A new system

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Today we had our first full day working in the hospital in the morning and in the clinic in the afternoon. In the hospital Katie saw 2 kids with newly diagnosed cancers. A 10 year old with medulloblastoma and a 2 year old with Hodgkin's lymphoma that presented as a lump in the groin. They do the chemotherapy at the hospital across the street so these kids are waiting for transfer there. She also saw the Gower's sign for the first time in a boy with muscular dystrophy. Per usual, she looks like a baby genius on rounds.

I have been seeing lots of babies with kwashiorker (malnutrition) and quite a few babies with VSD (heart defects). I also had the opportunity to add to the differential diagnosis on an 18 month old with chronic cough and worsening chest x rays. She is white (obviously not super common here) so I suggested cystic fibrosis (again obviously not very common here) so we are going to send out genetic tests for CF (sweat tests can't be done here) Also when we came in today I noticed that a baby we had discharged yesterday was still here and found out that it was because the bus to her region only comes once a week so they would have to wait in the hospital until then.

We were kind of all alone in the clinic so we were definitely flying by the seat of our pants a little. Most of their medications have different names and strengths so trying to figure out what meds to give and then figuring out the doses was a little tricky. Also, everyone in the country carries these little yellow books called passports that is basically their entire medical history and immunization record, so when a patient comes to clinic you have to quickly flip through the book to figure out their past medical history and then write up a note for their current visit. Even the prescriptions go in the book. The bad part about these books is that very few people still have their original books so there are generally huge pieces of the medical history missing. The medical officer (attending) we were working with wasn't very friendly so we had to figure things out for ourselves but we managed. Hopefully things will get easier as we get used to the system here.

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Photos

Lauren and Hubert
Lauren with a baby she treated for facial cellulitis and his Mom

Dr. Brown with baby
Dr. Brown examining a baby with diarrhea and dehydration

clinic
The clinic