rotating header

Wednesday, October 08, 2014

Kijabe paediatrics

This is what life is like as a Paediatrician in a busy referral hospital in East Africa.

Early mornings, because Jack is taking a class on-line, and it meets on a CA schedule.  Plus I've finally figured out that it is impossible to carve out time for prayer and exercise unless it is dawn-ish.  Make breakfast, read aloud devotions, check email, get ready. A frustratingly concrete new hospital policy separates patient and staff entrances, so we have to walk to the opposite side to enter and exit, doubling our few-minute commute.  Sounds trivial.  It isn't, because we are always pushing on a nearly-disappearing margin.  

Then the race begins.  Check in on ICU patients, touch base with the excellent clinical officer working with me there.  Pour over labs, check ventilator settings, examine x-rays.  Try to get to the paeds floor, the nursery, the casualty, and the MCH clinic all before meeting with the overnight team for morning report at 8:30.  Evaluate any admissions still waiting for beds.  Teach trainees as we review cases.  Then rounds, with the brilliant adult ICU doctors, in which I pretend to merely listen while I'm actually learning just as much as the interns.  Bop down to pathology to find out a patients's spinal mass is a very malignant astrocytoma.  Check in the lab to see if another patient's stool sample for polio ever got sent.  Meet the maternity in-charge to hand-over a donated syringe pump for babies.  Generate a list of pending admissions and talk to the nurses about discharges and bed openings.  Get called to private clinic to see a more well-to-do family referred from Nairobi with a shopping bag full of reports on a teen with chronic pain issues, which takes an hour of concentrated attention to be sure that there is no dire illness, rather the harder issues of life and relationship.  Get paged out of that for a code to find another teen who is paralyzed and may have a blood clot and needs immediate care.  Try to make a reasonable plan for her while seeing the minutes tick by to get up to RVA clinic, late as usual.  Meet with some parents and kids, always a great thing, good nurses, brave teens, chronic illnesses, low resources, insights, encouragements.  Tough problems, few experts.  Feeling out of my depth.  But enjoying the people and the challenges.  Back to our hospital MCH clinic to look at a rash that has puzzled the clinicians.  Start call, preterm twins.  Pull together dinner, or more likely, help Scott do so since he's already started.  Scour news reports about ebola, talk about it, feel the reality and loss and helplessness.  Remember friends.
That's the mostly good parts of yesterday and today mashed together.  But there were harder parts too. Two babies in one day admitted to ICU brain dead.  Two times to go through the whole heart-wrenching process of explaining the hopeless situation, of answering questions, of examining and re-examining to be sure the brain is gone, pouring over the file, calling or finding the midwife to hear about the delivery, the anesthetist to hear about the surgery.  Sometimes things go wrong.  Very wrong.  Baby J was born unexpectedly stressed, with meconium and a low heart rate and a limp body.  Baby F was a thriving two-month-old who stopped breathing a couple hours after an operation to repair his cleft lip.   Both needed CPR.  Both had a beating heart but not much else when I received them.  Both, one could argue, should never have been on life-support, but in both cases the process was good.  I could meet families, call in chaplains, pray, explain, advise.  Both moms held their babies as they died, with support and tears.  And truth.  And prayer, lots.

By this afternoon, post-call, 11 kids waiting for beds (admissions from casualty and clinic and surgery) but no beds at all amongst the 50-some for paeds.  Oh, there are 10 discharged patients held "prisoner" for unpaid bills.  Hard.  Two deaths, hard.  Tiredness, hard.  Sick colleagues, interns pulled out for government registration exercises, hard.  Sitting down as a team to debate care for super-complicated patients with rare congenital anomalies and serious fungal infections, hard.  Talking to a colleague about the government, public health, the big picture, priorities, realities, hard.

I love this job, and yet some hours I want to quit.  When sorting through dozens of texts and emails and complaints and absences and malfunctions, when work piles up and solutions are elusive.  When I keep adding meetings, budgets, research, projects to the to-do but not-likely-to-get-done list.  Then a little girl on the Paeds ward I'm helping consult on takes my hand, and says in Swahili even I can understand, doctor, I want to go to school.  She's 6, paralyzed by spinal bifida, malnourished, being cared for along with 11 cousins by a barely-functional grandmother.  Her lifeless lower body has sores so bad the bones of her legs are poking through.  She needs amputations.  But even so, what she wants is a book.  To read.

So I keep on keeping on.  I call the amazing chaplain Mercy to see little Grace, and she leads her to Jesus.  And tells me she's working on helping her to get to Joytown, a school for children with disabilities like hers.

This is Paediatrics in Kijabe.


Lyds said...

Prayers for encouragement, strength, perseverance and hope sent your way. I am constantly amazed at the work you and Scott are a part of. Thank you for what you do and for follow God's calling on your lives, even if it is a very hard road. Also thinking a lot about you guys with all of the Ebola and of Jonah and his family. Love and hugs. -Lydia

mobileprice said...

i prayer