It's always difficult to imagine what it's like in a work place that's different from your own, let alone one in a different country, so, bearing this in mind, I thought I would describe one of my days in the medical centre.
My day began at 0830 so I left home a measly 5 minutes before to walk the hundred metres or so to work. Like most wards, we begin with a ward round. The night staff hand over each patient, Dr Mike assesses each and we decide on the plan of care for the day. This morning was no different. We only had 4 on the ward, one was for discharge after recovering from malnutrition, one was a baby who had become dehydrated for unknown reasons but was recovering well, and one we were concerned about who has a resistant cerebral malaria. The nursery has just three babies, all feeders and growers and doing well, two will be discharged tomorrow. There is the usual joking among the staff as the kids on the paediatric ward start crying the moment Mike approaches the a stethoscope, making it all the harder for him to hear a thing.
Through the morning I did the usual drug round at 10am, make the daily plans for the nursery babies, increasing their feeds, checking weight gain etc. and review a few of the Potter's Village babies who aren't well, Amos has a sore on his leg that's infected and Emmanuel has a flu that has been very persistent! According to the immunisation calendar, David and Daniel, the twins, are up for immunisations today and Jacinta needs to be weighed as she has lost weight recently. Throughout this time outpatients came in to be seen by Dr Mike and Olivah takes care of the government provided immunisations which we administer Monday-Friday.
Things are fairly quiet so I sat down at midday with a cuppa and my lap top to enter in some of the medical centre stats on flow charts, i.e. the income, expenditure and patient numbers, and finish typing up the next roster. My reprieve is short lived though as Mike pops his head out and announces a baby has been brought in, found abandoned in a field by the road. The baby, only a few days old by the looks, is very yellow, wet and cold. The recordable temperature is 28.7C. The incubators take at least 1/2 an hour to warm up and without that time available, I go for the next best option, kangaroo care, and just like that I am a temporary incubator. There is a lot of laughter as Mike and Jovia hold up a sheet so I can pull my top off, get the baby into position and wrap a blanket around us both. Winafred, our social worker, names him Timothy. About 20 minutes after I have commenced my incubator duties, Joviah sticks her head into the office where I’m sitting to inform me a premature baby has arrived, weight 870grams, estimated gestation 30 weeks. Keeping hold of my precious cargo I head through to the nursery, sure enough, there she is, her name is Maureen and, she seems to be doing well though is quite cold so her mother becomes her temporary incubator. She’s breathing well on her own at this stage but we keep a close eye on her and give her a breathing stimulant.
I’ve just settled in the lab with little Timothy who has now reached 32C, when Vera, one of the nursing assistants rushes through beckoning for me to come quickly. Following her back to the office I find Mike with Niwarinda, the little 17 month old with cerebral malaria… he dies moments after I walk into the room. There was nothing we could do. I sit for a while with his mother Elizabeth. She speaks no English but sometimes words aren’t needed, she just rests her head on my shoulder and cries.
Timothy mean-while needs to be fed and is warming up well, but first I need to test his jaundice because he is a rich yellow! With the help of the centrifuge and SBR meter I soon have my results and, sure enough, he needs photo therapy. His temperature is at 34C so into the incubator he goes, goggles made of self-adhesive bandage with gauze inside, and phototherapy on. I decided to head out for lunch then, being 3pm I was pretty hungry and everyone seemed to be okay for the moment.
When I get back Maureen looks like she needs some assistance, we had already put her on 1L of low flow oxygen but she is working hard, so with Mike’s help we get the CPAP out and set up. Her little nose is so small the nasal prongs only just fit. I’ve just got her sorted when the power goes off! The incubators shut off, phototherapy off, CPAP off… blast! Usually it doesn’t go off for long but not wanting to take the risk we put the generator on. By the time I get back to the nursery to make sure everything is back on, Timothy catches my eye, his hand is twitching. Sure enough, when I get a closer look, he’s having a seizure and two more quickly follow after confirming that it isn’t because of his temperature of blood sugar we give him anti-convulsants and continue to monitor him. By now it’s already 7pm. Maureen’s mother comes into the nursery now and, through an interpreter, tells us she wants to leave, to transfer her baby to another hospital, we have already explained to her that no other hospitals in the district have neonatal facilities and to remove her baby will be to kill her, but she is insistent. I can only conclude that she does not want her baby to live. Taking a deep breath I once again tell her, through the translator, that we cannot allow her to remove the baby. It seems she will let the matter rest for now.
I’m on call tonight so I’ll stay at the medical centre. Usually I just sleep in my house and they will call if I’m needed but with Maureen on CPAP and Timothy’s seizures I’ll sleep in the clinic tonight to be near if something happens. I’m rostered to work tomorrow so I hope I get some sleep.
Not every days is like this, sometimes it’s very quiet and drama free, other days it is non-stop, but it is always unpredictable. There is no such thing as advance referrals, people just show up and there is no telling when or in what condition, we just handle what-ever walks through the door in the best way we can.
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