Second and Final day of Screening-April 22, 2017
This was a generally frustrating and difficult day, starting with the lack of WIFI at the hotel and continuing with some sad medical diagnoses. The IT nightmare is complicated because the personal WIFI unit I rented for this mission isn't functioning. I’m not able to email support at the company as I don’t have email. The hotel internet is “present but not functional.” It has attached to my laptop’s WIFI but is not providing service for either the laptop or the phone. Because it’s there, I can’t use the personal hotspot on my phone. I wouldn’t want to use it long, but I was hoping to turn it on long enough to send my long-suffering husband an email letting him know I hadn’t fallen off a cliff. In the end, I used a team member’s phone to send my message, and soon one of the IT guys from the team is coming over to take a look at my computer and phone and the WIFI thing. It’s amazing how disconnected I feel being so far away from home and unable to talk with anyone in my family or to check the news. If this were a planned wilderness camping trip sans electronics, it might have been very relaxing. As it is, I’m stressed !!
The medical part of the day started with me in my continuing role as Team Doctor. Thank goodness the Ped Intensivist, to whom this job belongs, is arriving tonight. Yesterday, a nurse came to see me with fever, chills, headache and abdominal pain. Her rapid Malaria screening test (yes, there is one,) was positive and she is now on treatment and starting to improve. Today the man who does medical records, the one who chose not to take malaria pills on the Ghana mission, (Ghana, practically the center of malaria’s universe,) came down with the same symptoms and, indeed, the same positive test. Two for Two. Back in my pediatrician role, I saw a two year old boy with diarrhea for 2 ½ weeks. After much prying, I learned that he had been treated for malaria three weeks ago and that the drugs that treat malaria often cause vomiting, diarrhea and cramps for weeks. I also handed out Maalox and Pepcid from the kit to a nurse with heartburn, and Tylenol for headaches, likely brought on by mild dehydration. It’s a challenge to drink enough water to keep up with the heat.
I guess I’ve been trying to avoid writing about today’s patients, but I can’t babble on forever. Yesterday I wrote a bit in the blog about the three babies with heart murmurs. Only one was hypoxic (low oxygen,) but all three had significantly enlarged hearts on X-ray. They’ll have their Echocardiograms on Monday. Today I rechecked the baby whom I started on a diuretic for his early heart failure. He’s much improved with a normal size liver and slower breathing. However, I saw three more babies today with serious heart defects. None of the mothers had been told there was any problem other than a cleft lip. One baby is four months old and is still at birth weight. His mother says she nurses him and then gives formula and he’s a great eater. However, his oxygen is very low, and I think he just can’t keep up with his caloric needs. He also appears to have glaucoma. The second baby was 18 months old and has a normal twin sister who was on Mom’s back. The boy had a cleft lip and palate, and his mother was very excited about finally having him look “more normal when I take them out together.” He was so blue! He had a very quiet murmur but a huge heart on his X-ray. His oxygen saturation was only 60% (normal 95-100.) He had the most impressive clubbing, an abnormal swelling of the bases of the fingernails, that I have ever seen. Finally, I saw a 2 ½ month old baby with multiple problems. I think the baby has Trisomy 13, a syndrome in which about 70 % of the babies live less than a year. This baby had very low oxygen, a long loud murmur, extra fingers, dislocated hips and bilateral microphthalmia, very small poorly formed eyes. Although his mother had brought all his records with her, including his cardiac Echo, his X-rays and specialist reports, she had no idea about the results of his tests. She was tearful and said that each doctor would see one part of her son and say there was nothing to do. The eye doctor, Mom said, told her, “Your son is blind so good-bye.” Her question to me was, “If my son can’ t see well, why isn’t the doctor helping him?” Since there were two other pediatricians there for screening, I spent the next hour with her, trying to explain his medical problems and to answer her questions. Although she left with a much clearer idea of her son’s situation, and seemed grateful, we were both profoundly sad. Her final comment was that she had hoped that he would be able to walk. Even in the face of this devastating condition, parents have such strong hopes for their children. Each of these parents, the four yesterday and three today, came here hoping for a new face for their child. Instead they have learned that their child has a much bigger problem, hidden though it is. We won’t know until the ECHO’s are what the magnitude of the problems are, and whether they can be fixed, but I expect, given where we are that prospects will be limited.
So briefly, we screened 280 children and adults and tomorrow the team will announce who is on the schedule and will meet with those who are not to set up next steps and next missions. It’s bound to be difficult. I don’t think I’m in on that part of it, so I’ll likely be helping to set up the wards. We don’t have an official team day this mission, but there’s a “Make your own Batik” session tomorrow that I’ll likely skip.
