Did somebody call for an anesthetist? 8/8/2014
After 2+ months in Chad, it has become apparent that we are being served at least as much as we are serving others. We also find ourselves taking on roles we didn't anticipate. Almost everything here is foreign and we rely on a lot of help. Hospital employees, friends, new neighbors, and short term missionaries, all contribute something to making our lives better or easier or more efficient.
Even my patients offer encouragement or joke with me when I butcher their local languages. My French is improving quickly but so many people only speak other languages. Normally I speak to the nurses in French and they will translate that into a handful of other languages. Occasionally someone from another family steps over to help translate if we encounter a language we can't speak (no HIPAA issues here). I have managed to pick up a few "other language phrases" but rarely say them correctly. The other day I thought I asked a mom if her child had diarrhea but I actually asked her for a kiss. I wish all my intended jokes got as much laughter! Needless to say, I am pretty popular at the hospital.
With 2 physicians gone on annual leave for 2months, I now serve as the Pediatrician AND Anesthetist. I felt a bit like a fish out of water at first since I haven't focused on pediatrics since the late 90s. It turns out its a lot like riding a bike except this time the bike has malaria. My work day begins with morning rounds on Pediatrics: 90%of my ~28 kids have malaria and the average age is probably 18 months old; There likely will be closer to 40 inpatient kids/day in the next month as rainy season is in full swing and malaria overwhelms the villages. Everyone gets malaria. Some kids will be brought for treatment but many will die at home. It's a sad reality.
I also treat typhoid, and meningitis and pneumonia, and Giardia, and everyone seems to have worms. Unfortunately we are seeing more snake bites now that everyone is working in the fields. Burn injuries are also common since children live with little or no supervision and everyone cooks over open fire. Scalds from boiling water are typical. Still, malaria gets most of my focus.
Many children come in with a hemoglobin of 3, or 2, or even 1.1--my all time new record low!!) high fever, lethargy & occasionally having convulsions. Scary sick kids are becoming routine and malnutrition is ever present. Now I refer children to Kim for nutrition consults and she refers them to me for medical care. We see each others names in so many medical records now. What a team!
As I make my inpatient rounds, I greet each patient and family with a handshake. Sometimes the kids will cry as I approach simply because I am white and that is an extremely rare sight. I also have a puffy beard now and am affectionately named "the lion of Chad." Sometimes I make a silly introduction or joke as I lay my hands on the child's forehead, chest and stomach. I whisper a quick prayer over those children as I'm checking for fever, respiratory difficulty, and hepato/spleenomegaly. I also gently pry open their eyes to see if their inner eyelids are too pale indicating severe anemia. After a quick glance to make sure the IV isn't infiltrated, I quickly order labs or explain test results and treatment plans, request blood transfusions, add or change medications, discharge, etc. Ideally I spend 3-5 minutes at each bedside in a large, dimly lit, noisy open ward that apparently is an old abandoned church on the hospital compound. It is crammed with beds, family members, and a small entourage of nurses & sometimes students. "Has she eaten today?", "Is he vomiting or having diarrhea?"
With +\- 30kids, Pediatric rounds normally take at least 2hours. It takes even longer when I have to ask why a nurse didn't give medicine, or why parents didn't buy medicine, or is someone coming today from their village with money? When the child is very sick and there just is no money, what do I do? Discharge her and say "good luck with that?"
Lets just say being the Pediatrician has become an expensive profession. There is no social safety net here. The reality is, I buy a lot of medicine for my patients or they will die. It's a common model that the missionary docs follow here. In a land filled with overwhelming need, who could ever say no? [One day I want to write about Olen & Danae. They do so much for so many people and are absolutely humble heroes.]
Finally after finishing rounds we try to begin the surgery schedule. Luckily we are pretty slow in the OR right now. Everyone is in his field working during the rainy season so elective surgery just isn't happening for most people. They also have no money because they haven't harvested crops to sell yet. Weeks ago we were doing surgery 5-6 days/week, typically not stopping for lunch and pausing around
4pm until we return later for urgent surgical add-ons or an Obstetric emergency. For now, I'm thankful for more time in Peds, more time to eat a midday meal, & more time to build relationships. It's so gratifying and exhausting at the same time.
I wrap my day up by eating a final meal around 7 or
8pm to keep up my calorie count, guzzling lots of water, and studying some French and reading a lot. Mostly I read about pediatric care in Africa.
Children die in my hospital. It still guts me every time. Typically they come here too late after a disease has ravaged their frail little bodies. It's a heavy burden and I have become a bit obsessed with studying tropical diseases, malnutrition, and pediatrics. I spend each night reviewing research, treatment protocols, and guidelines published by the World Health Organization, other NGOs or other African hospitals with similar situations & limited resources. I finished my doctoral studies when I was 41 yrs old but it seems I will never be finished learning. And that's just how I like it.
P.S.
The power went out at the hospital the other night. Guess who is in charge of checking fuses, resetting the inverters and maintaining the generator? Thankfully Rollin can lend an experienced hand & Olen is (usually) just a text message away. I knew I would be stretched when I came to Chad, but I didn't imagine how much.
Um, did somebody call for an anesthetist?
-Mason
