56 children, 20 new admissions, 1 death. The paediatric ward on Monday. So it was a bit hectic. They’re short staffed on the ward with one or two nurses dealing with all the patients and medication. The sister running the ward is one of these people who are just amazing. Incidentally, it turns out she spent about 5 years in Scotland-in Thurso and in the Borders. Malaria and anaemia are the vast majority of cases with pneumonia, bilharzia, TB and HIV related problems making up the rest. Two oxygen concentrators sit in the corner of the room with the illest wee ones attached. Sometimes newborns in need of oxygen join the ward as there’s no oxygen in maternity, they’re a bit like sardines all wrapped up in chitenges in the one resussitaion trolley. I think the record for most babies at one time is 5.
When I started on Monday, the intern clinical officer was also new so we had fun and games trying to do the ward round whilst trying to remember all the drug doses the senior clinical officer had reeled off before he headed to theatre. The good thing is most children come in very sick and over a day or two they’re back to what seems like their usual selves. The hardest part is, not surprisingly the deaths. 6 weeks on paediatrics at home and I witnessed no deaths, 1 day here and I witness 2, both of which would probably not have happened at home. Life’s crap. The first one was a little boy of almost a year, who had been on the ward for about a week in respiratory distress and appeared to have a pneumonia resistant to a whole host of antibiotics (I’m still getting to grips with what they use here-not that I really know what they use at home if I think about it. According to the BNF, chloramphenicol is only to be used as a last resort due to severe haematological side effects but here they use it left, right and centre and sing it’s praises so I never quite know what’s going on). Just as they were considering starting TB treatment and as I was attempting to sort a clogged up drip in the next bed, his mother shouted and when I went over he was unresponsive, pulse gone, not breathing. I don’t think I’ve ever felt so clueless and useless. We dug out the bag and mask and started chest compressions but I guess it was never going to work. He passed away. The second was a tiny 1 year old weighing 5 kg who had a oxygen saturation of 30% at 8.50am and at 9am she gave up the ghost. Just too much work for one little soul. Survival of the fittest without a doubt but when you weigh less then half of what you’re supposed to the odds are stacked against you.
Discharging home lots of happy healthy children was a relief after that morning. Unfortunately, the time when malnutrition becomes most apparent is beginning and with malaria season too it’s tough for these kiddos. They all have little books called health passports where everything is recorded so we plot their growth, check on vaccinations, vitamin A and mosquito nets. Apparently, lots of people use their free mosquito net for catching birds or fishing. And the men are reluctant to sleep under a net for fear of decreasing their fertility. I guess the later is difficult to prove either way. (I’ve just killed three mosquitos whilst I’m typing this-so strangely satisfying.)
Putting up drips is another thing which takes up a large part of the time on the ward. As all malaria cases get IV quinine to start with. Yesterday, I had a day of spurting body fluids. First one kiddo yanked out their cannula followed by a shot of blood, then I over enthusiastically flushed a cannula which was blocked and landed up with a polka dot white coat for the rest of the day. Lastly, as nappies are either non exsistent or chitenges it was only going to be a matter of time before I encountered a wet puddle forming at my feet. Delightful. Today was more successful on the body fluid front.
So I think I’ll be on paediatrics for the next 3 weeks or so then perhaps a little bit of general medicine before I head back. In one day, I go from thinking I’d love to work in Malawi to being so frustrated at what I’d never be able to do, I just want to leave. (usually when I’m stuck to a child by elastoplast that sticks to everything you don't want it to as I try to put in a cannula without pulling it out again, wishing I could have those nice peel-off-the-back venflon plasters. The small things I guess.) The usual indecisiveness, nothing new there.