Free At Last

Today had an interesting start. We live in the doctors dorms, which is a JFK provided facility. It has a gate to our sleeping quarters, which is locked with a padlock. This morning we had a lock malfunction, and we were locked in. It is quite intersting to be unable to get out your door in the morning. Luckily we were planning to head to the wards early, so we had time to call security to let us out. It took him a few tries to break the lock open, but when he finally sawed it off the door, he started to shout "Free at last, free at last, thank God Almighty, free at last!"
There is an amazing group here right now called Hospitals for Hope. They are partnering with JFK to update lots of the wards and medical supplies. They are bringing in donated supplies from all over the world and working hard with the administration at JFK to make big changes at the hospital. I am in awe of all the good work they have done in the past week.

Quinine quinine everywhere

Or should I say mosquitoes, mosquitoes everywhere? There are mosquitoes all around-at the dorm, in the hospital, on or walk in between. And there is no shortage of severe malaria all around. Malaria is such an awful disease which can make a perfectly healthy child very sick in so many ways. There is cerebral malaria, complete with seizures and altered mental status, and children can be obtunded for days. The amazing part is when the kids get better, they just sit up and start eating, and then walk out the next day.
We have a very sad case in the NICU right now. The baby was born "depressed," meaning it dit not breathe spontaneously and was limp. He was put on oxygen, but when we arrived to see him, he began seizing. He seemed to have sustained some sort of birth injury, since he had a cephalohematoma. We gave him all the treatment we had available, and tried to do a head ultrasound, but did not have the right probe. The next day, he was floppy, and his pupils were fixed and dilated. We are all very sad for him.

Country Medicine

It is funny how time passes in Liberia. I feel like there is so much work to do everyday, but I can get caught up in one task. We are seeing quite a bit of malnourishment on the wards. The Peds team spent a good deal of time calculating, and then mixing, a formula for one of the babies out of ingredients we had on hand.
I gave a talk on nephrotic syndrome yesterday, which was really fun. I am going to try and do a journal club either this Friday or early next week. The medical students are very eager to learn and ask lots of great questions.
We have a case on the Wards of a girl with sickle who came in with malaria and pain crisis. She is the first patient I have ever seen in Liberia with sickle cell. Where are all the sicklers, we wonder.
I am learning so much every day about malaria, typhoid, malnutrition, and even some "country medicine," which is what they call Liberian home remedies.

The quiet after the storm

Today was the first real weekday of rounds. I met the medical students, and was reunited with the residents. We have a very large team, but lots of opportunity for teaching. We have many interesting cases on the wards right now, and a few diagnostic mysteries. Again, I long for some diagnostics and consultants, but I feel lucky to have my amazing pediatrics colleagues to consult with.
All of our patients who were "jerking" yesterday are improved today, and one even got discharged home from the ED because she was looking so good.
I am sorry for the lack of pictures thus far, but my camera battery died the second I landed in Monrovia. I am going to steal Amir's camera tomorrow, though. It would be really embarrassing to have my only picture on this Liberia blog to be of Worcester, MA.

The weekend

Today, I rounded on the Wards, ED, and NICU, then stopped for a lunch of jollof rice in the hospital cafeteria. I forgot how spicy Liberian food can be! I feel like I am back in the swing of things.
It is a wet rainy season here, and malaria and typhoid are rampant on the Wards. The Liberians are complaining because it is so cold (75-80 degrees) but when I am rounding in the hot crowded hospital with no breeze, I am glad for the slightly lower temperature.
It seemed that everyone was "jerking" today, which is what they call seizing. A few of the children were certainly jerking from severe cerebral malaria, a few from suspected meningitis, and one little girl had what looked like it may be early tetanus, but for her sake I hope it wasn't.
The wards are more crowded than I was here the last time. They have added more beds and cribs in every room. Right now we have more children than beds, even with the additional ones added.
The nurses greeted me warmly today and welcomed me back. They then promptly asked for hand sanitizer, which I consider a victory.