The Agony and the Ectasy

This morning two striking events occurred in close proximity to each other that illustrate the polar opposite of pediatrics both in the US and in Gabon. In the first case there was a young girl of five who arrived during the night with a peanut lodged in her windpipe. It was a big peanut that she had choked on and it was blocking most of the air in and out of her lungs. At some point overnight she went into cardiopulmonary shock and had to be resuscitated. This morning she was holding up alright on 5L of oxygen until we were about to start rounds. She went into arrest again and this time none of our efforts worked to revive her. It was crazy sad. Her mom, aunt, and GM all started wailing the child's name and other laments. The whole hospital kind of stopped to watch and listen, Just a very very sad scene all the way around for a child to pass away from such bad luck.

Not five minutes later I had one of my greatest successes yet. It drives me crazy when parents seem not to look after their children's health be it back home in Chicago or here in Lambarene. So when a parent really does take a close interest it makes me incredibly happy and thrilled. I had looked up an electrophoresis result for a recently discharged patient and it had come back positive, meaning that the girl had sickle cell disease. I called the mom's cell and she promised to bring the daughter the next morning (ie this morning). Not only did she show up on time, but she had lots of questions about the diagnosis and treatment of sickle cell. I wrote down a bunch of information for her and arranged our first follow-up appointment in a month to monitor hemoglobin and thick smear status. Satisfaction in the midst of an otherwise dismal morning.

Room for Improvement

(written Thursday August 19th) It's pretty amazing to think that I have been working at Schweitzer for almost three weeks now. Time flies when you are treating gastroenteritis and malaria, eating pseudo-European meals, and fighting off mosquitos after 6pm. Sidenote: even with 95% DEET on I am a freaking mosquito magnet. It's a good thing that there are few malaria carriers around the hospital and that mefloquin is such an effective prophylactic medication because otherwise I would certainly have had malaria 10 times already.

Tomorrow marks my ¼ of the time here and thus I would like to take a moment of reflection and respite. I have come a long way in my tropical medicine and medical French ways. I can take on and entire afternoon's worth of patients on my own. I am learning the names and dosages of European medications. Ca arrive. But I am also at the point where I can think about making improvements in my treatment of patients as well as how the pediatrie handles things. Thus I would like to send a special thought/question out to my medically minded family and friends: if you imagine yourself practicing medicine in a developing country, what kinds of things would you focus on for improvement? Specific knowledge base? Management of certain diseases? Approach/education of patients and their families? Community health mini-initiative? Any thoughts or ideas would be much appreciated. I definitely want to continually improve as a practioner while I am here so I will make a plan of attack based on people's input and my own reflection. Please email or leave comments. Thank you in advance and a toute a l'heure mes amis!

Gabonese independence

Yesterday marked 50 years of Gabonese independence from French rule. There was much drinking and carousing in the streets. Lots of yellow, green, and blue (the national colors of the Gabonese). Dancing. Parades. Fireworks. Surprisingly little political fanfare or discussion. I wonder what people really think of the French or of being a former colony. Whenever I ask people, I feel as though I don't get a straight answer. And I probably do not. For me the best part was that two of the French girls here had organized a soiree of Gabonese foods and one of the nurses at the pediatrie, who lives nearby, taught us how to cook some basic local dishes. It was fun to mash bananas the traditional way and to have everyone laugh at our inept whiteness. Plus some of the things are delightfully yummy like fonlon leaves, which are a creamier spinach.

Lambarene 10K

I have never regretted forgetting my camera more than I did yesterday morning. Today is the celebration of 50 years of independence for Gabon. There already has been drinking and carousing and there will be much more celebrating today. As part of the festivities, the mayor's office organized a 10K (approximately 10K, no one knows the real distance) road race yesterday morning. My roommate found out about it and invited me to come along with her. Oh the scene of it all! We took a taxi out to a police checkpoint outside Lambarene where we found about 40 people milling about with their tiny and brightly colored running ensembles. And oh the footwear! Most people were running in plastic sandals called jellies or barefoot. I could not believe it! As we lined up for the start I wished so badly that I had not left my camera back at the house. It was too incredible of a scene with all the young lithe men in jellies and tiny Gabon emblazoned singlets. There were three women besides me and my roommate to run as well. The first was a young woman who competes in track in Libreville the capital city. She was tiny and fast and beat us all handily. The second was a high school aged girl who ran in, yes, jellies, and had incredible blisters at the end of the race, but still beat me. Elise edged her out for second though. The final woman was about 50 years old and a total ham. I loved her esprit. As we wound through the different neighborhoods of Lambarene people all came out to the road to cheer for us and yell “bon courage”. I laughed with a lot of the people because I get really red when I run, which was a hilarious sight to them. Little kids ran with me, teenage boys ran with me, and at the end this super fast guy doubled back to run with me and coach me to the finish. It was very cool and felt a little like running a marathon in the US except it was tropical weather, there were no water stations, and government officials waited at the finish line here to clap for us. There was a trophy presentation ceremony at the end, and I got the “esprit de competition” trophy, which cracked me up. I think the race officials felt bad because Elise had won a 2nd place trophy and I won nothing. It also reminds me of how I always won spirit awards in high school athletics. At least if I'm not the best, than I have a good time with the competition! Once again, the internet is too slow to load pics, but Elise and I took a bunch of photos with our winnings after the race when we got back home. I'll post when I can. What a hilarious time though. Later today we'll head into town to watch the parade and celebration of Independence. A toute a l'heure mes amis!

Community Health at Schweitzer

This Thursday I went out with the community health nurses to do a PMI visit there. It was pretty fascinating. Allow me to explain. PMI stands for Protection Maternale et Infantile. It is the community health arm of the hospital and has been run for almost 30 years by a nurse named Maman Sophie who is famous throughout the region for her efforts. The nurses have a clinic here on the hospital campus where they do immunizations and weigh children. Vaccination is free up until 1 year of age, provided by the Gabonese government. They actually just got the Penta vaccines here (DPT, Hepatitis B, and HiB make it up, I think). In any case, it's a great early childhood vaccine. They also still use BCG vaccine against TB. The Schweitzer PMI have achieved great vaccination coverage for this region, averaging around 85% of kids vaccinated. For Africa that is an impressive number.

As I was saying they vaccinate kids here at the hospital, but also on community visits every Wednesday and Thursday. They have 16 towns around Lambarene that they visit on a rotating basis. When they arrive, they weigh all the babies. This was quite the scene Thursday as there were about 50 moms and babies waiting for us. They all rushed forward to get a little harness for their kid, then they strip them nude, load them in the harness, and hang the kids up on hanging scales. For some reason all the babies hate this and so there was a crazy ruckus with all these naked kids screaming and hanging on scales.

Once they get weighed, the nurses go through the kids' health booklets to see what vaccines they need. Then they give them out. Another wild round of tears. While the three nurses were doing all the vaccines, Maman Sophie and I did “consulations” together. Basically this means doing a little clinic visit together. We are in the midst of an intense gastroenteritis (vomiting, diarrhea) epidemic, so that was the majority of cases. There was also an impressive case of a little one with months of scabies burrows that the mom had not taken care of. Those things can really get situated in your skin if you let them. After Maman Sophie and I saw the moms, I would take them over to this ancient chest of drawers that contained all the medicines and would try to get out all of the medicines that they needed. At the end, Maman Sophie gave a talk about safe sex, family planning, dehydration, and education. It was community public health at its best. I really enjoyed getting out a bit and seeing how things work outside of the hospital. Its neat to see how this system of vaccination and triage works in Gabon and to note its success.