So far we have spent most of our time on the children’s ward and then gone to theater two mornings a week when the operating lists are done. Coming from the super sterilized theatres of Australia it was a slight shock to find that most patients are expected to walk into theatre themselves instead of being brought in on a bed, even a case of a man with a broken hip had to walk in. The people here have an incredibly high pain tolerance and many minor procedures, like setting broken bones, are done with no analgesia and others with minimal pain relief. Major operations are done with either ketamine or ether!!!
On our second day at the hospital we were in theatre when they did a Caesarean section and the baby came out covered with the worst meconium I have ever seen (shows baby was distressed) and was not breathing. The nurse suctioned the nose and mouth using a footpump operated suction device and then attempted to bag and mask the baby. This didn’t appear to be effective and when she was called to get something for the surgeon I had a chance to step in and help. The baby’s pulse was only 40 beats per minute (should be over 100 and preferably 120 – 160) so I started CPR and the pulse eventually came up and the baby started crying but it was a very long 5 minutes before this happened. It is an amazing feeling to know that the baby would not have lived if I hadn’t been there to help and I am so glad that we received several tutorials early in the year on neonatal resuscitation.
The children’s ward at the hospital has about 46 beds and is divided into a main ward, dysentery (gastro) ward, a malnutrition unit and a 4 bed “ICU”. The ICU is only different from the rest of the ward in that it has an oxygen concentrator (oxygen cylinders aren’t available over here). Most of the children on the ward have malaria +/- anaemia (from the malaria). They stay in hospital for about 3-4 days, receive IV quinine and a blood transfusion and then are discharged. We spend our time after the ward round writing discharge summaries for the doctor. The usual entry in the notes is “Seen, treated and cured”, a lot less information than would usually be recorded back home. The rest of the cases on the ward are usually pneumonia (or have been diagnosed as having pneumonia because their chest sounds like pneumonia) with a few cases of gastro, which is often due to hookworm.
On the ward round on our 3rd day at the hospital we saw a 3 year old boy in the ICU with ‘severe pneumonia’ and ?poisoning who had been admitted about 11pm the night before. He was breathing about 4 times as fast as he should have been, was frothing at the mouth, had pinpoint pupils and was unconscious. When reading the history taken by the clinical officer we found that he had drunk insecticide the night before!!! Pulling out our trusted Oxford Handbooks of Clinical Medicine (aka the medical student’s bible) we found that the treatment for organophosphate poisoning is atropine but it only gave the adult dose. The doctor then said we would all go away and see if we could find the paediatric dose and then meet back at the ward in half an hour. The 3 of us rushed down to Rose and Nigel’s and when we told Rose what the problem was she came back up with us. The child had a GCS of 3 (lowest possible score on the coma scale) and only had oxygen sats of 82%!! Atropine is the cure for organophosphate poisoning and in Australia you would give it continuously for up to 3 days. But the hospital only had 4 vials (8 doses) available for us to use, so we gave him these 15 minutes apart and by the 4th dose he had started to improved and by the 6th dose he was awake enough to fight us ventilating him with a bag and mask. Since atropine only works for a short time we expected him to get worse after the last dose had worn off but miraculously he improved and a week later he was completely well and ready to go home. Rose, Naomi and I had all been praying that what we had would be enough but I certainly didn’t have much hope that he would survive the night. God has to get all the credit for this case and the child’s father certainly thought that it was a miraculous cure.
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