Busy Hospital Days!

Our time in Zim is moving steadily along. While life is generally a slower pace (think less meetings, softball games, cell phones, and trips to wal mart), things have been quite busy at the hospital lately. This is a typical picture of the "waiting room" here at Karanda!

Just a before and after picture of a massive tumor resection of this man's shoulder/arm.

While the wet season- usually followed closely by her ugly sister malaria season- is long past, we have had an unseasonably high number of malaria cases. All of our wards have been affected. I've had urban men in their late fifties, otherwise healthy women in their early twenties, pregnant women, and even young children passing through our clinic with the diagnosis of malaria. The hospital- perhaps even the country- is completely out of our Rapid Diagnostic Test supplies for malaria. For the lay person, this is analogous to the EPT of the pregnancy testing world. simple. easy. could be used by a third grader. only it involves a skin poke, so I don't actually endorse third graders running around doing RDTs. Consequentially, we're relying on our lab manpower to get more work intensive diagnostics done for those suspected of malaria. I've been pretty surprised at the accuracy of a Malaria Parasite Smear.

In addtion to being out of rapid malaria tests, we're also out of Coartem, our usual go to med for simple, short course malaria eradication. So, I've been getting good at several other forms of treatment. there is more than one way to skin the proverbial malaria cat. The flavor of the day is chloroquine and fansidar. Many of the sickest patients come in having seizures, tipping us off immediately to the diagnosis of Cerebral Malaria. These people usually wind up spending most of their time with us on a concoction of quinine and doxycycline.

Aside from treating TB, the great masquerader, HIV, that ravenous beast, and malaria, (and the permutations thereof) we care for a broad swath of surgical and medical maladies native to this part of the world. In any given day, we'll see Lymphoma, pediatric protein malnutrition, hydrocephalus (and subsequent shunting), cervical cancer, prostatic hypertrophy (and resultant , asthma, congestive heart failure, prostrate cancer and it's resultant orchidectomy, adult male circumcision, fungating cancer of the X (fill in the X), and all manner of orthopedic trauma.

This particular weekend I was on call for our hospital. This basically entailed rounding on all of the wards, taking night call, cleaning up Saturday clinic, doing any surgical work that I am qualified for, fielding all emergent labor, delivery, and neonatal work that went on. I would have literally been at the hospital all day saturday and sunday if our new pal Alice wouldn't have seen a couple of wards for me.

Our wards currently consist of 25 beds in the peds ward (sometimes kids are on the floor too), 30 beds in male ward, 30 beds in female ward, and 20 beds on maternity. We've got a 2 OR operating theatre, an orthopedic theatre, and an OB theatre room. It gets a little hairy around here when all of those beds are full.

My weekday assignment has been to round on the post partum moms and the premie babies. I've got a couple of 1 kg (2.2 pound) twins i've been caring for for the last week and a half. please pray for them. They seem to always just be on the edge of life and death. It's hard to be patient as we "feed and grow" these little ones. Many of the post c section ladies have complicated stories. Many labor for multiple days before we get to meet them.

Having taken care of the obstetrics ward over the last week, I was delighted to pick up the female ward as one of our local docs is away.

The female ward is great. The patients are a diverse bunch of ladies and much more conversant that the babies, so that's nice. There is a nice mix of medical pathology in the female ward, from cerebral malaria to advanced cervical cancer. Additionally we provide surgical care for a variety of conditions. we currently have patients that have hip prosthesis (austin-moore), pelvic fractures, tubo-ovarian abcesses, chest tubes, and ruptured ectopic pregnancy.

Currently we have to eye surgeons in town, so we are swamped with eye patients. All of the eye patients seem to have brought their entire families with them, as we are totally inundated with patients this week. it should be interesting. i'll keep you posted.

1 peter 1:22

"Now that you have purified yourselves by obeying the truth so that you have sincere love for your brothers, love one another deeply, from the heart. For you have been born again, not of perishable seed, but of imperishable, through the living and enduring word of God. For,

“All men are like grass,

and all their glory is like the flowers of the field;

the grass withers and the flowers fall,

but the word of the Lord stands forever.”