Pediatric Ward Tour...

This is the main wing of the pediatric ward. At first I show you the nurses' station. Then you see the small emergency room with 3 beds. Then its the main wing which is anything not burns, not just Tuberculosis, or not just malnutrition. So the kids mainly had AIDS, Malaria, Diarrhea, Tuberculosis, Malnutrition, and broken bones in this wing.

Swedy

Swedy is my hero. Also known as my favorite Zambian. Also known as the charge nurse in the pediatric ward. Throughout my stay, he was the one person in the hospital that cared about the children, would discuss their care, and bring concerns to my attention. He has more clinical judgement than any of the doctors in Macha. He and I cried together when children died. And we would sit and discuss diagnoses and treatment of the difficult children while the doctors would just shrug their shoulders and say I don’t know. Last week he had me test him for malaria since his stomach was so upset. When it came back negative, he told me it was likely from the stress of worrying about the pediatric ward since the doctors are so bad. Swedy is so concerned for the children that he often comes back to check on the ward at night when some of the bad nurses are on. But that’s not why Swedy is my hero.

Swedy is an orphan. His father died of TB and from working in the copper mines when Swedy was 8 years old. His mother died a few months later after being sick for many months. She most likely died from AIDS but at that time testing was not done in Zambia. He and his brother and sister moved in with his uncle, who raised him. Swedy went to nursing school and is working in Macha to support his sister and brother through college. He says hes also going to support his uncle’s children. He says that when he hears children cry for their mommy or daddy he wishes he had a mommy or daddy to cry for too. He told me that he could not wish that his parents were still alive because then he would not be the same person he is now. He asked if I was an orphan too. It was then that it really hit me how common it is to lose a parent or be an orphan here. About one quarter of the children on the ward were orphans. And Swedy gives me hope that they will live beautiful, successful lives.

Metrude

Metrude is a little girl who presented with "she won't walk" and she would cry and refuse. I first saw her the day after she was admitted. They had stuck a needle into her hip and didn't get anything. They really didn't have any other ideas. The differential for a child not walking is big, but they couldn't name any other reason or idea. So over lunch I researched and went back to the doctor and taught him the main causes, what would indicate one over another and what you would order to tell. I still thought she had a septic hip. They were skeptical....so I taught them how to tap a hip. The trick is not to do it blindly...Ultrasound that hip! They were able to tap it and get the pus out easily. Two weeks later it is still healing but now she is running and skipping around the ward.

Pictures of the hospital!

Abcon

Abcon is a child I met not on the pediatric ward. He is on the men's ward because he is over 6 years old (Yes, thats right...pediatrics is under 6!). So anyways, I met him when he was crying in the middle of the hospital last week. And by middle of the hospital, I mean outside, on a dusty cement path connecting the different wards. He was wailing away, saying something in Tonga, as everyone stopped what they were doing, stared and did nothing. He didn't stop, so I walked up rubbed him on his head. Then he gave me a big hug, crying into my white coat. I made him a balloon and by that point someone told me he was crying because his dad had just beat him. He settled down a bit and a nurse came to take him back inside. That was last week.

On Sunday, he came running up to me chatting excitiedly in Tonga when I walked into the hospital. So I played with him and tickled him and then continued on. And he followed. He followed me for over an hour as I worked in the pediatric ward. He would hold the charts, look at xrays, and peer at the babies. And then when I was done, I walked him back to the men's ward. As we walked back, he started chatting happily in tonga. I wonder what he thought of the day. :)

By the way, for those wondering, he is admitted for a burn on his hand and arm that is infected.

Blood Transfusions

After this you should appreciate when you go to the hospital.

This morning, a little girl with malaria started seizing. When I opened the chart to write the orders for the phenobarbital, I noticed that some lab results had come back. Her hemoglobin was 3.5. That should cause a panic inside of you....that is a dangerously low level of blood cells. Especially in a child who is continuing to drop from the malaria. The lab was so concerned they had someone run over with the results and told one of the nurses. She just wrote it in the chart and didn't tell anyone. So I ran the order over to the lab for the transfusion. But it still took 1 hour to get the blood.

