reflections

June 14th, 2015 by Brittni McLam
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So I must confess, I’ve returned to the states nearly a month ago.  It was hard to leave the jungle hospital…although killing two cockroaches in my room two days prior to departure may have helped.

 

I miss the warmth.  Not just physical warmth (although that too!) but the wonderful open hearts of the Bengali people.  The midwives and the medics and the nurses and the social workers who are all part of the team of helping people heal.  The patients, especially the moms and babies.  But it was time.  I have not yet completed my medical training, although certainly two months in the jungle does wonders for one’s ability to handle certain things.  Like the chief complaint “fell out of a mango tree.”  Pretty sure I won’t see that one during my residency in the upper Midwest!

 

On to the next step of family medicine residency.  I have a passion and have had a long, slow trajectory leading towards serving cross-culturally.  We will see what happens in the future.  Thanks for journeying with me!

Non-Medical Thoughts In Bangladesh

May 18th, 2015 by Brittni McLam
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melonsa herd

 

There is much that happens here that is only indirectly related to medicine. There are health education lessons being written regarding many different things.  There is a business providing employment for women that, among other things, makes uniforms and other items occasionally for the hospital.  There are agricultural projects seeking to both improve both the nutrition intake and provide income for many different people groups. Because health is more than just physical.

 

It is being well enough to work, as the Creator made us to do.  Having healthy relationships.  Meaningful employment.  Maybe even opportunities to learn (which in turn, contribute to life-affecting decisions, which can lead to improved health). As a hospital, much of what we do is solve the acute problem of illness, and create opportunities for positive health interventions through our outpatient clinic.  But for all of us just putting energy towards meeting immediate physical needs–though necessary–is perhaps somewhat unsatisfactory in the long run…

 

“Jungle Orthopedics”

May 2nd, 2015 by Brittni McLam
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brittni

 

Well it has been a warm few weeks. Contrary to popular opinion, it is important to drink lots of water, especially during pregnancy and afterwards. So we have been constantly talking with our patients about that. I am slowly getting more comfortable with moms and newborns in both the inpatient and outpatient setting.

 

The rest is dependent on the moment. Last week I had back to back patients that could not walk–one because a rock had dropped on his foot, the other some kind of hip pathology that we have not figured out. At 7yo she is a very sweet girl feeling much better after 5 days of high dose antibiotics and still a very nasty looking xray. I am finding myself wishing I could talk to them more. I have learned a few words but only really enough to greet someone and to count, and ask if it hurts here and to take a deep breath (on PE).

 

After cases like the above, I have spent some time reviewing a document entitled “Jungle orthopedics” written by an orthopedic surgeon who spent many years here, and is currently here for a few months training medics. Wonderful gentleman and great teacher too. We just celebrated his 80-something birthday. And though it feels more like a zoo than a jungle (at least in my humble opinion) the principles are put to good use!

 

I saw the afore-mentioned neonate as a follow up in clinic this week.  The answer to the case?  We never actually figured out what was going on.  The septic workup was negative, but the bilirubin went through the roof.  So he was in the hospital for nearly a week with elevated bili and no other cause. It happens. B

Some Thoughts And A Case

March 31st, 2015 by Brittni McLam
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imageimage

Here’s the view looking out over the river valley from the hospital compound

 

One of the joys of taking care of patients here is the variety. Common things are still common, but there are uncommon things also, and one never quite knows what to expect. We do a fair amount of prenatal care, and that at least is becoming a bit easier. Otherwise I feel quite over my head most of the time. Especially with children. Who are all scared of me, and I haven’t yet figured out how to win them over. My attending carries balloons to give out, but I didn’t think to bring any of those.

 

This has been the first time in a while that I have been abroad in a country where I cannot communicate at all in a second language. Its a rather disconcerting feeling! That and it is not culturally rude to stare, so one often feels like a parade animal or something. Or the piper with many children following through the market! They are beautiful though, and friendly, there are bright colors everywhere, and many sounds and lots of smells. Such a rich mixture for the senses!

 

Anyway, here’s a bit of something think about, with apologies to the non-medical readers…

 

A G1P1 mother and her newborn (3 hrs old) arrive at the clinic with a chief complaint of “poor sucking.” The night medic decides to admit them to your service. The mother is found to have abdominal pain, a fever, elevated white count, and UA suspicious for a UTI.

 

The newborn [your patient] is admitted also: Chief Complaint: “poor sucking”, estimated gestational age 38 weeks, born at home 3 hours ago. No prenatal care was available. Vital Signs: temp 97, heart rate 144, respirations 28, pulse ox 97%, weight 2.1 kg. No abnormalities are reported on exam. Plan is to encourage breastfeeding and monitor.

 

The next morning, there is report of a seizure at 0430. Staff started O2 and gave diazepam. On rounds, vitals are similar to above except RR is now 76, sats 95%. O2 is running at 1/2L with the prongs in the baby’s mouth. Blood glucose was 61, bili 11.9, a CBC showed WBC 20, Hb 18.9, Hct 59.5, platelets 217. Ca 9.13

 

What would you like to do? Feel free to email, or just ponder and I will post an update in a couple days 🙂

Learning Medicine…

March 27th, 2015 by Brittni McLam
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brittni

 

So you might think that medicine would be different in the developing world than it is in the US. Which in some sense is true. In another sense, it might be the way we should all strive to practice a little more! Sometimes patients show up with a multitude of complaints, and they really only have a viral Upper Respiratory Infection or are constipated and need reassurance or maybe something simple over the counter. All history is done via an interpreter, and similar to some patients I’ve met, the patient may or may not answer your actual question, or understand it, and there may be a long discussion followed by the interpreter turning to you and saying “yes.” It can be frustrating. I’m learning to really work on physical exam and trust those findings, learning to ask before every test “how will this change what I do” and have a significant differential in mind before proceeding anywhere.  Every test I order costs the patient something that might seem trivial to us, but is significant to them when the daily wage here is roughly equivalent to $1.50.  Prenatal care is roughly similar, except trying to determine the correct dates can be a bit of a challenge, UltraSound is done whenever it is convenient for the patient (and they can self-refer for that), and breech vs cephalic presentation is confirmed either manually or by fetal position xray.

 

And I’ve never had so much fun. It is challenging to the utmost degree, heartbreaking when tragedies that could be prevented or resolved with quicker access (some of our patients travel days out of the hill tracks to get here), and joyous when recovery happens that only God can bring against all hope. The best and worst moments sometimes happen back to back. I’ll try and post a case soon also for you medically inclined folks 🙂

 

And hopefully someday soon I’ll post some pictures, at the moment I cannot get them to upload.

 

PS for those who really want to know, I matched to Duluth Family Medicine Residency in Duluth, MN last week. Yahoo!

Preparations for departure

March 11th, 2015 by Brittni McLam
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Ski trail

Greetings everyone! Preparations are finishing and the clock is winding down to departure.  Many thanks to everyone who has supported me in a multitude of ways! It will be quite a change, although the weather has finally warmed up here and a well worn trail 🙂 has melted away in the rain and sun the last couple days.

 

Looking forward to sharing this journey with you! PS this is my pre-departure test post…since I’m a bit new to this blogging thing!  Brittni

 

My First INMED Blog Post

March 1st, 2015 by INMED
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mclam-brittniHello! My name is Brittni McLam. I am a medical student at Des Moines University, and I’m starting my INMED service-learning experience at Malumghat Hospital in Bangladesh, beginning in March 2015.