My week in Pediatrics

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First of all, here is a link to Derek's photo album:
http://picasaweb.google.com/daugz14/PeruPhotos?authkey=Gv1sRgCOKK7MWz9I-4zwE&feat=email#

He is the only one to have successfully loaded photos. They include pictures from our two hours in Lima, the bus ride to Huancayo, the outside of the hospital, the fluoride treatment day, playing with the kids at Rosario orphanage, the concert and the hike, please enjoy!

Now on to this week. This week I have been doing rounds in the Pediatrics unit. What I should tell you is that pediatrics here is not like pediatrics in the US. In the US the survival rate of children brought into the Pediatric unit is high, it is known as a happy specialty. Pediatrics here is the unit that is usually the most depressing. The kids are still troopers, but their illnesses are more severe and the mortality rate is much higher. The problem is that they are not brought into the hospital soon enough, so when they get there they are in such advanced states of the diseases that there is often little that can be done. Most of the cases in Pediatrics right now are diarrhea/ vomiting or pneumonia, or a combination of the two. Pneumonia is a huge problem right now because it is the winter and very cold here in the morning and at night. Many children or their parents do not have the means to provide them with warm enough clothing or blankets at night. Parents are also not trained to see the first signs of pneumonia or diarrhea/vomiting. They may think that it is just a cough or stomach flu that will pass. Parents preparing food do not consistently wash their hands and so children's food is exposed to feces. This may also be due to the lack of information given to parents. Either way many wait way to long, in some cases over a week to bring in their child. Tuesday night in the emergency room a mother and father brought in their child. When they arrived the child had no vital signs and they were not able to resuscitate him. On Monday we had a 27 day old baby come in. He had sepsis and his oxygen saturation level was 52%. He died at 7:30 the next morning. Half an hour later his mother came in with diapers for him and discovered he was gone. She asked the head nurse where her baby was and she told her that he had died. HIPPA here is completely non-existent. Although I tried to distance myself from this situation all of this information was given to the mother at the front desk. I was upset by this site, but things like that happen everyday in Pediatrics. Resources are so limited in the hospital that only the simplest procedures and treatments can be given, otherwisethe patient must go to Lima.If a child is in such poor condition she may not survive the eight hour ride in the make-shift ambulance to Lima. The doctors work so hard, but without most technology and with patients being brought in so late they are limited in what they can do. For instance on Wednesday a little boy came in early in the morning. He had advanced pneumonia. When we got to him in rounds his oxygen was at 80% and his heart rate was 40bpm (For a child this is almost three times lower than it should be). His limbs were turning blue and his feet were ice cold and purple because the oxygen coming in was so low and the blood was being pumped through the body at such a low rate that the oxygenated blood was flowing only to the heart , brain and lungs. Self preservation at its last steps. Every time the boy breathed his whole body shook. He was working so hard to get oxygen in. He had short shallow breaths with a respiration rate of 54 breaths per minute. In an adult human in Huancayo normal respirations are between 14 and 22 (higher than most because of the altitude). This child was carted down to the adult ICU, which only happens in the worst cases. Last week a child in a similar condition was sent to ICU and died three hours later. Usually the ICU is the last resort for children before they die. As of today he was still alive but still in very bad condition.

Life for children in the hospital is bad, and for many children life outside of the hospital is also troubled. Besides living in poverty many children are either abandoned, given up due to poverty, or abused sexually, physically, or mentally. On Tuesday afternoon we went to the baby orphanage. This is where children from new infants to around five years old are housed. The facility is very nice but limited in staff. Infants are not allowed to be picked up because they will become too used to human touch and crave it and it cannot always be provided by the nurses. This kills me because I strongly believe that love and touch and cuddling are important ingredients in childhood development. At Rosario, the orphanage for older children, most of the children have behavioral issues due to feelings of abandonment, histories of abuse, or unhealthy relationships with their family. They are all loving and have very kind hearts, but they have been given no release for those other emotions so they express them by hitting each other or picking on the weaker children. These children need love, care, and attention mixed with a little discipline. It is a wonder that they can trust any adult after what many of them have been through. Some of he children's families visit them in the orphanage, but for others their parents are not allowed to see them. Yesterday we found out that one of the sweetest little girls from Rosario was taken off of the street while she was walking back from school by her mother. She is not allowed to have contact with her mother because her mother knew that her father, who is now in jail, was raping her. As of now they are still trying to get her back.

Children here in Huancayo suffer the most due to poverty. There are many teenage mothers without the resources to raise a child. Parents also are told to have only one child if they are poor. All of the pediatric doctors tell parents to use family planning, but family planning here for most consists of using the rhythm method which without the proper resources is completely ineffective. Most people are opposed to birth control because they are strong Catholics. Abortions are completely illegal, but some women do choose to have an abortion. Their only resource for abortions are secret clinics in back alleys done by sketchy doctors with dull and unclean surgical tools. The ob intern said that at least 3-5 incomplete (attempted) abortions come in a day. Women can opt to have their tubes tied, but this even poses risks. Today Anna was in surgery to watch what should be a routine procedure, but the woman flat lined fifteen minutes into the surgery and they had to do CPR for ten minutes before she came back. Then she woke up partway through the surgery because the anesthesiologist did not compensate for the time that was spent resuscitating her.
This week has been a challenging and emotionally draining week, and yet very educational and important for me. Although it may not sound like it I am still enjoying my experience here in Huancayo. The experiences this trip is providing are invaluable and I will treasure them and learn a lot from them!
Hope all is well with all of you!
Caitlin

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Comments

[Trudy]

Isn't there just such tragedy in the world. I know your presence will be an asset. Am thinking of you. Love you, Trudy

[Claire]

Pediatrics week
Dear God, Caitlin: It amazes me the depth of experience you are having. I didn't know you would witness poverty and its consequences so closely. It's emotionally overwhelming just to read your entry. So much seems out of the control of the medical staff. It is clear that having plenty of doctors, etc. is not enough to overcome the interrelated factors of poverty. The fight/discussion over the new federal health care programs is raging here.. People, like me, are amazed that the single payer plan is not even being considered by Congress. The insurance industry is gigantic ( I don't know how it compares to the auto industry). Most members of Congress receive money from the industry. The chair of one of the committees drafting legislation receives the third highest amount of these contributions. If they don't go for single payer, I don't see how they can fund any program that significantly lowers the number of uninsured. I wonder how our system looks to you now, even though time-wise your visit has been brief. Wish all of its problems, it sounds like health care here, and accompanying social supports, works very well compared to Huancayo, etc. I am sorry for the pain and outrage you are experiencing, and also thank God for guiding you into it. You are fully sufficient to handle the turmoil and really not far from home. I feel you being changed and I honor your courage and deep commitment! Love, ADC