I can't believe this is already week 6 of my trip. This is the last week the current group of interns are on pediatrics before they switch services. And all the long term doctors are preparing to leave for a retreat in the next 1.5 weeks. I hope I've learned enough about the Kenyan pediatric protocols to teach the new interns how to care for the patients and manage the patients myself while everyone is away!
Today, I saw a 24 week old stillborn infant with anencephaly (absence of a brain), open spinal cord, and large oomphalocele. It was definitely the most depressing thing I've seen so far. Apparently there are a lot of pregnancies here that result in anencephalic fetuses. And there's a fair amount of spina bifida as well. Last week I attended the resuscitation of a full term infant with large hydrocephalus, bilateral club feet, and an open lumbar myelomeningocele. When I asked the OB's why neural tube defects are so common, they listed several possible reasons. One, dietary folate deficiency is common. Two, many pregnancies are not planned so women do not take folate supplementation prior to conception. Three, many women do not come for prenatal care to receive folate supplements. Finally, the women who have a history of anecephalic pregnancies are not aware or not motivated to take the megadoses of folate recommended to prevent repeat spinal column defects.
I learned today that risus sardonicus is the term for the facial muscle spasms that occur in tetanus. We had a patient with grade II tetanus who presented with risus sardonicus, but I didn't get to see it because he improved rapidly with diazepam and was sent home after a few days in the hospital. I'm also learning that caterpillars can be dangerous and lead to limb amputations. Now that the rainy season has arrived, there are numerous hairy caterpillars crawling around. Their spines are poisonous and a sting from their spines can lead to secondary infections that may require amputation if the infection is severe. The surgeons are potentially amputating 5 patients' hands this week due to caterpillar stings!
We are celebrating another birthday tonight with chocolate cake and nutella frosting- delicious. We had home-made brownies with reeses pieces over the weekend, but the Kenyan housekeepers threw the leftover brownies away- I don't think they understood what they were doing!
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| A Kenyan spacer for inhaler medications- originally a coke bottle. When asked where I'm from, everyone can relate when I say, "Atlanta, the home of coca-cola." |
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| One of the malnourished patients who has been discharged but is at the hospital until her family can pay the bill to leave. With this system, we actually observe patients improve even after discharge (or readmit them if they stay long enought to get sick from the other patients). |
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| Ophthalmologist doing ROP exams in the NICU. |
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| A Kenyan breastpump. |
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| Cephas and Lando's last week on the pediatric service. |
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| Dan's birthday dinner at the guest house with Todd, Heather, Rachel, Patty, Annette, and Roche. |
