Drama in Gabon

One thing that has been interesting in my first week is how communal the hospital experience is for patients. (Sorry that I did not write for two days family, I just felt fluish and under the weather and slept a lot, apparently this is a common reaction to arriving in Gabon. It's a full on immune system attack so it takes a bit of time to adjust.) Patients are kept three to a room and everybody knows exactly what is going on with all the different babies in the room, they help each other out, they answer each other's questions from the doctor. There is little concern about health care privacy. Even clinic visits are done two to a room. There was a particularly dramatic example of this communal health care on Thursday when a 14 year old girl who had arrived 3 days earlier from a small village with a premature baby that she had just given birth to that was all floppy and weak asked to leave the hospital. She told us that her father had called from the village and wanted them to come home. The main pediatrician refused saying that the baby is too weak, which he is. He barely breast feeds and only takes 2ccs of breast milk every few hours through a naso-gastric tube. The girl insists. Then the nurse gets the father's phone number and calls. He has not asked for any such thing as the girl returning to her village. Clearly she wanted to get out and this was her ruse. Interestingly, the nurse (and nurses do a lot of public health type stuff her with what they say to patients) announces to everyone in the room what the girl wanted to do. All the moms start in on her about how she has to care for her baby, does she want a dead baby, what will she do when she shows up at the village with a dead baby. The other nurses start nagging her about staying. It was as if the small pseudo-village in the pediatrie waiting room rose up to issue collective advice and pressure. I had never seen anything like it in the US. And what did the young mom do? Of course, after all that, she stayed.

La Palu, or Malaria

Before I came to Lambarene I had never seen a case of malaria. My first day here I saw 15. It is incredible the time and resources at the hospital that are dedicated to malaria, just a huge percentage of what we do. Then when you imagine how much time and energy it takes for the families to come to the hospital, scrape together money to pay, time off work, worry for everyone involved. It is just an enormous amount of stuff in this country decimated by malaria. Even though we try to give out mosquito nets and tell people to have little ones sleep under them, it still dominates the health care scene here (Unicef article on the current state of the fight against malaria). Briefly, malaria is a parasitical infection caused by one of four main parasites (here is Gabon, mostly falciparum). It enters the blood by the bite of a certain kind of mosquito. Then the parasite multiplies within red blood cells until they are so many that their mass causes the cell to lyse and they all rush into the blood stream causing a fever spike. Each parasite has a specific reproduction cycle length, giving a specific every 48hr, 72hr, or 96hr fever. Malaria also gives headaches, vomiting, loss of appetite, and (possibly) severe anemia. It can also cause neural malaria, which is the worst and deadliest manifestation possible. If I get back to the US and there is a malaria case, I am going to manage it like no body's business. As a sidenote to my medical school compatriots- I had somehow remembered that sickle cell disease is protective against malaria. It is not. Sickle cell trait is (and even then they can still have mild cases). Sickle cell disease gives a terrible malaria with worse anemia than otherwise. A toute a l'heure mes amis.

La Pediatrie

As I now have two days of working at the hospital under my belt, I think I can talk a bit more authoritatively about the daily schedule. It is both similar to medical school rotations in the United States and crazily different. First thing we do is gather to hear about the patient's overnight from the nurse who was on call. There is no doctor who takes call normally. The nurses just have everyone's cell phone numbers and they call if something really serious is going on. The report also consists of kids who had fevers, and the rest is "rien a signaler" (nothing to report). Next we round on all the patients, the first day there were 44, this morning there were 40. Patients are 3, to a room, or if they sick/premie babies there are 4 incubators, 2 to a room. We chat with each patient, look at their hemogram if they have one, and then move on. There are no daily notes, certainly no daily labs, and a very difficult to learn formulary list of medications. Rounding takes a couple of hours. Then we go do newborn baby checks, which I loved in Chicago and continue to do so here. Next we start "consultations" which are basically clinic appointments. These run until 1/2pm, we have lunch, come back and finish up with consults who need lab results returned to them and anyone else who may have straggled in. But at any point if there are emergencies or things to talk about then we do those things as well when the moment calls for it.

So far that about makes up my day. I work with an ever changing team of French/German/Gabonese/Togoan/Guinean doctors which also makes things interesting and spicy. I took some pictures today and will post them soon. A toute a l'heure mes amis.

Baby CPR

First day today-- totally exhilirating--I loved the hospital experience. I'll write tons more later, I'm just super tired. Let's just say my first act of the day was to perform infant CPR on a 1-day old baby born premature at 7mos. And it lived! Now that is a crazy way to get started with you big hands holding the delicate chest of a 1,2 kg baby and pressing you two thumbs against its tiny thorax. A toute a l'heure mes amis!

Albert Schweitzer, back story

After writing yesterday about the basics of Gabon, I thought today it might behoove me to write a bit about Albert Schweitzer, the man who started the hospital at Lambarene, where I begin my work tomorrow. Once I start work, I can start explaining the hospital and my patients.

So, notre grand Docteur Schweitzer was German-French, having been born in 1875 in Alsace. He initially was a theologian and distinguished himself by writing a famous treatise on the historical Jesus. Along with his theological doctorate, he was also well-known for his masterful organ recitals and seminal work on Bach. In 1905 he read about the Paris Theological Mission's call for a doctor to come to their mission site in Lambarene, Gabon. Although he had no medical training and disagreed with much of their theology, he embarked upon a 7 year process of obtaining a medical doctorate so that he could serve as their doctor and "make his life argument." Schweitzer also argued that rather than preaching to Africans about Christianity, dedicating his life to service in Africa would allow him to show compassion and humanity directly.

After he obtained his medical degree, he and his wife moved to Lambarene, started building the hospital, and saw patients initially in a converted chicken coop. He worked at the hospital most of the time until his death in 1965. He also spent time abroad, giving speeches and organ recitals to raise money for the hospital. In 1952 he received the Nobel Prize for Peace for his work. Discussion and criticism of Schweitzer linger, and probably always will, as to whether he bore paternalistic attitudes towards local Gabonese staff and patients. Regardless of what you think about that question, and how you judge Schweitzer's attitudes, you cannot dispute that he followed through on commitment to moving to Gabon and serving as a doctor here. That shows incredible strong will, faith, and dedication. Coupled with his diverse intellectual achievements and engagements, I find Schweitzer personally relevant and inspirational in my life.