Blood Draw Extravaganza

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Today was a crazy busy 2nd day at Katatura State Hospital. Ward 8B where I am working exploded overnight with 8 new admission! Ward 8A, where Raissa is working has been blessed with her White Cloud from Geisinger and only has a few sick patients, the rest are playing around the halls waiting for bus ride on friday. They are fun to play with though, and tomorrow we are bringing a few little things to keep them busy until they get to leave. Rounding on 8A was long this morning, and I have quickly been introduced to writing daily SOAP notes sort of the Namibian way (although theirs are very sparse, and usually say "see above, stable, and plan continue current management." so I feel like i'm writing a novel!). My work rounds on ward was the same as yesterday, though busier. basically just told to "grab a chart" and went on my own. I am asking a lot of questions of the 2 medical officers because the whole system is so unfamiliar, and even the medications I hopefully will understand soon. I saw all different kids than yesterday because they don't really follow the continuity of care plan, they just see whoever. So, I still stopped to check on the ones I saw yesterday but had a whole new set I saw today. Lots of interesting kiddos. One baby, whom mother gave me permission to take photos has a congenital syndrome that no one is sure of. I am going to sit down with Smith's one night and figure it out (maybe). He has a huge hemangioma in his abdomen and along skin surface covering most of right abdomen/back/buttocks and all of right leg. the abdominal mass is so large its causing lymphedema of the whole leg which is also severely deformed. He sort of has toes, but they are not formed properly. other leg has syndactyly of 2nd and 3rd toes. He also has ambiguous genitalia so if anyone out there can put those things together send me an email! He is only 9 days old, and was born this way. The consultant came today and says the only treatment is amputation. I don't understand how this would take care of the abdominal mass, but they are not planning anything for now. He is otherwise a happy healthy and growing adorable baby. I saw a few babies with Chicken Pox...seems common, but I have actually never seen a patient with this now that the vaccine is given. I sort of remember having chicken pox when I was 5 or 6, but that was way too long ago! He had secondary infection and pneumonia, but is better and I got to send him home today! he also had a new murmur on exam yesterday the other doc noticed. he is scheduled for echo in 2 weeks! I listened today and it sounds like a benign flow murmur, but I don't think they trust me yet so he will come all the way back to Central Hospital (down the road) for the Echo in a few weeks. I saw a baby admitted overnight with bronchiolitis. When I saw him this morning he was happy and healthy, only received one neb of salbutamol (like albuterol) 6 hr prior and was never on oxygen. he was breathing fine all morning and lungs clear every time I listened! I don't think it was bronchiolitis, but he did have a very stuffy nose. Also, nasty bilateral ear infections when i looked. We were told they don't often examine ears here unless specific complaint from family, and that definately seems the case. However, in clinic this afternoon Raissa and I diagnosed 5 total ear infections! So, we are hopefully going to help them with that. After a busy morning rounding, then it was procedure time. I was with one of the medical officers and we had what seemed like a never ending list of blood draws. I got to do a bunch and also a radial blood draw (which we are never allowed to do in the states!)...its a good feeling to know I can get blood from a baby and child if needed since only phlebotomists usually do this in the states. Unless its a newborn/premie of course. They also do not like saphenous sticks, which is our mainstay of blood drawing in babies...I may try to teach the new interns just so they know! After a few hours of blood draws it was lunch quickly and then afternoon clinic in the POPD (peds outpatient clinic). Raissa and I had our own exam tables and desks in same room. I saw 10 patients in 2 hours! It was busy but a lot of fun too. One mother was not happy with me for diagnosing viral URI and not giving antibiotics. I tried to explain the reason and give supportive care, but not sure it mattered. I know the baby was fine but it was hard to say no. I also learned that social work exists and can actually help get formula for a baby! I saw a 1 month old who was otherwise healthy, but just now above her birthweight only by 100 grams! that's bad for those of you that don't know! She was adorable and poor mother had really awful mastitis bilaterally and no more milk supply (she had seen her doctor) and was giving the baby only 2 small bottles per day of cow milk as that is all they could get on the area they live. So, I had to figure out what to do. Turns out you have to refer the patient to social work (around the corner in the hospital, sort of) and give a note saying why you think they qualify for formula, then social work approves or does not. luckily they approved this mother/patient. then they come back to see me, and I have to write a prescription for formula for the baby. then pharmacy will fill it for no cost. Such a hassle and took forever, but atleast the baby will eat! They will come back to see me in 2 weeks, so hopefully will be well then and growing strong! off to bed, another busy day tomorrow.

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