Week Six

This week we began new placements at another district hospital, King Edward VIII Hospital.  Shanley & I were both on the pediatric rotation which was a nice change of patients and exposure to a lot of new things medically.  At King Edward there is a Pediatric Outpatient Department (POPD), a Pediatric Resuscitation Unit (critical care, PRU), a Neonatal Unit ("Nursery"), two inpatient wards, and an entire unit of pediatric gastroenteritis.

Monday through Wednesday we stayed pretty close to the PRU, learning from the department chief Dr. Ramji, who spent anywhere from 2 to 3 hours doing rounds with us!  King Edward is a teaching hospital and is linked to the University of Kwazulu-Natal's Nelson Mandela Medical School.  There are 4 interns and 1 resident on his service in the unit and they invited us to go to a lecture on Newborn Assessment/Physical Exams and the weekly M&M (morbidity & mortality) meeting, which was also pretty cool.  For the rest of the week we worked in the outpatient department doing measurements for neonates, as well as experiencing the nursery with its high volume and insufficient resources.

In nursery there is a constant flow of babies needing intensive care and only 3 respirators for the whole department. As such we witnessed some very difficult decisions being made about which babies had the best prognosis and social support to continue receiving care, versus those who didn't and would be taken off ventilation in order to make it available for another child in need.  On the other hand, we saw some pretty unique life-saving procedures like placing a central line through the umbilicus, which provides both venous and arterial access.

When we had some spare time we would go into the inpatient wards and play with/comfort the kids.  The inpatient wards are chaotic, with the kids roaming in hospital gowns doing anything to keep themselves entertained.  What was most difficult about the week was working with the kids that have conditions as a result of being a victim of their environment.  One little girl in particular, aged 10, presented with severe dehydration and headaches.  She has AIDS and had a recent admission of cryptococcal meningitis - which was the readmitting diagnosis this time.  She weighs only 17kgs, which classifies her a marasmus patient and stage IV AIDS.  Despite her physical condition, she kept bright eyes and a diligent smile which made reflect on why I love medicine: work is love made visible.