End of Week One in Africa

It was so good to see Lisa and Marta :)

Alexis and I had very smooth travel to the hospital, with all of our luggage! The short-term associates' apartments were much nicer than I had anticipated, and I'm very thankful to have readily-available filtered water at home.

Still in the humid rainy season, it has been quite moist and hot here. Aside from mosquitoes, there are bugs that stealthily bite us, so we soon found ourselves with itchy blisters :(  There are plenty of lizards and spiders, but maybe they're busy, too.

The hospital has been very overwhelmed with admissions, mostly for children with malaria needing medications and sometimes blood. The medical ward that's supposed to have 35 beds was housing 115 patients one day, with two children to each hospital bed. There were only three nurses and their aides! Sometimes discharge medications may not be exactly as we prescribed, just due to the chaos and patient load, but that's why we need prayers to cover every level of the patient's admission process: clinical judgment, medication processing at the pharmacy, payment process, blood donation and transfusion checking, and discharge medications, etc.

The hospital staff have been very welcoming and are very hard working. The interpreters are also very helpful and even try to teach me some words and phrases. The problem is then patients' parents start talking to me in their local language, expecting me to know what they're saying. :P

It's interesting while learning their greeting to find out that one always answer favorably. For example, your night always went well, you always say you're not tired, etc. Our patients' parents always answer each day the child is "better", before they list the complaints. It was a bit frustrating and feeling like it was a pointless exercise, especially when interpretation is involved; however, I thought about how it's the same with us, too. We always ask, "How are you?" We always say, "Fine. good. I'm doing all right. And you?" It's not exactly lying, but we do waste a lot of words.

Similar to some patients at home, I've come to find out I need to always prescribe something when I send them out of the clinic or from the hospital. One patient completed his course of antibiotics at the hospital and didn't have fever anymore, so I wrote to go home without any additional prescriptions. Later in the day or the next day, the father came and asked why the mother and child were sent home without anything? "Give them multivitamins," the nurse said to me. Sure, I can do that, but I don't think patients in the States would be that easily appeased. I also found it interesting that parents often complain of "eye infection", but on exam I would only find a kid with some crusting or gooey eye discharge where the tear ducts are. No sign of infection and probably just needs better hydration and cleaning the eyes with a warm wash cloth. I can't imagine how difficult it is for parents to not get antibiotic eye ointment when they think their child's eye is sick but the doctor is too busy to even explain why they're ignoring the problem. Unfortunately, they don't even have "the germ theory", so how do you know how much of what you're trying to say doesn't sound like "crazy Western magic" to them?

One theory why patients come to the hospital so late is that they consider illness to have a spiritual component, so when someone falls sick, families tend to first turn to traditional healers to request for charms or cutting. You would, too, if you believed your fever is the result of someone cursing you or you have done something to upset the spirit world. Also, it's easy to get a little flustered to see a child having been treated for malaria for the fifth time in the last two years. Not only is there problem with being over-treated, but why aren't they under mosquito nets?? It's not because they don't have them, because most of them do. Maybe they couldn't help but be reinfected. There are much I still don't know about their way of life and public health conditions. These are some of the obstacles that I've come to face.

Then there are the deaths. Right before we came, there was one night where 27 patients died in a 24-hour period. Since I've started to round on hospital patients, I've had about one or two die each night. Over the weekend, after being on call on Friday, I rounded on about 25 patients on Saturday. Thankfully, paperwork is a lot less than back in the States. There are, of course, pros and cons to that.

The death that hit me the hardest was a fifteen-year-old girl with intestinal obstruction. Shortly after I got an x-ray on her, she died. It caught me by surprise, but then I thought I should've known. I'm reminded of so many of my failures and shortcomings, but talking to Alexis and Marta helped me realized I couldn't have saved her anyways. It made me want to go home and be somewhere safe, where I can't be in power to take care of someone so critically ill. Yet, the next day, as I looked at children who were now perky and sitting up after being treated with medication and transfusion, ready to go home, I was comforted by some of the good I've been allowed to facilitate. Yet, when I think of a patient who got sterile abscess from the IM injection of quinine in the front thigh, I shudder at the thought of "how much harm is my current 'good' eventually causing"? Of course I won't know that, and the risk of a potential sterile abscess currently outweighs the benefit of saving a life from dying of malaria, but the pendulum just keeps swinging back and forth between "I'm glad I'm a doctor" and "can't I just be somewhere I can't mess up on life-and-death decisions?"

I'm thankful for a event-full first week, and there are still many many lessons to learn.