Luse is my little baby in the malnourished section. She is protein deficient, so she has huge ulcers all over her body. She also has mucositis, or inflammation of all the mucus of her mouth, throat, stomach, intestines. So she will not eat, making problems worse. She likely now has an infection but we do not know what...HIV, TB, bacterial. She is spiking high fevers. She sits and moans all day long. Mortality rate for malnourished children like Luse at the hospital is 40%.
Monday, April 6, 2009
Luse
Luse is my little baby in the malnourished section. She is protein deficient, so she has huge ulcers all over her body. She also has mucositis, or inflammation of all the mucus of her mouth, throat, stomach, intestines. So she will not eat, making problems worse. She likely now has an infection but we do not know what...HIV, TB, bacterial. She is spiking high fevers. She sits and moans all day long. Mortality rate for malnourished children like Luse at the hospital is 40%.
Tough Monday Morning
So once again, I had a tough day today. A child died during morning rounds. The Dutch nurse, Miranda, waved me away from rounds to come to the malnourished room. The head nurse had just found the child. We began chest compressions and bagging, but I told them to stop after a minute. It was the first time I have ever called a death before. The boy was 4 years old and only 12kg. He had AIDS and TB, both untreated. The mother began weeping, wailing, and praying. All the other mothers in the room surrounded her. Miranda and I took the body to a private room and prepared him for the mother to see. She wailed so loudly, praying and chanting in Tonga. We stood with her for a long time. The head nurse, a Zambian man, stayed with us as well. I notified the American doctor who was rounding with all the other medical students and doctors. He did not ask which child died. He just told me that the nurses handle it. And they all went right back to rounding. They act as if lives do not matter. But it is not true at all. It matters to the mothers, to the families…they grieve so much. It matters to a few of the staff. The Zambian head nurse at one point slumped against the counter and then hit his head against the wall in frustration, grief, pain, anger, I don’t know. I knew things would be tough here, that I would see children die. But I did not think that the staff, especially the American staff would just not care. My crying count is still at zero. I have not let myself yet, but today it was very close. My favorite patient, Jester, is very sick and will likely not live. I have already decided that for her, I will cry.
Saturday, April 4, 2009
Jane
Jane is a 9 month old girl who is HIV positive and as you can see is quite small. That is usually the first sign that a baby has HIV is that they stop growing. She was admitted for nutritional feeds. She also has TB. The TB must be treated first before you can start treating the HIV. The symptoms of TB or other infections are not from the bug but from your immune system attacking the bug. If you treat the HIV first, and thereby improve her immune system, she would get such a strong immune reaction that she would likely go into a coma and die. So we treat the TB first for about a month or two and then will begin her on anti-retrovirals. Babies either get HIV during the birthing process if the mom does not get anti-retroviral therapy right before and during birth. Or the baby will get HIV through breast feeding.
Regan!
Regan is a 6 year old boy who had a stroke after having a sickle cell crisis that caused his left leg to be paralyzed last year. He also has a chronic osteomyelitis (infection of the bone) of his right lower leg. He was admitted for another sickle crisis due to pharyngitis. He always has a huge smile and is one of my favorites. We discharged him today!
Baby Update
I think taking care of this baby, or rather resisting being at the bedside all day trying to save him, was the one of the hardest things I've ever had to do. I am not God, and I can not change this whole system. There are so many things that come into play: culture, politics, education, health system, religion, money. So many things that I cannot change today or ever.
Friday, April 3, 2009
Hospital Photos
This is the "hallway" to the peds and maternity wards. Leprosy ward on left.
Outside of the outpatient clinic.
Normally crowded with people on the porch but it was pouring with rain.
This is the waiting room towards the end of the day. Normally there are people literally sitting on top of each other! :)