{"id":23,"date":"2013-05-21T19:29:22","date_gmt":"2013-05-21T19:29:22","guid":{"rendered":"https:\/\/inmedblogs.us\/jeffreywalden\/?p=23"},"modified":"2015-06-08T19:32:37","modified_gmt":"2015-06-08T19:32:37","slug":"peds-and-adult-hiv-clinic","status":"publish","type":"post","link":"https:\/\/inmedblogs.us\/jeffreywalden\/2013\/05\/21\/peds-and-adult-hiv-clinic\/","title":{"rendered":"Peds And Adult HIV Clinic"},"content":{"rendered":"

\"Families<\/a><\/p>\n

 <\/p>\n

Today was my third day on Pediatrics.\u00a0 Dr. Susan and I will split the ward in half and see each patient, in theory at least.\u00a0 She rounds on the sickest patients (i.e. those on oxygen) and I start seeing the other patients.\u00a0 Today, however, there was a new admission from last night who is very ill.\u00a0 He is a 2 year old with HIV and severe malnutrition.\u00a0 He only ways 7 kg and is so malnourished that his skin is paper-thin and basically peeling off.\u00a0 Very sad.\u00a0 Susan spent most of the morning seeing him, while I saw the rest of the patients.\u00a0 This was a good feeling, being able to manage a Peds ward.<\/p>\n

 <\/p>\n

Afterwards, we went to Doctor\u2019s meeting and then Adult HIV Clinic.\u00a0 This lasted much longer than Peds HIV Clinic, stretching right through lunch until about 3 in the afternoon.\u00a0 \u00a0 I am learning much about HIV management, when to start anti-retrovirals, when to switch to second-line therapy, the adverse effects associated with each medication, and so on.\u00a0 Most of the patients are fairly stable and therefore quick visits, but sick patients do arrive as well who need admission.\u00a0 One lady was wheeled in by her family and she was obviously very ill, exhibiting wasting, a deep cough that brought up blood, severe weight loss, and diarrhea for several weeks.\u00a0 She was almost so weak she could barely turn her head.\u00a0 We obviously admitted her.<\/p>\n

 <\/p>\n

As for Peds, we see lots of malaria, some of it very severe with children who come in basically obtunded or unconscious.\u00a0 Febrile seizures are fairly common here, as is malnutrition, sickle cell, and pediatric cardiac disease surprisingly.\u00a0 Many of the complex cardiac patients eventually require referral to Mulago Hospital, which is the main University-based referral hospital in Kampala.\u00a0 The way the health system works in Uganda is varying degrees of medical complexity.\u00a0 At its most basic, there are local health clinics.\u00a0 Based on what they provide, they are rated in a category from I-IV.\u00a0 Then there are the local government hospitals.\u00a0 Above those are regional referral hospitals, of which Kiwoko is considered one, although it is funded predominately as a missionary hospital rather than government based.\u00a0 Our catchment area here is about half a million people.\u00a0 Mulago meanwhile serves the entire population of Uganda.<\/p>\n

 <\/p>\n

Many patients do not want to make the trip to Mulago, mostly for financial reasons.\u00a0 It is very difficult when we explain to parents that we would like to send patients for referral and they are either not able to pay for the consultation or even pay for transportation to Kampala.\u00a0 Superstitions also play a major role here.\u00a0 We had one patient leave with her baby (who has Down\u2019s syndrome and known VSD found on echocardiography and is suffering from heart failure \u2014 she\u2019s only 14 months old) yesterday without telling any of the staff because she had thought the parent of another baby had cursed her child.\u00a0 Another patient told us yesterday that she believed her baby was cursed.\u00a0 Coincidentally, she also has unexplained tachypnea (increased respiratory rate) and oxygen dependency without any fevers or signs of infection.\u00a0 We wanted to refer her to Mulago as well, but the mother states that because her baby is cursed, the doctors at Mulago will not be able to help any more than the doctors here at Kiwoko and that she needs to see the local witch doctor instead.<\/p>\n

 <\/p>\n

I just realized that I have not described a typical day here.\u00a0 Generally, the day starts at 8:15 with morning prayers, which we are all expected to attend.\u00a0 Afterwards, we have Doctor\u2019s Meeting from 9 until 10 AM.\u00a0 This includes check-out from the night before as well as daily CME.\u00a0 Ward rounds start after this and generally continue until lunchtime.\u00a0 After lunch, we return to the wards for any admissions from OPD or \u201creviews\u201d which are patients that OPD has sent over because the doctor there is not sure whether the patient actually requires admission.\u00a0 We also round on some of the sicker patients again in the afternoons.<\/p>\n

 <\/p>\n

One last interesting fact:\u00a0 just before I arrived a man was admitted to the hospital after he was attacked by a leopard!\u00a0 Several of my housemates here before me were here when he was admitted.\u00a0 He was out in his fields and farming when he was attacked by a leopard.\u00a0 He suffered pretty severe lacerations around his skull but survived.\u00a0 It was actually pretty near Kiwoko, which is a bit unnerving considering I go out running around here.\u00a0 Not something you\u2019d see back in the States, unless you\u2019re out west where you have to worry about mountain lion attacks.\u00a0 Tomorrow is my last day on Peds even though it\u2019s the middle of the week.<\/p>\n

 <\/p>\n

Because I\u2019m here for such a short time, I\u2019m only cycling through each ward for only a few days at a time.\u00a0 I\u2019m headed to either Maternity or NICU after that.\u00a0 And then, most excitingly, going this weekend to see the gorillas in Bwindi Impenetrable Forest!<\/p>\n","protected":false},"excerpt":{"rendered":"

  Today was my third day on Pediatrics.\u00a0 Dr. Susan and I will split the ward in half and see […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-23","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/23","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/comments?post=23"}],"version-history":[{"count":0,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/23\/revisions"}],"wp:attachment":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/media?parent=23"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/categories?post=23"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/tags?post=23"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}