First Day of Screening, April 21, 2017
Today was the first of our two screening days. There are about 300 patients in the shelter from as far away as 12 hours by bus. A woman named Sabrina and her husband were on a motorcycle trip around Ghana a couple of years ago and came across an Op Smile mission. They asked if they could help, and ended up playing with patients, unloading cargo and visiting with parents while their kids were in surgery. They were so taken with the whole event that they decided to stay in Ghana and join the Op Smile Ghana organization. Their main job is to scour the countryside on their Harleys, searching out infants, children and adults with clefts and telling them about Op Smile. They then arrange busses at pick-up points the day before screening to bring the patients to the shelter. As you might expect with someone doing that work, they are both incredibly exuberant, energetic people.
The screening was conducted at the hospital where the surgeries will take place next week. As usual, pediatrics and anesthesia joined together to screen patients. Usually a pediatrician and an anesthesiologist see each child, but since there are three pediatricians, Hans, a first time volunteer from Sweden, Ella, a second year pediatrics resident from Ghana, and me. (the pediatric intensivist won’t be here until Monday,) and nine anesthesiologists, the six “extra” anesthesiologists paired up and saw older kids and adults. Any patient five and under was seen by the pediatricians. Hans watched me do one patient and was then off on his own with an anesthesiologist, though because we are all together in one room, we often ask each other to have a look at a child we are screening. This made it easy for Hans to be independent but also have backup if he needed it. Ella is extremely experienced and a great pediatrician. She has to finish her residency before she can be credentialed, but I’ll sign her Op Smile credentials at the end of the week.
There were two kids with acute malaria at screening today, and both the parents and Ella were very calm about it. One mother had had malaria herself about a month ago, and both expected that the high fever and achiness their children were complaining of would turn out to be malaria. Ella arranged the prescriptions and off they went. The Pedi Intensivist acts as the doctor for any team member who is taken ill on the mission. Since he isn’t here yet, I get to play Team doctor until he arrives. One of the nurses came to me saying, “I think I have malaria again.” We did her rapid test right in the screening room, and it was positive. Ella arranged her meds as well. I ruled out scabies and chicken pox in a couple of patients and handed out bacitracin for some superficial skin infections. I’ll be glad when the real team doctor arrives.
Today was fascinating, (medically,) due to the “extra-cleft” diagnoses. Within the first hour of screening, I saw three babies with cyanotic heart disease. One was a four month old with an oxygen saturation in the low 80’s, a loud long murmur and a weight just 500 grams above his birth weight. His liver was big and his breathing fast. His chest X-ray was rotated (not straight on,) so it was hard to say much about it except that his heart is huge and globular. After discussion with Ella and the pediatric anesthesiologist, I started him on a little diuretic to see if he can eat more easily. Two other babies had big murmurs but oxygen saturations in the low 90’s and normal livers. They also had big hearts, one with a wide mediastinum and the other not. They’ll have Echocardiograms on Monday and then we’ll try to get them appointments with one of the two pediatric cardiologists in the country for next week.😝😝 I also examined a baby with microcephally and spasticity in addition to her cleft lip. Her disabilities may well be due to the ZIKA virus. Finally, I saw a nine-month old who weighed 4 kg at birth and now weighs 4.9 kg. He’s grown pretty well in height, but is very scrawny. I watched him nurse and he did fine. It took a bit of careful, gentle questioning through an interpreter, but I found that Mom is only offering the breast three times a day. As I was finishing my exam of the baby, I went over to discuss this baby with one of the surgeons whom I knew from previous missions. He's not only great technically, but I knew he was always careful to consider each child's circumstances fully. I found him in the midst of an argument with the rest of the group who wanted to postpone this baby’s surgery to give him time to gain weight. He felt strongly that they should put the baby on the schedule now because he thought the infrequent feeding was due to the mother's embarrassment by the baby’s appearance. He argued that fixing the baby’s lip make him more acceptable and the mother will be open to feeding more. More importantly, he’s afraid that if we don’t fix the lip, the child will continue to waste away.
Tomorrow we screen the second 150 and on Saturday night, make up the surgery schedule. Sunday is devoted to telling the parents whose children were not chosen, explaining why and setting up their appointments for the next mission. Some are straight forward – too young or poorly nourished, the babies with the heart defects that need attention and kids who are acutely ill. Some, however will miss the cut by chance as there are more qualified patients than there are spots on the schedule. Just like in Madagascar, here in Ghana there is a huge backlog of untreated patients. These training missions are designed to address that problem but will take some time.
