I’ve seen some shocking things while working on pediatrics
so far. I went to the NICU last week on
Friday, but to be honest, I couldn’t really stand the humid 90F incubator room for
too long; widespread heating is required for lack of individualized
incubators. While there isn’t much we
can do for them medically given our setting, we ended up feeding this little
babe who was found back in January, lying (and crying) in the waste contents of
a latrine. Maggot scars are all over his
body, and while he seems fine medically (at least from the basic investigations
that they can do here) he is failing to thrive.
But that is no wonder. The
hospital is understaffed, and so he may get fed every 3 or 4 hours but
otherwise, there is no one to pay him attention and show him love. Also, because he is without a birth mother,
he only gets this cow milk based formula, which I’m pretty sure is lacking in a
lot of the essential vitamins (and fed from a little cup…they don’t even have
proper bottles here!) Cows milk is
really bad for infants in general. Food
products aren’t fortified like we have come to expect. When working on the pediatric floor, I’m
amazed to see so much marasmus, kwashikor, and rickets (diseases of
malnutrition). And when I ask about
incorporating vitamins into the diet, the interns and attendings just laugh
because vitamins apparently are not even an option here, not that they are too
expensive for any local to afford, but literally there are none for
purchase. It’s incredible to me that so
many of the wretched diseases that I am confronting should not even be an issue,
and it’s heart breaking that once these children do succumb to disease, there
is very little that is offered for intervention (as is all too commonplace). The money and the resources just aren’t
available. For a lot of these sick kids,
the crux of the matter is social and economical, requiring a bit of education
and money.
We have also seen the typical pneumonias and bronchiolitis
and maybe even some unconfirmed malaria cases; nothing here is legitimately
diagnosed. Again, it’s the best guess
based on the limited studies we have at our disposal (and the history and
physical, of course). AND when we do get
labs, even labs as simple as a blood picture, we can’t really trust it. Every practicing physician at Mt. Meru knows
that the laboratory is unreliable, so order tests at your own risk. Absolutely mind-blowing. Anyway, I’m digressing, let me expound upon
these before mentioned febrile illnesses.
Several of these children with the probable pneumonias are seizing from fever. It looks like here instead of treating the
seizure by decreasing the fever with Tylenol, they go for the big guns
(completely contraindicated) using a heavy duty sedative and anticonvulsant,
phenobarbital. Now any doc knows that
phenobarbital also decreases respiratory effort so watch out when using
it. It is horrific that so many of the
kids I’ve seen here are getting phenobarbital to treat their febrile
seizures. Apparently, when diclofenac
(another NSAID like ibuprofen that they love to use) or paracetamol (Tylenol)
doesn’t do the trick, they reach for phenobarbital and Valium. CRAZINESS!
Here even the simple treatment of bronchiolitis (which back in the
States is inhaled albuterol and maybe a course of systemic steroids to calm
down the inflammatory process) baffles me.
I think their medications are in such short supply or the parents can’t afford
the medications, the staff have to resort to nebulized saline solution and hope
for the best. I’ve also seen oral
albuterol being given which takes a lot longer to take effect and is not nearly
as effective. I was told also, for a
child with bronchoconstriction that epinephrine instead of albuterol could be
used because albuterol is ineffective in children under 6mos of age. That’s really quite false and is not the
current recommendation back home, but again, I don’t have to understand
everything that goes on here. I’m just
taking it in and pondering my reflections.
The most shocking thing I’m seeing by far is the nutritional
deficits that are killing these kids. We
had a child on the floor who died just a day or so ago from rickets (Vit D
deficiency which interferes with bone mineralization). And since we have no vitamins, the best we
can do is educate about proper nutrition and hope for compliance, truly
shocking.
Besides the bleak yet beneficial hospital experience, I am
truly enjoying life here. I wrote a
couple weeks ago about settling into the rhythm of African life. I love that Witness gives us a predictable
breakfast variety depending on the day of the week, yet provides consistency
with brewing coffee each morning. I love
that Polo is our day security guard who comes every Wednesday to relieve
Innocent on his day off. Polo is a dear
older Tanzanian who doesn’t speak a lick of English but is so friendly and
reminds me a little of my grandpa. I really look forward to our meetings each
week. And I’ve been having fantastic
discussions with my ‘lover friend’ Emanuel our night security guard, hearing
about his aspirations to start up his own real estate company and maybe do
schooling to become a teacher. His was
the church I visited my first week in Arusha.
Sunday evening is Emanuel’s night off, so that’s when Solomon comes who
has given me equally intriguing conversation telling me tales of his father’s
death at an early age making him grow up all the faster to support his mother
and sister; and yet all the hardships of life have not squashed his aspirations
of being something more than a night guardsmen; he too wants to further his education,
a privilege that we too often overlook as such, instead calling it by another
name, drudgery (at least I have). And
the conversations are not one sided; they like to ask me about America aka
Obamaland (as they call it) with questions like ‘why do you like guns so much?’
or ‘why don’t you like Obama?’ Even if for but a brief time, these Tanzanians have
been my family, and as I’ve settled into the ebb and flow of the slow-going
lull that is typical of Africa, my Tanzanian family has been a welcomed
comfort.
***I am fully aware that some of my housemates might read
this and take offense to that last paragraph.
All you Aussies, Brits, and fellow countrymen have been a fun-loving
bunch as well :) Still, I think I depended on your company too heavily, when
the whole point of being in Tanzania is to experience the true flavor of the
land, which is at the heart of the locals NOT the other mzungus. Still fun getting to know you all! ***
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