This was a generally frustrating and difficult day, starting with the lack of WIFI at the hotel and continuing with some sad medical diagnoses. The IT nightmare is complicated because the personal WIFI unit I rented for this mission isn't functioning. I’m not able to email support at the company as I don’t have email. The hotel internet is “present but not functional.” It has attached to my laptop’s WIFI but is not providing service for either the laptop or the phone. Because it’s there, I can’t use the personal hotspot on my phone. I wouldn’t want to use it long, but I was hoping to turn it on long enough to send my long-suffering husband an email letting him know I hadn’t fallen off a cliff. In the end, I used a team member’s phone to send my message, and soon one of the IT guys from the team is coming over to take a look at my computer and phone and the WIFI thing. It’s amazing how disconnected I feel being so far away from home and unable to talk with anyone in my family or to check the news. If this were a planned wilderness camping trip sans electronics, it might have been very relaxing. As it is, I’m stressed !!
The medical part of the day started with me in my continuing role as Team Doctor. Thank goodness the Ped Intensivist, to whom this job belongs, is arriving tonight. Yesterday, a nurse came to see me with fever, chills, headache and abdominal pain. Her rapid Malaria screening test (yes, there is one,) was positive and she is now on treatment and starting to improve. Today the man who does medical records, the one who chose not to take malaria pills on the Ghana mission, (Ghana, practically the center of malaria’s universe,) came down with the same symptoms and, indeed, the same positive test. Two for Two. Back in my pediatrician role, I saw a two year old boy with diarrhea for 2 ½ weeks. After much prying, I learned that he had been treated for malaria three weeks ago and that the drugs that treat malaria often cause vomiting, diarrhea and cramps for weeks. I also handed out Maalox and Pepcid from the kit to a nurse with heartburn, and Tylenol for headaches, likely brought on by mild dehydration. It’s a challenge to drink enough water to keep up with the heat.
I guess I’ve been trying to avoid writing about today’s patients, but I can’t babble on forever. Yesterday I wrote a bit in the blog about the three babies with heart murmurs. Only one was hypoxic (low oxygen,) but all three had significantly enlarged hearts on X-ray. They’ll have their Echocardiograms on Monday. Today I rechecked the baby whom I started on a diuretic for his early heart failure. He’s much improved with a normal size liver and slower breathing. However, I saw three more babies today with serious heart defects. None of the mothers had been told there was any problem other than a cleft lip. One baby is four months old and is still at birth weight. His mother says she nurses him and then gives formula and he’s a great eater. However, his oxygen is very low, and I think he just can’t keep up with his caloric needs. He also appears to have glaucoma. The second baby was 18 months old and has a normal twin sister who was on Mom’s back. The boy had a cleft lip and palate, and his mother was very excited about finally having him look “more normal when I take them out together.” He was so blue! He had a very quiet murmur but a huge heart on his X-ray. His oxygen saturation was only 60% (normal 95-100.) He had the most impressive clubbing, an abnormal swelling of the bases of the fingernails, that I have ever seen. Finally, I saw a 2 ½ month old baby with multiple problems. I think the baby has Trisomy 13, a syndrome in which about 70 % of the babies live less than a year. This baby had very low oxygen, a long loud murmur, extra fingers, dislocated hips and bilateral microphthalmia, very small poorly formed eyes. Although his mother had brought all his records with her, including his cardiac Echo, his X-rays and specialist reports, she had no idea about the results of his tests. She was tearful and said that each doctor would see one part of her son and say there was nothing to do. The eye doctor, Mom said, told her, “Your son is blind so good-bye.” Her question to me was, “If my son can’ t see well, why isn’t the doctor helping him?” Since there were two other pediatricians there for screening, I spent the next hour with her, trying to explain his medical problems and to answer her questions. Although she left with a much clearer idea of her son’s situation, and seemed grateful, we were both profoundly sad. Her final comment was that she had hoped that he would be able to walk. Even in the face of this devastating condition, parents have such strong hopes for their children. Each of these parents, the four yesterday and three today, came here hoping for a new face for their child. Instead they have learned that their child has a much bigger problem, hidden though it is. We won’t know until the ECHO’s are what the magnitude of the problems are, and whether they can be fixed, but I expect, given where we are that prospects will be limited.
So briefly, we screened 280 children and adults and tomorrow the team will announce who is on the schedule and will meet with those who are not to set up next steps and next missions. It’s bound to be difficult. I don’t think I’m in on that part of it, so I’ll likely be helping to set up the wards. We don’t have an official team day this mission, but there’s a “Make your own Batik” session tomorrow that I’ll likely skip.
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