I suppose Mondays everywhere are always busy, but here at Karanda there is no comparison. There is no ER open within 150 Km of our hospital on the weekends. So on Monday everyone comes pouring in with quite a wide array of medical issues. While the nurses begin triaging the 200 plus patients, most of whom have all shown up by 8am, we all begin our rounds.
My ward this month is peds ward, and as we mentioned last week is quite busy, especially with the hydrocephalus patients. There are a large assortment of other issues including: meningitis, HIV, TB, malnutrition, severe pneumonia, jaundice, large abscesses, bone infections, and several patients with significant fractures. Since I wasn't on call this weekend, sorting through all these issues takes a fair amount of time.
Also during rounds, there happened to be 2 urgent Csections that needed to be done. One of the mothers was in labor, and has a history of 3 previous Csections. Allowing her to labor on 3 previous scars can be quite devastating especially if the uterus ruptures. So this mom took surgical priority. The 2nd Csection of the morning was a mother who had been laboring for several hours and just stopped progressing. Fortunately, both Csections went well, and both the mothers and babies were happy and stable.
After rounds were done, and the Csections were finished I was able to enjoy the traditional Zimbabwean tea break. Usually between 10-1030am, this break always seems to come at the right time, and allows us to re-energize on some coffee or tea, and a nice small meal (Usually hard-boiled eggs for us). Its also a great time to spend with my family.
After tea, I headed to the (OPD) outpatient department. My time is usually spent in theatre or the OPD. Since there are so many new patients on Monday I usually start the day in OPD, and then finish up in theatre when all the patients have been seen. The rains have just about stopped, so the temperature is heating up. The building where we see patients gets a little warm as the benches fill with anxious patients. As I've mentioned before this is called the outpatient department, but is really more of emergency/trauma/outpatient department as the patients line up with a tremendous spectrum of pathology. We see illnesses ranging from osteoarthritis, back pain, and headache, to end stage HIV, severe fractures, necrotic wounds and comatose meningitis patients.
Today was no different then the rest! The department was packed with people all day long. It seemed like no matter how many patients we saw the lines kept multiplying. I admitted 10 patients all of whom were very sick. There was probably another 10 that could have easily been admitted, but the wards are already full, so we try to manage as many things as possible without admission. To put that into perspective, in the US on a busy week I would admit less then 5 patients to the hospital. So needless to say it was a busy afternoon.
The most memorable patient I saw was an 11 year old girl. She looked to be no more then 5 years old, as she had been slowly wasting for the last several months do to HIV. She was taking the anti-retrovirals as prescribed for the last 4 years, but she was still slowly succombing to the disease. Over the last 3 months she had been treated as an outpatient for an assortment of conditions all related to her HIV. Unfortunately she continued to worsen at home. She had severe thrush (oral fungal infection) which kept her from eating. She had persisitent diarrhea which kept her in a constant state of dehydration. Now her constant coughing, most likely from TB, seemed to bring her closer to the end. Hopefully the hospitilization will stabilize some of her conditions, but even at best her long term prognosis is grim. Even despite her severe illness there was still a light in her eyes and an enchantment in her smile that I will never forget.
After OPD finished up, I went to theatre where I did several small surgical procedures, and some ultrasounds. The day finished with 2 more C-sections. The first was a mom that had severe pre-ecclampsia. This is a disease process that if goes untreated can lead to seizures which can comprise the life of both mother and baby. The best treatment is urgent delivery. Her C-section went well, and both mom and baby were stable throughout the surgery.
The last C-section of the day was a mom who had a complete placenta previa. She came to us late in the day with significant vaginal bleeding. We did an ultrasound that showed the placenta was completely covering the cervical opening. Of course this means that the only mode of delivery can be a C-section. The only problem with this, was the mother was only 33 weeks pregnant. At Karanda we don't have the technology to keep premature babies alive. Any baby born younger then 36 weeks is at risk for death. We had hoped the bleeding might slow down, and we could keep her pregnant a little longer. Unfortunately the bleeding became more brisk, and we were forced to perform an emergent C-section. Before starting the procedure, we spent extra time praying for the life of this baby, and God answered our prayer. The baby was born no older then 33 weeks, and probably closer to 32 weeks, but is doing great. She is not requiring oxygen, and is even starting to breast feed. She isn't out of the woods yet, but its been over 12 hours so we are quite encouraged. Another answered prayer at Karanda!
