Kamuzu Central Hospital-weeks 2 and 3

The saga continues, and only gets worse! I thought I was doing pretty well after the first two weeks--I was exhausted and my feet are swollen every night, but I could see the silver lining in most areas. Week 2 I worked at the HIV/AIDS clinic, where they have a fantastic system with computerized bar codes for each patient and a ton of needed services ranging from nutrition assessments to home-based hospice care from nurses that cruise around on motorcycles! They do see about 250 patients per day (all HIV+) which seemed amazing. And the vast majority of them looked perfectly healthy--it really hit home how the early stages can not be diagnosed by appearance! Then I also did a few days in the "Under 5" clinic where they see kids up to 14. Most were simple out-patient malaria treatments, coughs and colds. We did see a couple of measles cases, a first for me, and then bizarre things like kidney failure in a 10-yr old after a nasty strep infection, heart failure in a 12-yr old with rheumatic heart disease, and 2 cases of meningitis! I did want to tear my hair out over the staff (nurses AND doctors) letting kids sit there in respiratory distress and oxygen levels at 70% for 2 and 3 hours while we 'processed' the admission...just as in every other part of life, there truly is no hurry in Africa--even in a pediatric ER!!!

I was pretty cocky going into week 3, having survived so much already and found things to even enjoy on most days. I thought the pediatric in-patient unit would be a fun place to spend 3 days, seeing as I love kids and feel more comfortable practicing my broken Chichewa with them! Perhaps that is why it nailed me more than any other rotation. They have 175 beds...no, 175 patients on an average day, by putting at least 2 kids in each bed, and 8 nurses. They also have a mortality rate of over 60%...that means more kids DIE while admitted than get discharged!!!! 3 died my first day, and the families lay on the floor of the hall-way wailing and sobbing for hours.
Most kids were young, under 6, and they were sicker than I've ever seen. Cerebral malaria, pneumonia, HIV, malnutrition, hydrocephalus, kidney failure, liver failure due to chronic malaria, meningitis, heart failure due to anemia (I knew this was theoretically possible, but who knew it was common?) and neonatal sepsis due to umbilical cord infections (again, does this really happen???) I came home after my first day, grabbed ahold of Isaac, sat down on the kitchen floor, and cried. The only miracle in that unit is the fact that anyone here lives to adulthood.


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