem to be partnering with me.

After work, several of the ex-pats wanted to go on a short hike to “Sunset Rock” and I joined in.  We packed bags with snacks and watched the sun set behind the mountains. An beautiful display of God’s creation.  As I am loading the pictures, I am having one of those “Oh my goodness, I am in Africa. LOOK at it!” moments.

I particularly enjoyed just the fun and silly banter with young people. I find it so interesting that when we are all out of our normal habitats and life context, the barriers of age, social status, and lifestyles just fade away and you find yourself comfortable with people you would not normally be around.  I did walk back a little early alone and teased all the young people about staying safe and making good choices like I would with my kids. They all came back to the guesthouse later to play games and joked with me about making it home before curfew. I also was glad to see after our recent deep discussions that the girls are still joking and teasing with me and not leery.

I am going to bed and feeling much less anxious and at least for a few hours without sweaty palms!