BMC Days 3 And 4

February 17th, 2011 by INMED

bmc-peds-ward

 

The last few days are kind of a blur as a lot of things have happened. It has been incredibly hot here and although I am trying to drink several liters of water or gatorade each day, I am barely keeping up with the amount I am sweating.

 

Yesterday (Wed) had a rough start. I started to round with Dr. Prine, a pediatrician that is here, and we started in the Peds Ward. We had just finished examining a 6 mo old boy and we walked across the room to check on another baby when all of a sudden the mom says something and the nurse calls us back to the bedside. The child had died! No more than a minute after we had been there checking on him. He had been rushed to the OR the night before due to an acute abdomen and had been found to have severe intussusception. We thought he was on the road to recovery but things change pretty quickly here. Also, we don’t do CPR here since there are no ventilators here and the staff is not trained. Death is pretty much an every day occurance here at the hospital, usually a few each day, but this was the first child we lost since I’ve been here.

 

When we recovered from the shock we finished our rounds in the peds ward. We have a lot of malaria patients, typhoid with or without GI perforations, meningitis, TB, and malnutrition. I did my first lumbar puncture on a two year old girl that we suspect may have meningitis.

 

Clinic on Wednesday was busy and I admitted four new patients to the hospital, and once again the hospital was overflowing as all the other docs admitted several patients as well. After clinic I checked up on some of my patients and then proceded to round again with Dr. Prine in the Peds ward. As we were finishing up, someone brought a tiny little girl to us. She was a twin that had just been born at home that day, and the mother had died due to some complications during the delivery. She is probably a little premature, about 35 weeks, and was struggling to breath. We were able to give her some oxygen and put her in an incubator but she needed constant stimulation and occasional ventilatory support to keep her oxygen level up. Sheila and I volunteered to stay overnight in the hospital to take care of her… and we were in for a crazy night! Only in Nalerigu could all this happen at once!

 

The night started a few deliveries that the midwives handled, but the little girl kept us busy as we took turns bagging her every once in a while. Then we got a call about a woman whose labor was not progressing properly and we decided that she needed a C-section so we woke Rich up and he took care of that. Things calmed down for a while but then I was called to a patient’s bedside and all I was told was that “her condition has changed”. When I got there the patient was gasped a couple of times but then died. Unfortunately there is nothing we can do in these situations when the meds don’t work, since we don’t have all the necessary equipment. I haven’t had to pronounce someone dead before but it was a 70 year old lady with severe pneumonia. Sheila was up for the next call so I stayed with the baby girl. Again, all we are told that we needed to check on a patient in the women’s ward since “her condition has changed”. She gets there through the interpreter figures out that the lady is having contractions. As she hears that, the lady gets up, squats on the floor and delivers a baby girl!! Everyone was just standing and watching her so Sheila came running back to the maternity ward where I was and grabbed what she needed to cut the cord, suction the baby, etc., but both mother and child did well.

 

Our night wasn’t over yet, and we did have to call Dr. Prine to come help us because we couldn’t keep the little girl oxygenated well. Her O2 sats kept dropping, but he was able to stabilize her and she was fine for the rest of the night. However, the worst was yet to come. Around 6 in the morning I took the next call and I was told that a woman was being brought to the hospital due to prolonged labor. We went outside and a few men were moving a young woman from a van to a stretcher so that she can be moved inside. She was obviously in pain but she had all these sheets and plastic wrapped around her waist so I couldn’t really see what was going on as far as the delivery went. We took her inside to look her over and unfortunately I don’t think I will ever be able to forget this sight! The baby had been delivered breech (feet or butt first), she was unable to complete the delivery and the baby was stuck. The baby had been that way for several hours was dead. I called Rich in since neither I, Sheila or the midwives were able to get it out. The poor woman was in so much pain but luckily Rich was able to help us and the woman was actually doing really well today.

 

Dr. Prine came that morning to take over watching the baby girl and Sheila and I decided that after a night like that we needed to rest for a little bit so we slept until about 1pm. Luckily the afternoon and this evening were pretty uneventful… Admitted a crazy lady, Sheila did some sutures on a guy that fell of his motorcycle and we rounded on our patients. Dr. Prine and his wife were able to rig the equipment that we have so that be little girl is getting constant oxygen and CPAP and they taught the maternity nurses how to check on her and make sure she’s ok. We are not sure what’s going to happen to her, but if she had been born anywhere else she would have had about 95% chance of survival but she needs to be on a ventilator, which we don’t have. It is frustrating that we don’t have all the equipment, technology, or trained staff to treat patients properly. Well, my sleep schedule is all off since my call night so I need to try to get to bed before too long. Hope all is well with everyone back in Iceland and US!