Today, we saw our first baby with SEVERE dehydration. It was heartbreaking. The baby was 2 months old, his mother had died in childbirth, and he had been admitted yesterday afternoon and promptly (it seems) forgotten. The nurse overnight seemed to be fairly good, as far as Ghanian nurses are concerned. At least he wrote down the baby’s temperature, and incredibly quick heart rate and respiratory rate, even if he didn’t actually call a doctor. They hadn’t even drawn any labs or started basic fluids on him by the time we saw him in the morning, even though both were ordered yesterday afternoon. He had an impressively sunken fontanelle, pronounced skin turgor, respiratory rate in the 60s-70s, hear rate in the 150s. Obviously sicker than stink. They just let him lay there overnight, and did almost nothing. Long story short, we all got involved this morning and the baby ended up getting transferred to Okomfo Anokye hospital in Kumasi (the huge teaching hospital about an hour’s drive from here), praise the Lord. We didn’t even have any oxygen to administer to him. He should have been intubated hours ago, but if he suddenly stopped breathing, we had no way of intubating him or recusitating him at all.
It was just so frustrating to know that the baby had been laying there all night, with no real therapeutic interventions made, and that if he dies, it will be because he didn’t get adequate care. THIS is how kids die of dehydration so regularly in developing countries. There is just this cultural inability or unwillingness to react to emergent situations, and it can be infuriating sometimes. Cam handled the situation with amazing calm, staying true to his ideals of preserving relationships at all costs. He was obviously distressed about the situation, but never once yelled at anyone or got angry at any specific person. I truly wonder if I could function in an atmosphere like that, I think I might go nuts, simply for the knowledge of everything the patient’s WEREN’T getting. It would be hard to remember everything they ARE getting by being in the hospital at all.
Other firsts: first clinical conference at Mampongteng (Cam talked about bacterial meningitis, and the standard of treatment here), first experience with African drug reps (yes, they exist over here as well!), first experience with fish balls (well, Lisa’s first experience, and then she strongly urged me NOT to try them…), first trial of Malta (malt beverage). People have been right; Malta tastes like a mixture between straight molasses and liquid rasin bran. Needless to say, we did not finish them. In fact, they were mostly full when we handed the bottles back. 9
The drug rep talk was actually pretty exciting, even I have to admit that. There is this new pharma company called LeGray whose entire focus is creating pharmeceuticals that are entirely produced and distributed within Africa. Currently, there are tons of drug companies, but all of them import the ingredients for their pharmeceuticals from other countries, and so rely on the markets of those countries. This company, whose parent company and therefore source of funding is based out of Illinios, would be entirely independent in that regard. They are currently working on artesunate (an antimalarial we have become quite familiar with), and are trying to get approval from the WHO to begin manufacturing antiretrovirals for HIV. The exciting thing, among many, about producing these pharmeceuticals in Africa is that the costs would probably be incredibly reduced. Currently, 70% of drugs in Africa are imported, and 25% of drugs in Africa are sub-standard (including completely fake). So companies like this would do so much to improve the state of pharmeceuticals in Africa. How exciting!!!
We had dinner with Cam and Anne, and tried fu-fu for the first time finally. There were two types: casava and plantain based, and yam based. It’s this pastey/doughy food that you eat with soup (our soup had chicken in it). It was really good, and I hope to get it again before we go! The best part about the whole thing is that you eat it with your fingers! There’s nothing better than some finger food with friends. Caylor (Cam and Anne’s 10 year old daughter) made us all Valentine’s hats to wear with dinner, and we played Apples to Apples afterwards. All in all, a most memorable Valentine’s day!