Tail of the Hippo

Tuesday, October 8

First off, let me say Happy Birthday to Pax!  I hope your day is a great one and that the football game goes well. I will be cheering from Africa!

Secondly, I wanted to share that here instead of saying “that is just the tip of the iceberg”, you say “that is just the tail of the hippo.”  It just makes me laugh each time it is used and it came up in ward report again today.

Being Tuesday, we started the day off with a gathering on the wards.  They now hand me a Chichewa hymn book and I sing along, not comprehending what we are singing, but still managing to be tearful (I know this surprises all of you) with the beauty of singing along with my brothers and sisters in Christ.  Eliza, a senior nurse, brought the message about Paul praising God even in his suffering and the witness that was to those around him. She encouraged all of us that despite our own problems we should continue to praise God even in our work.  We then discussed the two new admissions from last night. Then I led the discussion about the baby with the breathing issues yesterday. There was discussion with the nursing students about lack of clarity in their learning objectives. It seems that the assumption is that their lecture teacher brings them to the unit and does this.  This evidently wasn’t done so after we concluded they all left to go back to the nursing school (a 20 minute walk) and we saw them an hour or so later with their instructors. I still don’t fully understand.

The result for us was that all the nursing students were gone for rounding, so there were many less people, less translators, and no one to give instructions for the day.  It did make things a little faster. Additionally, the surgeon came and did rounds and there is a new clinical officer who will take care of orthopedic problems. So, we had several patients we did not have to attend to this morning.  Mango trees seem to be a source of many injuries. Right now, they are starting to come into season but the ripe ones are high in the tree. This leads to the older children racing to the top to get the few good snacks. We have two in the ward right now with broken arms and one also has a head injury.

We rounded on all the kids in the ward and for the most part they are doing well.  The baby, Amara, that i mentioned with the breathing problems is breathing easily today such that she came off of oxygen.  Her mother is happy but did have a lot of questions. Eliza even commented that she thought the medicine was working well and it was a good connection point for me to affirm and thank her for all her help.  

Florida is still puffy but her blood pressure is a little less and her kidney function is still good.  Stella is more uncomfortable every day and we are really doing all we can. I had another conversation with Sam about her.  It was communicated that here the custom is that the physicians discuss with the family that the patient will not improve, that everything has been done, that there is limited time.  Death, however,is not directly discussed and not culturally appropriate. Then it is expected that the family will approach and state that they feel it is time to go home and the medical team agrees.  Sam stated that if we say that it is best to go home it is like we are coldly dismissing them from the hospital and will cause a bad reputation. He and the chaplains have been visiting with the family often to review this, but the dad is still not expressing a desire to leave.  We are all concerned that we are just prolonging Stella’s suffering and adding to the rising bill. Not at all that those carry the same weight, but it also it a factor here. So I wait, unsettled about it but wanting to be culturally sensitive and also knowing I am but a short time guest.

We have several who should go home today or tomorrow.  The girl with the mastoiditis and HIV responded very quickly to the antibiotics and went home yesterday on oral medications.  It is amazing with HIV how bad things can be and then how quickly they respond to medication. Our malaria patients are all looking good today as well.  

I love the small assurances of acceptance I see.  I love that all of the moms smile and wave at me. There are a few that I even have little jokes with.  The fact that they can laugh with the strange white doctor is good. The nursing students also came to me with a list of conditions they wanted to understand.  This is them seeking me out and then sitting around as I teach and look up pictures to show them.

We did not do much in the NICU today.  They had completed rounds when I made it there.  There is one with severe birth asphyxia that will most likely pass away today.  It has so much brain damage that it just simply fails to breathe. It is on our maximum support and not doing well.  This is another mom facing such a hard day, but I will admit that in seeing the moms with children with significant brain damage in this place, this suffering may be less than what they endure.

Lunch was nice and easy today.  The girls and Melissa have gone into town with Nicole to do shopping. The picture shows how Nicole found the car this morning-it was not an easy fix and required work and multiple cars for errands-not a good start for the day! Nicole goes on Tuesday so that she has Lactogen (formula) and likuni phala (porridge) for the Wednesday clinic for all the children and families she helps.  

The afternoon was not crazy but it went very quickly which was so nice.  When we got back we had a new admission. It was put in with a diagnosis of dental abscess vs. mastoiditis.  However, the patient is only eight months old, meaning no teeth to abscess and the swelling was not over his mastoid bone.  Instead, he had swelling of his left cheek over his parotid gland. Given his blood work it is suspicious of suppurative parotitis but may be mumps.  We put him in isolation. I so wish I had a test to confirm, but it was interesting to see. The nursing students and medical students continue to show great interest and it was good teaching and learning with a patient.  We then went back through some patients and were able to discharge one. Stella continues to have more issues. This afternoon we discovered some breakdown of the skin on her bottom from all the dampness. She is just so miserable.

After work, I decided to go on a long walk.  I walked to see the kids school, Ebenezer, the nursing school, and just through the neighborhoods.  Lots of greeting with people. Lots of goats and chickens. Then by the Presbyterian church, three different choirs were practicing.  The English choir sang inside, the Chichewa women practiced on the front steps, and the children were singing in a side building. The air was full of music. I felt like I was in a movie with a great soundtrack playing for my walk.  I will just put pictures and video clips at the end of this. The videos don’t have much to see but were capturing the sounds. Happy and Deona were on a walk with Deona’s grandparents and ran over to say hello. Later on my walk, some men called out “Hello Dr. Alyson” waving from their homes.  Likely nursing students. It was just fun to take a village walk and feel known and like part of the community. The walk was good for my legs and heart!

It was a very enjoyable day. Now it is early in the evening, I am settling in to shower, eat, and read.