{"id":26,"date":"2013-05-22T19:32:58","date_gmt":"2013-05-22T19:32:58","guid":{"rendered":"https:\/\/inmedblogs.us\/jeffreywalden\/?p=26"},"modified":"2015-06-08T19:36:55","modified_gmt":"2015-06-08T19:36:55","slug":"stuff-to-remember-when-coming-overseas","status":"publish","type":"post","link":"https:\/\/inmedblogs.us\/jeffreywalden\/2013\/05\/22\/stuff-to-remember-when-coming-overseas\/","title":{"rendered":"Stuff To Remember When Coming Overseas"},"content":{"rendered":"

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

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Fourth day on Peds.\u00a0 Dr. Susan and I split the wards again today, but today I saw the sicker patients while she saw the more ambulatory ones.\u00a0 Of the ones I saw, malaria seems to be the cause for the more severely ill.\u00a0 One 4 year old boy who was admitted yesterday afternoon came in minimally responsive, almost obtunded.\u00a0 We\u2019ve been treating him with IV quinine and placed an NG tube to feed him as he refused to feed and at times is too unresponsive to take anything by mouth including fluids.\u00a0 I wrote to repeat his malaria slide this afternoon because his original slide had >500 parasites per 200 WBC field.\u00a0 Most slides have anywhere from 50 – 100, sometimes 200 parasites per field.\u00a0 Meaning, that his parasite load was basically too high to count.\u00a0 If his repeat count remains high we will keep him on IV quinine rather than the usual practice of switching to oral Coartem after 3 doses of either quinine or artesunate.<\/p>\n

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By the way, peds ward only encompasses ages 29 days to 5 years old.\u00a0 If they are 28 days or younger, they go to NICU; if >5 years they go to adult male or female ward.\u00a0 Obviously children are not \u201clittle adults,\u201d the shift to the adult wards is to prevent Peds ward from becoming too overrun.\u00a0 As it is Peds is the busiest ward here in the hospital, especially this time of year as it\u2019s the rainy season and malaria is rampant.<\/p>\n

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Another if the sicker children I saw today is a 4 year old girl who also was admitted last night.\u00a0 The admitting physician thought she had a surgical abdomen, meaning that her belly was rigid and she could hear no bowel sounds.\u00a0 She also came in with malaria and a parasite load of about 200, but she is also very jaundiced (the bottom of her feet are yellow!).\u00a0 The surgeon was unable to see her last night, which is actually not that uncommon.\u00a0 Surgeons here do everything from circumcisions to C-sections to prostatic removals and all orthopedic procedures! \u00a0 Not to mention the usual intra-abdominal surgical cases that you would see back in the States.\u00a0 There\u2019s just no other surgical specialists to help out.\u00a0 Anyway, by the time I saw her this morning, her abdominal pain had lessened and she had bowel sounds.\u00a0 She also had had a bowel movement, which was reassuring.\u00a0 Her fever had also resolved, but she still obviously was sick and refused to take anything by mouth.\u00a0 She was very restless, rolling over in bed and crying out.\u00a0 Her father had initially refused any further blood tests on her because she cried so much when being stuck with needles, but I was able to convince him that we needed to test her for sickle cell, hepatitis, and typhoid fever as well as obtain some liver function tests.<\/p>\n

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These finally returned late in the day.\u00a0 By that time I had gone by to review her again, but this time was much more worrisome.\u00a0 I no longer heard any bowel sounds and her abdominal pain had become specified to her right upper quadrant, where her liver and gallbladder are located.\u00a0 I called the surgeon and he came by about 20 minutes later.\u00a0 By that point, she was no longer tender in her right upper quadrant, but was continuing to cry and moan whenever you touched her legs or arms.\u00a0 Her liver function tests came back elevated (both gallbladder and liver tests) and he was concerned more for possible cerebral malaria causing her changes in attentiveness\/alertness and the persistent crying.\u00a0 However, he admitted this did not explain either her jaundice or her elevated liver tests.\u00a0 The joint decision was to keep her on quinine for 3 more doses in case this was cerebral malaria, cover her for sepsis (a standard practice when children are diagnosed with cerebral malaria) and obtain an abdominal ultrasound tomorrow.<\/p>\n

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I have kept a running list of things necessary before coming overseas to help anyone deciding to come to Kiwoko and for my own future reference:<\/p>\n

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