First day of work at Macha Mission Hospital.

September 2nd, 2017 by nitaavrith

Monday August 28th

First day of work at Macha Mission Hospital. Started in the morning by rounding on the women’s medical ward. There were 7 patients in a large open room lined with stretchers. Most of the patients speak little English and so the nurse acts as my translator.

 

One young woman was there for an asthma exacerbation with diffuse inspiratory and expiratory wheezes. Back home, I would usually order this patient duonebs x3, solumedrol IV and magnesium. None of this is available here so instead the patient received salbuterol, aminophylline, hydrocortisone and amoxicillin.

 

An elderly lady with a cough, RLL crackles on exam, WBC 19, covering suspected pneumonia with ampicillin. CXR pending xray machine being fixed.

 

Another lady had a stroke 2 weeks ago with right-sided deficits. She had a known history of hypertension, noncompliant with medications but also found to have an irregular heart rate on exam. Without a CT scanner at Macha, there is no way of knowing whether the stroke was ischemic or hemorrhagic. And so she was started on digoxin for heart rate control, atenolol and enalapril for BP control.

 

Another young woman with TB. WBC 24, started going into liver and renal failure despite IV fluids, steroids, antibiotics and TB treatment regimen. On exam, the patient was cachetic and staring into the distance.  She was gasping for air and her mother stood by the head of the bed trying to comfort her. Oxygen sats dropped frequently into the 60s with little improvement on 3L O2. Lungs sounded clear. There is no CXR available. No CPAP/BiPAP or resources for endotracheal intubation. I propped the patient up in bed, bumped the oxygen up to 5L. Not much else one could do. There is such a stark contrast in the resources available here versus the US. It is difficult not to get  frustrated. I am told that I must focus on what CAN be done instead of what CAN’T be done.  This is actually a comforting mindset.

 

Afternoon was spent in ARV clinic and then OPD clinic. ARV is the antiretroviral clinic. 15% of the population of Zambia is HIV+. First line medications for HIV here are truvada and efavirenz. They are started independent of the CD4 count. The hospital used to go out into the community and screen everyone for HIV and the treat those who were positive. They are now screening everyone who presents and is symptomatic or anyone who gets admitted to the hospital or if a patient is found to be HIV positive, the patient will serve as an index case and members of his/her family and community will be screened as well. Macha Mission will soon be changing the screening system so that they will screen everyone who has contact with the health care system.  Many of the patients I encountered at the clinic today were in their late teens,; they were either born with HIV or became infected via breastfeeding. Since the introduction of ARVs to Macha in 2005 and by aggressively screening and treating all pregnant mother, the mother to infant transmission rates of HIV has dramatically declined. With aggressive public health campaigns, effective treatments, and good community support it seems like the face of HIV is making a change.

 

More to come on OPD clinic another day.