Traction

Tuesday, October 1

It is October!!!!! I am getting excited about the return home being in site. I don’t want that to make it seem that I am in dire straights,  but I am ready for home and ready to see my people!!!

We really had a low patient count this morning and no one prepared a Bible study for the ward meeting. I had very few comments or cases to discuss and so at 7:20 I was wondering how we would occupy the whole day.  I did manage to hit the record button on my phone before the singing began. The nurses sing at the beginning of the meeting and I think it is a huge testimony to the patients and families. I just love it. Getting video would have been invasive but at least you can listen.

We started rounds and with the very first patient I had concerns. This is a one year old that was admitted for concerns about vomiting and diarrhea.  This morning his abdomen was very distended, he was very uncomfortable, and the bowel sounds were decreased. I ordered an abdominal ultrasound and went on about rounding.  

The patient with Down Syndrome was improved as far as respiratory symptoms were concerned but his pulse oximetry was even lower.  I checked with two different machines but the oxygen levels were very low. The nurses have recorded normal levels but that is incorrect for this patient.  Then I checked the nasal cannula and found it had no flow. Great! The oxygen concentrator had been turned to zero. So basically, this wee one with an illness and heart defect was trying to breath with someone holding his nose closed.  We are here to help little man! So the oxygen was turned back on but still the pulse ox was not at good levels.

I realized at this point that this patient is never going to reach a place where we can discharge him home without oxygen to go as an outpatient for further studies.  I called Treasure at the Central Hospital and he gave the okay to transfer. We continued to round and see patients while we waited on all the communications. We then looped back around to the first patient.  The ultrasound I ordered had not been done. I explained to Esu, an incredible nurse, that I wanted it done quickly so if the child needed to be transferred he and the heart patient could ride share.

The abdominal ultrasound did show concerns for a bowel obstruction.  We rushed to do an X-ray and this gave further proof. I called Treasure back and they accepted this patient as well.  We got IVF and antibiotics started while the ambulance was arranged. Fortunately, both patients met criteria for the transport to be paid for.  It was also good that Sam had talked to the mother of the baby with Down Syndrome this morning so she wasn’t caught completely off guard.  

I did get to do some teaching on both wards.  We have a new Malawian intern who was with us. In the nursery, we went over Ballard scoring that helps us assess gestational age of a newborn.  This is very helpful here as often there is no prenatal care and so mothers don’t routinely know how far along they are in their pregnancy.

Needless to say, we found a way to fill the morning.

Lunch was fine.  Taco Tuesday is consistently good but the wait is long.  Marjoline waited for all of us but was there for almost an hour.  I had ordered some extra tortillas-she didn’t wait for those but Victor sent someone to the inn with them later.  

We have two older boys in the far end of the unit that are admitted for broken legs.  They are both in traction. This means that these guys are stuck in there beds for weeks.  Their legs are bandaged and tied to weights that hang off the bed keeping their legs in traction.  I took pictures of their “weight” which are rocks in a bag and bottles of saline. This is not one of the higher tech components of the hospital. These boys are so bored.  I brought them some hot wheel cars that I promised to them earlier in the day. They were so happy. We talked about them keeping them a secret and it was very cute that when a clinical officer checked on them later in the day, they hid the cars under their blankets.

We also had another nephrotic syndrome (puffy kid) admitted this afternoon.  She unfortunately already has high blood pressure and rising creatinine. We have just seen so many of these kids.  Again, very likely an untreated infection that now will have long term effects.

We did have demonstrations in the capital today.  They are scheduled to continue through Friday. We also continue to have power outages.  The period between power out and generator on at the hospital is longer than anyone likes and not fun.  All oxygen concentrators go off, heaters for babies, phototherapy lights-you get the point. This isn’t just human convenience stuff.  It is almost like we are in Africa or something. CRAZY!

My last tidbit, is that today I played chicken with a chicken.  In the hospital there is one stretch of hallway with a brick wall on either side and no openings.  I ran head on into a large grey chicken. We did the dance one side then the other. I paused and really decided to keep to my path and kick it if needed.  It headed right for me and diverted only after I had raised my arms to block if it jumped up. It was one of those moments that after you look around to see if anyone saw it.  No laughter other than my own.