Anyway, just a brief overview of monday at Karanda. Always intellectually stimulating, physically challenging, yet always rewarding. In the victories and tragedies God is always glorified!
My ward this month is peds ward, and as we mentioned last week is quite busy, especially with the hydrocephalus patients. There are a large assortment of other issues including: meningitis, HIV, TB, malnutrition, severe pneumonia, jaundice, large abscesses, bone infections, and several patients with significant fractures. Since I wasn't on call this weekend, sorting through all these issues takes a fair amount of time.
Also during rounds, there happened to be 2 urgent Csections that needed to be done. One of the mothers was in labor, and has a history of 3 previous Csections. Allowing her to labor on 3 previous scars can be quite devastating especially if the uterus ruptures. So this mom took surgical priority. The 2nd Csection of the morning was a mother who had been laboring for several hours and just stopped progressing. Fortunately, both Csections went well, and both the mothers and babies were happy and stable.
After rounds were done, and the Csections were finished I was able to enjoy the traditional Zimbabwean tea break. Usually between 10-1030am, this break always seems to come at the right time, and allows us to re-energize on some coffee or tea, and a nice small meal (Usually hard-boiled eggs for us). Its also a great time to spend with my family.
After tea, I headed to the (OPD) outpatient department. My time is usually spent in theatre or the OPD. Since there are so many new patients on Monday I usually start the day in OPD, and then finish up in theatre when all the patients have been seen. The rains have just about stopped, so the temperature is heating up. The building where we see patients gets a little warm as the benches fill with anxious patients. As I've mentioned before this is called the outpatient department, but is really more of emergency/trauma/outpatient department as the patients line up with a tremendous spectrum of pathology. We see illnesses ranging from osteoarthritis, back pain, and headache, to end stage HIV, severe fractures, necrotic wounds and comatose meningitis patients.
Today was no different then the rest! The department was packed with people all day long. It seemed like no matter how many patients we saw the lines kept multiplying. I admitted 10 patients all of whom were very sick. There was probably another 10 that could have easily been admitted, but the wards are already full, so we try to manage as many things as possible without admission. To put that into perspective, in the US on a busy week I would admit less then 5 patients to the hospital. So needless to say it was a busy afternoon.
The most memorable patient I saw was an 11 year old girl. She looked to be no more then 5 years old, as she had been slowly wasting for the last several months do to HIV. She was taking the anti-retrovirals as prescribed for the last 4 years, but she was still slowly succombing to the disease. Over the last 3 months she had been treated as an outpatient for an assortment of conditions all related to her HIV. Unfortunately she continued to worsen at home. She had severe thrush (oral fungal infection) which kept her from eating. She had persisitent diarrhea which kept her in a constant state of dehydration. Now her constant coughing, most likely from TB, seemed to bring her closer to the end. Hopefully the hospitilization will stabilize some of her conditions, but even at best her long term prognosis is grim. Even despite her severe illness there was still a light in her eyes and an enchantment in her smile that I will never forget.
After OPD finished up, I went to theatre where I did several small surgical procedures, and some ultrasounds. The day finished with 2 more C-sections. The first was a mom that had severe pre-ecclampsia. This is a disease process that if goes untreated can lead to seizures which can comprise the life of both mother and baby. The best treatment is urgent delivery. Her C-section went well, and both mom and baby were stable throughout the surgery.
The last C-section of the day was a mom who had a complete placenta previa. She came to us late in the day with significant vaginal bleeding. We did an ultrasound that showed the placenta was completely covering the cervical opening. Of course this means that the only mode of delivery can be a C-section. The only problem with this, was the mother was only 33 weeks pregnant. At Karanda we don't have the technology to keep premature babies alive. Any baby born younger then 36 weeks is at risk for death. We had hoped the bleeding might slow down, and we could keep her pregnant a little longer. Unfortunately the bleeding became more brisk, and we were forced to perform an emergent C-section. Before starting the procedure, we spent extra time praying for the life of this baby, and God answered our prayer. The baby was born no older then 33 weeks, and probably closer to 32 weeks, but is doing great. She is not requiring oxygen, and is even starting to breast feed. She isn't out of the woods yet, but its been over 12 hours so we are quite encouraged. Another answered prayer at Karanda!
Anyway, just a brief overview of monday at Karanda. Always intellectually stimulating, physically challenging, yet always rewarding. In the victories and tragedies God is always glorified!
