Bad day

Today ranks among my sheistier days here in Lambarene. There were some really sick kids in the hospital today and some terrible outcomes. The first thing that happened was a kid who arrived with tetanus. Straight out tetanic spasms, sardonic smile, lockjaw, arched back, and lack of proper vaccination (only one of three DPT vaccines). It was awful to see. The kid seems super sweet too. He kept telling his mom not to cry, that she shouldn't worry about him. But then when we gave him medicine and he went into deeper spams he started whimpering “je vais mourir, je vais mourir” which means I am going to die. Too freakin depressing. We looked up the dosage for tetanus immunoglobulin and then went to see if the pharmacy had some. They did. So I mixed up a big syringe full of immunoglobulin and adminstered it. Yes, that's right. Today I adminstered tetanus immunoglobulin. Never in my life did I think I would do such a thing. He is hanging in there for now, but we will see how it plays out. I am not too optimistic.

The other maddeningly depressing event today was the arrival of two day old twins in septic shock. We couldn't figure out a source or a causative bacteria so we put them on amp and gent, which is the standard when you don't know the source of infection. Then we waited. Within a few hours one of the twins went into arrest. By the time the mom alerted us, the baby was cool and very dead looking. We did CPR for 10 minutes while the mom and grandma cried beside us. It was so sad to hold a tiny dead baby in my hands and try to pump its heart and lungs back to life with no effect.

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!