Wednesday, October 27, 2010

Just Another Day in Kijabe

So, I found the only poorly behaved child in Kenya. He was hiding in the outpatient clinic waiting for an asthma follow up visit. The medical student needed a lung exam confirmation so after I listened to his lungs and agreed that his beclomethasone inhaler was working perfectly, I offered him a sticker for being good and he reached over and literally slapped me in the face. And I must say, that kid was strong! The mother then started hitting HIM to discipline him. I tried to stop her but I could tell it was no use. She was horrified and wouldn't look me in the eye for the rest of the visit. On my way out the door, I dodged another jab, this time a punch to the hip area. Gosh, and I thought I was good with kids.

Other than being beaten up by a skinny 6 year old, it was a typical day on the maternity ward. Started off with rounds where we discovered that a woman had come in with chickenpox the night before and delivered her first baby. The good news: the nurses had put her in REAL isolation (like, I didn't even think we were still in the hospital compound.) The bad news: they put the baby in isolation with her and have been letting him breastfeed with open chickenpox vesicles all over mom's nipples. My panicked look upon hearing this yielded blank stares that I interpreted as: "well, what else were we supposed to do?" <sigh> After much thinking, consulting, phone-calling, and more thinking, I finally decided to give the baby prophylactic acyclovir since there is no IVIG here-- the only way to make this happen is to break 200 mg pills into fourths and then pulverize them mixed with breastmilk (no IV or liquid PO acyclovir here.) The parents can't afford formula and there are no breast-pumps so mom was going to try to express her milk but she's a first time mom so not much was coming out. I hope I prevented badness in this little one... because this badness is B.A.D.

Rounds were followed by a few c-sections (one of which I was primary) and other various procedures. Just before he was heading off to the operating room, the Ob/Gyn glanced at me and said, "You can handle the two MacDonald cerclage stitches, right?" I think he needs a refresher course on what exactly my qualifications are. I felt guilty telling him that I'd never actually seen one placed before and that he should probably do it. I mean, sure, I will do cowboy things at times but this was pushing it.

My day ended with a few more admissions from the maternal child health clinic. A woman who thought she was 25 weeks by dates but who has a fetal demise at 19 weeks-- she will be induced tonight. The second was another sad case with twins but found to have one early twin demise on ultrasound and the other twin is anencephalic (basically, doesn't have a brain.) So, we are inducing her as well. On my way out I checked on my 5 day old 34 weeker with kernicterus (serious brain damage from neonatal jaundice) who was admitted last night with a bilirubin of 48. Yes, that's right, 48. We did an exchange transfusion on her and today it's down to 30. Given that she probably won't make it, we aren't exhanging her again. The most frustrating part is that she has been in a private hospital since her birth and they noticed she was becoming "more jaundiced" and transferred her to us. Umm, ya think!? Incredibly sad.

Since I don't like ending with sad things, I am happy to report that my mom with rheumatic heart disease I delivered via vacuum the other day is doing GREAT-- turns out, not every story here has a sad ending.

No comments:

Post a Comment