Hospital pictures (finally!)

I have been trying to bring our camera to the hospital more often this week, and I finally have some pictures of where I've been spending my time and a couple of our little patients.

As I've said, my time thus far has been mainly in the pediatrics wing, or A ward. Here is a picture as you walk in. There are 27 beds, and today we had three kids on the floor along the middle, making 30 kids. For the most part, we see a lot of gastroenteritis which may or may not be viral. As part of the workup, everyone gets a malaria smear. One of the lab techs, a native named Johnson, was very helpful and showed me what malaria looks like and how to tell the difference between falciparum (really bad) and vivax (bad) malaria on a slide. Anyway, other things we see quite a bit are neonatal sepsis - basically babies who are less than a month old with fevers caused by anything from a virus to meningitis - and malnutrition. This is really quite sad. As some of you are aware, there are two types of malnutrition. The first is a general calorie deficit called marasmus, the second is a protein deficit called Kwashiorkor. Kwashiorkor is the kind where you get the skinny little kids with huge pot bellies from all the gas and distension in their intestines. I have seen both here. Kwashiorkor kids are generally adopted for various reasons and thus have no access to breast milk or anything similar. They are fed mostly kowkow (PNG sweet potatoes) which is a really poor source of protein and essential fats. As far as the marasmus kids go, sometimes it is neglect, sometimes some other disease like HIV, and other times adopted kids whose parents can't afford much cow's milk or formula. This is one of the many (certainly not the worst) marasmus kids I saw in the ER when I had my camera handy. He is over 7 months old and weighs less than 14 lbs. I haven't looked at a growth chart in a while, but something tells me he's on the low end. With these kids, we generally start feeds slow along with some vitamin and mineral supplements. They are generally brought in for something else, like pneumonia or diarrhea or fever, so we also have to try to treat that.

One of the sad things about the way things are here is what happens when you don't have access to care. Have you ever wondered what happens to a kid with meningitis who doesn't get treated? I always just assumed they died, but as I'm finding out, my assumptions aren't always correct. We have a boy on our ward named Edward who has been here for about a week. He came in after being "sick" for two months. When I saw him, he was unresponsive, his eyes were perpetually rolled up, and his arms were drawn up and stiff. We did a spinal tap which showed some white cells, so we figured we'd try and treat what was left of his meningitis, hoping against hope that he'd recover a bit. Well, his 10 days are almost up, and he's just about the same. The poor kid is probably going to be a vegetable until he gets some bad infection and dies. The lesson for you all is this: if your kid has a fever and a stiff neck, get him to the ER ASAP.

On a bit of a lighter note, here is a little boy who has been on the ward since I got here. He cried when he saw me for the first few days, but now he laughs and smiles. Score one for scary white guy! He has some upper airway obstruction which we can't deal with because we have no pediatric bronchoscope. He also has some underlying heart and lung disease. This is about as far as he can wander from his bed because he is tethered to the wall on oxygen! In spite of this, he does what he can to cause mischief.

A major event happened today. I got to sew up my first chopchop. I didn't really get the story, but I can only assume this lady was the victim of domestic violence. The back side of her thumb and hand were split wide open and the tip of her index finger at about the first knuckle was hanging on by a bit of skin. There was a chip of her metatarsal head (bone where hand meets thumb) that was only attached by a piece of tissue. I decided that it couldn't survive, and since she still had good thumb movement, I had to cut it out. I put in a couple layers of stitches in her thumb/hand (deep and superficial), and it turned out pretty well. Her finger tip was another story. I tried my best to reapproximate the edges, but it was pretty swollen and looked pretty rough. I'm pretty sure it won't survive (the bone was completely severed) because so little tissue was left connected. In retrospect, I probably should have taken it off and amputated a bit of bone to make a good closure, but I'll have that opportunity when she comes back in two days. In the mean time, I just put her on some good antibiotic coverage with some ibuprofen for pain. Yeah, that's about as good as it gets for pain control. It seems that either no one donates narcotics (go figure) or they are just not used here. People can definitely take the pain here. Of note regarding suturing, it is almost impossible to find the size and kind of suture you want in the ER. We don't have organized dispensers of all kinds of suture at our disposal. Instead, there is a large kitchen mixing bowl of various sizes and types. Unfortunately, the only non-absorbably suture (for skin closing) was like 2-0 braided silk on a half inch needle. (read: freaking huge needle and frankenstein thread) I ended up using some of the absorbable suture (for deep stitches) for skin closing as well after I had reapproximated with the big thick stuff. This made for an interesting look. If I see her in follow-up I'll take a picture just for laughs.

Well, those pictures took forever to load, and it's time for bed. I'm on call tomorrow (Fri) night, so hopefully I'll get some good pictures and stories. Enjoy some fast food for me!