Friday, January 31, 2014

Tough days

We've been having some hard days at the hospital. The wards have been busy, and there have been a number of really sick people, both adults and kids. The challenges, similarly seen at just about every hospital in the region, are many: not enough staff, medication shortages, not enough diagnostic tests, trouble getting specialists to come when they say they will. We're doing a pretty good job, all things considered. The hospital has made some amazing strides in the last one and a half years. And the attitude of the staff is overall positive, which is a big difference from a lot of African government hospitals I've worked in. As tired and frustrated as we all get sometimes, I feel like this hospital is doing better and better, and the community seems to be benefitting. 

Sunday, January 5, 2014

Dangerous Side Effects

Last night as I was getting ready to leave the hospital, one of the nurse assistants told me there was a patient that needed review. An older woman who had been admitted to the ward with symptoms of potential heart burn was having trouble swallowing. From the outside, things looked OK. Her lips weren't swollen. And when she opened her mouth, her tongue looked normal. When we got a look at her soft palate, or the roof of her mouth towards the back of her throat, we could see a serious amount of swelling on both sides. This was coming on quickly, and we knew right away that she was potentially in serious trouble. If the swelling continued, the opening to her windpipe would swell shut and she would lose the ability to breathe. At this moment in the US, I would be on the phone with an anesthesiologist who would urgently come to her bedside and evaluate her. If he thought that she was going to lose her airway quickly, he would give her medicines to sedate her, and then use a fiber-optic scope to place a tube into her windpipe. She would then be placed on a ventilator machine and would stay on it until her swelling was improved and she could safely breathe on her own. Here, we didn't have that option. So we gathered what we had available to place a tube in her windpipe, and even materials to perform an emergency cricothyroidotomy if her throat was too swollen. This scary procedure involves trying to cut a hole in the front part of her neck down to her trachea, slip a breathing tube in, securing it to the skin, and then breathing for her by squeezing a bag for the next 12 hours or so. We gave her some emergency medications to try to stop the swelling, watched, and thankfully (so very thankfully), she remained stable over the next few hours. The swelling was not worsening. We reviewed her medications and found that she was on enalapril, a medicine for hypertension that is in the ACE inhibitor class. By her family member's report, it seems like she might have had a similar episode in the past. In case this reaction was caused by her medication, we stopped it and warned her never to take it again. Today, she remains stable. We are all very thankful.

Thursday, January 2, 2014

Welcome back

Hi, again. Mimi and I have just returned for another trip to the village of Sagam in western Kenya. We made the journey from Penngrove to San Francisco to Amsterdam and then on to Nairobi, Kisumu, and then little Sagam. We were quickly reminded how tough things can get at this little hospital. I was seeing patients when we heard a great commotion outside and people running down the halls with wheelchairs. A truck had brought in multiple victims of a crash between a motorcycle and a vehicle. One of our nurses was involved and is pretty seriously hurt. At the same time, a woman with a preterm pregnancy presented with a complication involving the umbilical cord coming out of the uterus prior to delivery of the baby. The cord then becomes compressed and oxygen-rich blood from the mom ceases to flow to the baby.  Unfortunately, the infant did not survive. The medical team here is great and supportive during these tough times. Here's praying that these times will be few and far between.