My first full day of pediatrics with Richard. It began in the morning with a child with malaria, followed by a child with pyelonephritis, then typhoid, then malaria, then a broken leg from being run over by a bicycle, then two different boys, each with a broken femur that was in traction. It was then followed by a little 5 month old with rotavirus.
All along, I was giving out these "Cars" stickers. I gave one to the 5 month old, and one of the other doctors, Dr. Abega, asked about them. I said it was from a popular cartoon in America, about these cars that talk and live in a town just like people. He thought that was hilarious. He kept saying, "and these cars they talk?" and I said "yes, you can see them smiling on the sticker, see? and see, the windshield is the eyes!" and he just about died laughing.
Then we went to the nutrition ward, where I got to see vitamin A deficiency and zinc deficiency. One of the major problems here is not a poor diet per se, it is a lack of family planning. When a mom has a baby, she tends to breast feed at least until 6 months, frequently longer. However, if she becomes pregnant in the mean time, she will stop breastfeeding and wean the child early.
As a consequence of this early weaning, we start to see kids come in with nutritional deficiencies. Our child with vitamin A deficiency was 24 months old and had been having recurrent diarrhea and decreased appetite, and came in with very puffy eyes, watery eyes, and decreased night vision. He had been weaned early and had a 1 month old sibling. Our child with zinc deficiency had also been supplanted from the breast by a younger sibling, and had a difficult time developing an appetite for other food. This is definitely something that I've never seen in the US. The doctors cracked up when I said, "the major nutrition problem in America is obesity."
On our way back to the medicine ward in order to do a bone marrow aspirate, Dr. Abega asked me if I wanted to come back to Shyira. I said yes, potentially, but I'd have to wait until my 4 years of residency were over (I neglected to say 8 if I did a fellowship), when I would be 31. That is how we discovered that we are both the same age. He then began to inquire about how I was educated. I told him that I finished high school at the age of 17, was in college when I turned 18, 19, 20, 21, then graduated, took a year off to work and study and turned 22, went to grad school and turned 23, went to medical school and turned 24, 25, 26, and finally 27. He was very impressed that I will have 3 degrees at his age. I
He then told me that he wished that he could become a pediatrician, and that he loved children the most. He asked if there was any way that there could be an exchange program between Shyira and Arkansas, and I said, "I don't know. I'll have to ask, but probably you could come and observe but you couldn't be responsible for the treatment. You would just watch." Which is the most likely truth.
Then finally, we did the bone marrow aspirate on my HIV/anemia lady, but because the needle was too short, we weren't able to get to the marrow. I felt so bad for her because we weren't able to sedate her or anything beforehand. We just used some lidocaine into her skin and then just twisted a needle around in the top of her iliac crest (hip bone). At the end, she saying how she wanted to go home. Dr. Abega then had her hold out her palms as he held out his. In Kinyarwandan, he said, "Look at your hands. Now look at mine. See how pale you are? We can't let you go home like this." She then got another unit of blood. We are now going to see if we can send her to Kigali, and I'm dying for her to go, get a real diagnosis, and then get definitive treatment. It's been really frustrating for me, and also very much so for her, to wait this long. I have a hard time legitimizing to myself a patient's hospital stay if we aren't making them better.
This afternoon, it is going to be a Kinyarwandan lesson followed by reading about nutritional deficiencies, as Richard loves to harp on those.
And by the way, I'm a lot better today, and actually had a good night's sleep without any crazy Lariam dreams. Hooray!
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