Malaria:Ghana as Common Cold:United States

                                                      Leonard and Pete make their debut...

                                                 

The last couple of days at work have had many ups and downs. Yesterday was our first real day of 'work.' In the U.S. we do monthly M&M conferences. (Morbidity & Mortality). The purpose is to review patients in the last month who had a negative clinical outcome for some reason or another so we can learn from it and do better in the future....In Ghana, it's mostly just one M.
                                       
Yesterday's mortality conference was focused on the NICU patients. That seemed to be the theme of the day, as we later went there to learn how to do IVs on small infants, and as soon as we walked in, Jonathan, Bertina and I ended up coding a 28 day old baby and doing chest compressions and full CPR on him. He unfortunately did not make it. I think even as young doctors we have already learned that everyone will not live, but the part that was most saddening was that much of the reason he did not have a fighting chance is because of lack of equipment and/or medical technology. It's only a microcosm of what takes place in 3rd world countries. It is such a blessing to live in the United States, where everything is available to you, be it medical care, a college education, or even fresh water. Each day I am more and more humbled by what I see, and in further admiration of those who have it rough but keep on smiling.

There are some really interesting cultural practices in Ghana too. Some patients have scars on certain parts of their bodies, which represent places where spiritual healers believed that evil was in the body at that particular location, and was trying to get rid of it. For example, a baby with chronic diarrhea and abdominal pain might have them around his abdomen, while a malnourished girl might have it around her mouth.

We have seen TONS of interesting pathology, of which I have taken lots of photos for educational purposes. Won't post them for patients' sake, but would be happy to share what I learned when I get home if anyone would like to see them. A few examples: extremely large tumors, chronic dactylitis from sickle cell disease, retinoblastoma, hepatosplenomegaly, skin peeling from zinc deficiency, corneal clouding from vitamin A deficiency, kwashiorkor just to name a few.
Rounds are taxing in the daytime not only because of the mental-emotional shock associated with some of what we are seeing, but also because it's straight up HOT. Often the electricity will go out for a short while, leaving no fans and just a few open windows. For example, today it was well over 100 degrees on the inpatient ward, and the rooms were so crowded with patients that some of them were lying on the floor on mats with their mothers. Also Tuesday is a big rounding day at the hospital, which meant there were about 12-15 house officers (Ghanian residents), medical students, an attending, and us, trying to squeeze in between the patients and crowd around each child as he or she was presented. For the 3 of us, much of this pathology is stuff we have never seen before, so we tried to jump in and examine the patients too, but it was physically difficult to get in there. Did I mention it was hot? Just to give you an example, my t-shirt was stuck to my back and we were all drenched with sweat within the first hour of being there.
Ironically, the little babies are carefully covered in wool hats and thick socks, despite the heat. I saw one baby in corduroy and several layers of wool today :)

Random factoid I learned today: Pediatric care in Ghana ends at age 14. After that, you are expected to be seen by adult physicians.
Also interesting, they do not use IV pumps for fluids. So if a patient gets IV fluids, they are ordered in every 2 hour boluses. I think it's cool how the body learns to adjust, no matter how big or small.

Maybe we will tell the next group to bring some smaller diapers....