Today was the first of our two screening days. There are about 300 patients in the shelter from as far away as 12 hours by bus. A woman named Sabrina and her husband were on a motorcycle trip around Ghana a couple of years ago and came across an Op Smile mission. They asked if they could help, and ended up playing with patients, unloading cargo and visiting with parents while their kids were in surgery. They were so taken with the whole event that they decided to stay in Ghana and join the Op Smile Ghana organization. Their main job is to scour the countryside on their Harleys, searching out infants, children and adults with clefts and telling them about Op Smile. They then arrange busses at pick-up points the day before screening to bring the patients to the shelter. As you might expect with someone doing that work, they are both incredibly exuberant, energetic people.
The screening was conducted at the hospital where the surgeries will take place next week. As usual, pediatrics and anesthesia joined together to screen patients. Usually a pediatrician and an anesthesiologist see each child, but since there are three pediatricians, Hans, a first time volunteer from Sweden, Ella, a second year pediatrics resident from Ghana, and me. (the pediatric intensivist won’t be here until Monday,) and nine anesthesiologists, the six “extra” anesthesiologists paired up and saw older kids and adults. Any patient five and under was seen by the pediatricians. Hans watched me do one patient and was then off on his own with an anesthesiologist, though because we are all together in one room, we often ask each other to have a look at a child we are screening. This made it easy for Hans to be independent but also have backup if he needed it. Ella is extremely experienced and a great pediatrician. She has to finish her residency before she can be credentialed, but I’ll sign her Op Smile credentials at the end of the week.
There were two kids with acute malaria at screening today, and both the parents and Ella were very calm about it. One mother had had malaria herself about a month ago, and both expected that the high fever and achiness their children were complaining of would turn out to be malaria. Ella arranged the prescriptions and off they went. The Pedi Intensivist acts as the doctor for any team member who is taken ill on the mission. Since he isn’t here yet, I get to play Team doctor until he arrives. One of the nurses came to me saying, “I think I have malaria again.” We did her rapid test right in the screening room, and it was positive. Ella arranged her meds as well. I ruled out scabies and chicken pox in a couple of patients and handed out bacitracin for some superficial skin infections. I’ll be glad when the real team doctor arrives.
Today was fascinating, (medically,) due to the “extra-cleft” diagnoses. Within the first hour of screening, I saw three babies with cyanotic heart disease. One was a four month old with an oxygen saturation in the low 80’s, a loud long murmur and a weight just 500 grams above his birth weight. His liver was big and his breathing fast. His chest X-ray was rotated (not straight on,) so it was hard to say much about it except that his heart is huge and globular. After discussion with Ella and the pediatric anesthesiologist, I started him on a little diuretic to see if he can eat more easily. Two other babies had big murmurs but oxygen saturations in the low 90’s and normal livers. They also had big hearts, one with a wide mediastinum and the other not. They’ll have Echocardiograms on Monday and then we’ll try to get them appointments with one of the two pediatric cardiologists in the country for next week.😝😝 I also examined a baby with microcephally and spasticity in addition to her cleft lip. Her disabilities may well be due to the ZIKA virus. Finally, I saw a nine-month old who weighed 4 kg at birth and now weighs 4.9 kg. He’s grown pretty well in height, but is very scrawny. I watched him nurse and he did fine. It took a bit of careful, gentle questioning through an interpreter, but I found that Mom is only offering the breast three times a day. As I was finishing my exam of the baby, I went over to discuss this baby with one of the surgeons whom I knew from previous missions. He's not only great technically, but I knew he was always careful to consider each child's circumstances fully. I found him in the midst of an argument with the rest of the group who wanted to postpone this baby’s surgery to give him time to gain weight. He felt strongly that they should put the baby on the schedule now because he thought the infrequent feeding was due to the mother's embarrassment by the baby’s appearance. He argued that fixing the baby’s lip make him more acceptable and the mother will be open to feeding more. More importantly, he’s afraid that if we don’t fix the lip, the child will continue to waste away.
Tomorrow we screen the second 150 and on Saturday night, make up the surgery schedule. Sunday is devoted to telling the parents whose children were not chosen, explaining why and setting up their appointments for the next mission. Some are straight forward – too young or poorly nourished, the babies with the heart defects that need attention and kids who are acutely ill. Some, however will miss the cut by chance as there are more qualified patients than there are spots on the schedule. Just like in Madagascar, here in Ghana there is a huge backlog of untreated patients. These training missions are designed to address that problem but will take some time.
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