2 weeks already ???!!!

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Cannot believe we are done with our 2nd week of work at Katatura State Hospital! It has been wonderful and different and busy and fun too. The time is going so fast! This morning ward 8B actually finished rounding before Raissa's ward! That never happens! So I went to join Raissa and see some of their interesting kids. The 6 year old I admitted from clinic with congenital heart disease (and NO surgeries) was doing well, thank you Amoxicillin for ear infections :-) She was actually a "scheduled" admission for cardiology review tomorrow. And by scheduled I mean a bus load of patients showed up at 430pm yesterday (clinic closes at 5pm, no matter what!) and almost all of them were sent from other clinics or far away parts of Namibia for admission to peds wards. However, its not nice like the states with a "call ahead" or transfer service. they just come. So she was the last patient I saw for the day and I did all the normal cardio admit stuff for the hospital here and she had a nasty ear infection. Looked a million times better today which was great to see! Bad news is all these patients have either been waiting for cardio review on friday, or came on a bus yesterday for admission for cardio review friday. Found out today...NO cardiologist is going to be around on friday. so, no peds cardiology clinic at central hospital. Then the decision for some comes whether to keep them in the hospital for another week and hope cardiology clinic happens next friday (its usually every friday at Central Hospital down the road) or send them home and pray they come back. We'll see but most will probably stick around another week. One of my favorite little guys from Raissa's ward went for his VSD repair on monday...he's still over at Central Hospital recovering so hopefully he'll come back over here for the rest of his recovery once he's out of special care. I miss seeing his little face around! We learned that cardiology is not only a special "almost" always friday clinic, but that surgeries are run a bit differently here. Here (well, at Central) they can do basic VSD or ASD or PDA repairs, but that is it. Anything more complex and depending on how complex they may be able to have surgery at CapeTown in South Africa. Maybe. But for most, especially some we have seen likes Tetralogy of Fallots ("tets") or Double outlet right ventricles with TGA (he's really sick) or single ventricle they will likely not get to surgery. The reason is that they require staged procedures and multiple costly surgeries and long recovery times. there just isn't funding for this. So surgeries are sort of done in Cape Town based on need but also how complex the lesions of the heart are. I wish we could bring them all the the states, get the surgeries and recovery they need, and then let them come home. But then the problem is follow up and long term care. Its just hard sometimes to see how much we have in the states that is just taken for granted, in that we don't even think twice about a congenital heart baby or kid getting surgery. of course they will have surgery. Maybe not at the big G right now, but somewhere. And here, its just keep them going as long as we can and make them comfortable. I wish I was a pediatric cardiologist this past week, only in that I could be better at diagnosing the new kids and treating the current ones. We see SO MANY!!! I wish one of us had at least done our peds cardio rotation before this. Well, atleast we are seeing and learning a lot as we go. We have so many rare and interesting cases. two more today that I had only read about, and one from yesterday I have never seen or heard of! I was able to read up on it and teach the rest of my team though which was good. Strange to see the pics I found and my notes attached into the patients chart though. We definately need another copy of Smith's here if anyone wants to donate let me know!!! they have one in the prem unit but nothing for the peds floors. Raissa had another successful IV start today...after a swift kick in the face by the kid. don't worry she's fine! The little girl was just getting her back for admitting her from clinic yesterday :-) She has pretty classical Kwashiorkor, which is a form of malnutrition here and really common unfortunately. All the Medical Officers and Interns call the kids with it "Kwashies." I am learning a lot of their slang and its funny. The problem is we're around them all day and have picked up a few things. I didn't even notice, but Pam and Dr. Brown did the other night. Ah well, it makes us more cultured right?
Right now we should be asleep, but we're finishing packing for the Coast tomorrow. We aren't taking computers so no blog for a few days. I'm sure we'll have lots of pictures and stories when we get back. I know we saw many more interesting patients in clinic, but I can't remember right now.
Oh, funny story. I don't think we ever mentioned my marriage proposal. That's for another day. don't worry, I basically ignored it since I was trying to take care of the patient. But today a mom and grandmother came in with a baby from a tribe far north. They were so excited to have a baby doctor from the states! It made me feel proud actually. I was hoping I could live up to their expectations. The baby ended up having bilateral ear infections and I gave Amoxicillin and they were so happy I found a cause for his fever. They asked very politely if I would take him back to the states with me. I very nicely responded that he needed to stay with his family. The mother agreed, despite the grandmother's insistance! finally the grandmother decided he could just come find me in the States when he grows up. I said that sounded good and wrote my name down for her :-) They also wanted a picture of me holding the baby, which was sweet but also a bit strange to know they have it. Ah well. The grandmother told me she will be back next week to bring "the US doctors" a present from Africa to bring back to the states. I just thought about this now, but I hope its not a baby! just kidding all, I do not think she is bringing us a baby to take back. Anyway, we have to sleep. More on Sunday when we get back from our Coastal/Desert Adventure!

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