Teaching Rounds

Monday, September 30

Here we go into another week.  The clinic is extremely short staffed.  After morning report, the clinicians stayed to talk.  We have had many medical officers leave and several are out of town.  Our surgeon/orthopedist had a fall and was in the capital to see a specialist.  Basically, as of this afternoon we have no surgeon until next Monday. There is one coming with his family who will be here long term, but for this week it may be interesting.

I have three medical students with me this week, 2 Dutch and one Malawian (Lisanne, Sharisa, and Grace).  We did slow teaching rounds as all the patients were new to them. We also have Malawian and Swedish nursing students so it was just a lot of teaching.  

We have all of our longstanding patients.  No new patients from the weekend. One patient named Hopson who was with us for a long time was discharged over the weekend and I am so glad.  The baby with Trisomy 21 is much improved today. The challenge will be weaning him off of his oxygen when his levels are abnormal but we have no idea what his normal is.  

We were able to talk at length about patients and go far into disease processes and plans for treatment.  We then went as a big group to the NICU. Marleen has been placed there to do her residency rotation over the next two weeks.  Catherine was also there to help orient her. I stayed and rounded on patients as they were moving slow and it was packed. Telesa, the baby with the skull abnormality was admitted over the weekend. I have played with her and fed her numerous times but never listened to her heart. She has a loud heart murmur. I felt so bad to have to tell Nicole. She has so much on her plate And now another worry about a sweet baby she cares for.

The hospital has had to stop paying for weekend shifts and so no one rounded on the patients in the nursery.  In fact, for several patients, they had nothing in their charts since my notes on Friday. Many of them were discharged today or moved with their moms in Kangaroo Mother Care.  

It was a very hot day here and the NICU was sweltering.  When I left I was thoroughly soaked. It makes you feel a little gross for the rest of the day.  

Before lunch, I spent time reviewing a chart with the three medical students.  I am presenting this case on Thursday at morning report, so I was able to ensure correctness of my slides as we reviewed and practice my facts.  They seemed to enjoy sorting through the chart and actively working through the thought process.  

Lunch was busy.  Because of the demonstrations, Amelia and the kids contacted the embassy and were picking up their visas this afternoon.  They went to visit the kids village to say good bye to family and then were here at lunch to play with the kids and say goodbye.  Things have been a little bumpy and drama filled for a few days, but I really think it is just stress and anxiety bubbling out. The kids ate lunch with us and are excited to ride in an airplane and see their Daddy again.  They are also looking forward to seeing their sibling and meeting the family pets they have heard so much about. This picture is later in the day when they got the visas. So CUTE!

The afternoon was not busy or stressful and I certainly rejoice in that.  We went back through patients to check on them and ensure everything was done.  There was one that had been admitted over the weekend that was given IVF for dehydration and is puffy (edematous).  However, when I talked to mom she reports the swelling started before the admission. I fear that he is another patient with nephrotic syndrome.  A urine sample was collected but results were not back before the lab closed for the day. We also finished with the chart review and teaching case.

This evening seems calm.  We are all so happy that Amelia and the kids are on their way and safe before the demonstrations start.  Kids drift around my chair as I type. The guard sweeps leaves. I think I have mentioned this before. There is trash everywhere but the sweeping up of leaves is what is done.  Just is humorous to me.

It is getting dark, conversation groups have assembled around the patio, dinner is being made and eaten.  I will say goodnight!