Transfusions are risky here for children. Not so much for the risk of disease transmission. But because of how hard it is to control the rate. In modern hospitals, IVs have computers attached that you can program the rate into. Here calculate how many drops a minute you want, adjust the dial, count how many drops, adjust it again, count, etc. There have been a few children who have died from fluid overload from getting their transfusions to quickly (over 1 hour rather than 4!).

So anyway, this little girl is still in a coma, is urinating blood, receiving her blood transfusion, but no more convulsions and her fever has come down a little bit. And so we wait and hope and pray she comes out of the coma.

Relaxing Saturday Night

So tonight we went out to the dam to watch the sunset and then the stars. There are no lights out there, so the stars are breath-taking. Absolutely amazing. We bought some beers at the illegal store and sat around to have a great night. Mark's, a dutch medical student, parents are visiting for the weekend and came with us. It was nice to just sit back, relax, and breathe. I haven't been sleeping well since being here. I haven't got more than 5 hours in a night, often less. Part of it is from nightmares from the malaria medication. Part is just from the stress of the hospital and worrying/thinking about everything. So it was good to relax.

Tonight one of the girls, who is just doing research, was asking me about the hospital and how things were going. I told her a lot of the stories. She has been on the wards twice now and she says she still can't believe it. Mark's parents walked through the hospital today. His mom cried when she was in the pediatric ward. It is so hard to describe how awful things are here. It is difficult to comprehend for anyone, even me. Some nights I wonder if events really happened during the day. Sometimes I reread my blogs or the diary I keep, and I can't believe it. Things are much worse than you could imagine, than pictures or stories could convey. Just walking on the wards would bring you to tears.

So you can see, I needed the beer tonight. :)

Child Abuse

So there is a lot of child abuse that I have seen. But it is never discussed. If I bring it up, the other doctors or medical students seem clueless that the injury was from child abuse. They also show no interest. Here are two examples that are on the ward right now.

Milness: Her story is that she fell into the fire. But she only has burns on her bottom and genitals. None on her arms or hands. When a child falls in a fire or scalding water, there are always burns elsewhere that occur as the child is trying to get out. Burns on the bottom only occur when someone is holding a child over a fire and the child is holding their legs out of the way.

Peter: His story is that he has spiral fractures of both legs from a bicycle falling on top of him. Maybe he could break his leg if he was ran over by a bicycle. But not spiral fractures. Spiral fractures are 95% of the time from child abuse...someone yanking and throwing the child. Peter has to be in traction like this for 3 weeks.

Isambe

Isambe is one of the malnourished children. He has Kwashiorkor, which leaves the children very small but swollen with ulcers all over their bodies rather than looking like a skeleton. He had been doing fairly well and gaining weight. Then over a period of four days, he became lethargic and started losing weight despite continued ng feeding. This happened over the weekend while I was gone. The notes in the chart said “consider treating for TB if survives” and provided no other treatment. So yesterday, I took over his care when he was unresponsive. He went downhill so quickly, I thought I might be able to reverse it. He was already on the best antibiotic we have: Ceftriaxone. All day I worked on him…I started him on fluids (difficult to do here…can’t be through IV, only thru ng tube) and ordered a lot of labs and tests. Half the tests didn’t get done because people went home early. I still had no clue what was wrong with him by the end of the day… I came to work early this morning to see if he survived and to talk to the night nurse.
Isambe died in the night. The nurse said he pulled the ng tube and then couldn’t get another one in. So that meant we couldn’t give him any more medications or fluids. I didn’t even want to ask why they would pull the ng tube.
The reason I fought so hard for Isambe was that his mother told me that her only other son had already died earlier this year.

The pictures are of other malnourished babies and their moms. Two are blind: one from Vitamin A deficiency and one from tribal medicine.

Joseph and his leg

2 physical therapists held down a child a put traction on a broken femur. The child, Joseph, screamed when even his other leg was straightened because it moved his left leg. I asked them as soon as I heard what they were doing to stop and bring him to the operating theater to put him under anesthesia. They laughed and said no. I explained how painful it was and how they need to give him something. They said they could reset the leg just fine without it. I kept working on a child two beds away. But the screaming got too awful. The entire ward stopped and turned to stare. I went back over and pleaded again. I told them that this is wrong and they were torturing the child. They laughed again. After they were done, one of them came to find me and said “see I reset the leg just fine without any pain medication”.