Hello everyone! I think it’s probably time to describe a little bit of what I have been doing in the hospital for the past couple of weeks. On April 1 I switched from out-patient into in-patient care. For the first week and a half I was rounding with the doctors on Women’s Ward. This is where all of the non-pregnant women are admitted to in the hospital. There are about 30 beds lining a long room that make up the ward and for the first week it was pretty much full. Sometimes they will even add a cot between others to make more space. So I was seeing a patient in bed “extra 17” for several days. It’s really amazing what they can do with what they have. The doctors have daily lectures after chapel until about 8 AM. Then we head to our respective wards. Once on the wards, we go through and see every patient until they’ve all been evaluated and had the necessary orders place.
By the end of my time on Women’s Ward I was seeing about 7 patients. I had several interesting cases. About 50-70% of the patients at any given time are HIV positive. Many of them have very low white blood counts and are susceptible to what we call “opportunistic infections”, or infections that most healthy people would never get. I was helping care for a woman who was HIV positive, who had recently been diagnosed with pulmonary tuberculosis and was on treatment for that, and came to the hospital feeling very sick and we discovered a urinary tract infection, kidney stone with swollen kidney, mildly inflamed hepatitis and peripheral neuropathy from some of her medications. Certainly not the kind of case I’ve seen often in the States! Many people, sadly, do not present until late in their diseases. I’ve seen more cases of likely cancer diagnoses than I’d like to. However, the patients here are mostly very grateful and appreciate that we’re taking the best care of them that we know how even when the prognosis may not be great. I had several sweet older patients who got rather mad at me when they heard I was leaving soon and would not be here to see them for follow-up. Of course that is a rewarding feeling and certainly patient satisfaction is not the end-all-be-all but it is an encouragement when someone you’ve been taking care of in the hospital wants to see you again.
This past Monday I switched to the Maternity ward. This includes pregnant but sick women, labor and delivery, post-partum, and the “preterm room”, which is the closest thing they have to a neonatal ward. Again, it is a large room with bed after bed of mother and baby and we walk from bed to bed seeing each one. I have enjoyed the week so far. Today I had a rewarding experience (probably especially because I don’t have kids yet and was proud of myself for figuring this out). A mom told me that her baby was crying anytime she was touched. So, I diligently undressed the little girl (which is a rather large task because they all wrap the babies in about 3-4 layers including knitted sweaters and blankets) and started to examine her. Yes, it was true – as soon as I touched her she was screaming loudly. However, when I tried to find some place where she might be hurting or look for any signs of infection I couldn’t find any! So, I asked mom if she had fed her recently and had mom try breastfeeding her. As soon as the little girl could she was sucking away! All the nurses then were “yelling” to put back on some of her layers, so I diligently obeyed them and as soon as I took her from her breakfast she started screaming again. So, I explained to mom, your baby is fine she is just hungry! Feed her every hour until tonight and then go to every 2 hours. I guess the mom’s milk hadn’t come in well the day before, but she hadn’t really tried again and now her milk was there. Anyway, problem solved – she’s hungry!! My med student brain was starting to think of all the problems that can happen in the digestive tract or infections in the body, but my Family Medicine (and probably woman) brain told me to start with the basics and it worked! This afternoon, when I came around to see her again the baby was much happier, as was the mom. Sorry for the long story, but as I said, it was rewarding.
I was also privileged to assist a Cesarean section delivery several days ago. I knew they saved and reused a lot of things here, but I didn’t realize to what extent until I got to experience the Operating Room. Basically, the only things that we threw out were our gloves and masks, used needles, and used suture needles. Everything else, surgical gowns, surgical towels and drapes, surgical “sponges” (laps), and more are thoroughly cleaned and then put into the autoclave and sterilized. It’s quite incredible when compared to how much gets thrown out after surgery in the US. It’s also great to see how talented the surgeons and doctors are here, as well as the surgical techs, who do more than in the States.
Finally, when I am finished rounding with the doctors I have been going to a place they call the procedure room. The workers in this room are the ones who carry out any procedure a doctor orders for inpatient or outpatient. For instance, if someone needs a spinal tap to look for infection in their spinal column the procedure room is the one to do it. So, I’ve been getting to learn how to do spinal taps, lung taps, abdominal taps, IV starts, and other things like that. I’ve really enjoyed working there with them.
This past Wednesday I prepared a presentation on seizure management for the lecture time in the mornings for the doctors. It went well and seems to have been well-received. With such limited access to the Internet I was thanking God that I had brought some actual books with me as well as had saved some documents onto my computer. Truly, the lack of access has been one of the hardest adjustments to make here, but God has been gracious and has allowed me to have access at just the times when I’ve really needed it. That is just one small example of the many ways God has been showing me that He is taking care of me here.
Thank you all for your thoughts and prayers. I am enjoying my time here and am learning so much. God bless! Racquel