Work is busy and a little odd.
The pathology here is as expected, phenomenal. We have a visiting peds surgeon who is here for a year who has done some crazy cases this past two weeks: omphalocele, congential diaphragmatic hernia and trachea-esophageal fistula. On the peds ward we have a nephrotic syndrome, a refeeding syndrome (from a prolonged complicated appendicitis that turned into peritonitis after appendectomy an another facility) and various pneumonia and bronchiolitis. In the nursery/NICU we have THREE cases of direct hyperbilirubeminia which is bizarre (most babies with jaundice have indirect). One kid came in with a total bili of 35 and direct of 24. We ended up doing an emergency exchange transfusion. I manually did the procedure under the guidance of my FMG colleague (an excellent example of something I have NEVER done in my ritzy American education). The repeat bili was 24 with an indirect of a 13 and continues to trend down. The AAP/WHO recommendations for direct hyperbili are vague and there is very little evidence of what actually helps beyond if you can find a metabolic disease you can treat it. But it says you can try exchange transfusion as a last ditch efforts. I have spent most of my time in the nursery this week partly because we are short a Kenyan resident and partly because it’s a good place to be if walking is a problem because its small.
The odd part...There is a FMG (foreign med grad) physician (not Kenyan) who graduated from medical school four years ago elsewhere and has been working in pediatrics since then informally at various mission hospitals around the world. Its hard because its unclear who is Sr to who and everyone is fawning over my education (all 8 mons of it) but he knows way more than I do especially about how things work in this kind of setting. To make matters more awkward he desperately wanted to get a spot at the program where I am in the states and every day asks me about it. He applied and was turned down for an interview (which really is a shame because he is great doc and we take 3 FMGs a year). He keeps asking me about making connections and such. I of course have little to NO power and he has already accepted an offer from a community pediatrics program elsewhere and the Match is over and done with. Its hard. I am not exactly sure how to handle it. I appreciate prayers and thoughts.
I did on Thursday after the knee had started to mend start my growth chart project so hopefully we can get that going. I did have a minor setback. The peds surgery ward is trying to get a scale donated and until then there is a very little I can do about daily weights. So I am focusing on general peds and then the outpatient clinics for now. Having been here before is a HUGE advantage because the nurses all know me and were not hard to convince to participate in the project. So far, so good.
Monday night before I HURT my knee I went to two parties. One was for all the new residents/students run by several of the full time Western Staff and the other was a surprise party for my Kenyan friend. The surprise party was particularly fun and I had such a good time catching up with everyone and of course Kenyan chai, cake and music. On Thurs night I went to a Kenyan worship service led by two of the pediatric C/Os (PAs). I was the only white person there (this happens to me a lot and I often wonder what all the other white people do all the time…especially the young people without kids…I have no idea!). It was a great time the music was half Swahili which I understood some of and half english (with a lot of Hillsong!). There was the obligatory dancing which I did some of despite my knee.
No comments:
Post a Comment