Liberian lessons

We have had a lot more time to do teaching on the wards in the past week. In addition to our morning lectures, Venee, Amir, and I have been taking time to do one on one teaching with the students. It was a lot of fun doing physical exam with them in the past few days. They are very bright and have rose to all the challenges we have thrown at them.
As I continue to work in Liberia, I am more and more amazed at the bond between families. The mother and child share so much in the first few months of life. The mothers come in wearing dresses, and the babies' outfits or blankets are made from the same piece of cloth. The mothers carry their babies on their backs in their lappas while they do their work.
We had a case of malarial hypersplenism, also known as tropical splenomegaly. It is a more chronic and less severe course. I am astounded by the all the different ways malaria can present.
I want to say thanks to everyone at UMass. There were so many people that chipped in to make this trip happen, from helping with forms to covering shifts.

A Long, Tough Day

Yesterday was a tough day.
It started with a baby with pneumonia. The baby was an 8 month old with some congenital animalies that had been admitted with pneumonia. He was in severe respiratory distress. We tried some medicines and suctioning, but he became apneic and bradycardic. We did CPR and brought him back, but he was still working so hard to breathe. My training has taught me that a malnourished, little baby is only going to be able to breathe for that long before he gets too tired. You recognize how much he would be helped by taking a break from all that work with mechanical ventilation, but we don't have the capacity for that yet. We used all the medicines available. I mixed and hung my very first aminophylline drip to try to open him up, kept him on the maximum amount of oxygen we are able to give with the compressors, but it was just too much for him.

Flag Day

Today was a holiday in Liberia, Flag Day. The hospital is running on a holiday schedule, which means We rounded in the morning, but no clinic in the afternoon.

It is funny how patients seem to come in with illnesses in themes- one day it seems to be all malaria, one day it is malnutrition, another day bronchiolitis. Today all our malaria patients decided they wanted to get better, collectively. We discharged a whole crew of happy kids. I am trying to attach some pictures to this blog of some of them, but the internet makes it SO slow. I think it might be quicker to print the pictures and send them in a corked bottle across the Atlantic for everyone to see.

I have done a lot of teaching about bronchiolitis in the past 2 days. There are no isolation rooms or blue gowns and masks to be had here, but we do encourage good hand washing. I have also been showing the mothers the benfits of normal saline and blue bulb suction. Even though I am in Africa, I can't escape RSV.

We have a few diagnostic puzzles on the floor. We have been limited because the xray machine has been down since we arrived, although we can do an ultrasound. We also have limited access to labs, and they don't have any labs on weekends or holidays, so we are trying to do our best with our brains, stethoscopes, and intermittent internet access.

Feeding time

Hopsitals of Hope has brough 4 monitors onto the Pediatric ward! They have attachments for oxygen saturations, blood pressure, and heart rate, and can even print an EKG. The staff was trained on them last week. We have a patient on the ward with bronchiolitis who was having some respiratory distress, so the nurses put him on the monitor. Shortly after, JFK had its first case of monitor-itis, where the family kept calling me over because they were concerned something was wrong with the baby. The reason for their concern was the blood pressure was coming up as "no reading" because the cuff was not attached to the monitor.
We are working hard on the malnutrition cases at JFK. We have done a lot of education with the medical students and the interns to use the WHO handbook and get these kids on feeding schedules. We have one little boy who is severely malnourished, even though he is 11 months old he only weighs 9 pounds, and has trouble tolerating feeds. He pulled out his NG tube this morning and his mother had gone home to get more clothes for him. Since it was Sunday and my schedule was a little lighter, I decided to feed him myself.
I lifted him out of the bed and he was like a bird, so fragile and light in my hands. As I snuggled him, instead of adorable baby chubby arms and legs, he seemed angular, as though every bone was making an impression on my arms. He reached up for the feeding syringe as though it was his favorite bottle, and he happily enjoyed every drop of his feed. Though there is more to do than I have time for in my short stay here, I am grateful for moments like these.