Clinical work at ODCH...

After many months at ODCH I finally spent a substantial amount of time on the wards. Last week I took the opportunity to work alongside a German doctor to do ward rounds in the intensive care unit every morning - some clinical work at last. It was great to talk to parents, examine children, discuss cases etc. And, I did a lumbar puncture on Friday, after not having done one for quite some time. Success!

I have to say that after a time away from clinical work it's once again a bit of a learning process. But that's okay, in the world of medicine we are continuously learning. Also, intensive care of course is very different medicine altogether! Having said that, when I talk about intensive care, I am referring to the ward in the hospital where the most ‘sophisticated’ care can be given.

Compared to the developed world, however, we are still talking basics; about half the beds have access to an oxygen concentrator and a third of the beds have access to a cardiac monitor. There is no ventilator, no infusion pumps, etc. It is a basic ICU with 10 beds, where the sickest children in the country end up.

Some children die, some children survive. Fortunately last week, most of them improved. We did however have two deaths. One child was transferred to us from another unit and stopped breathing within minutes of arriving. We resuscitated the child after 30 minutes but she died a few hours later. The second child was with us for about 6 hours before passing away. We saw a variety of conditions varying from complicated malaria to severe dehydration, sickle cell anemia crisis to meningitis, congenital heart disease to severe pneumonia.

What I found difficult was that at two different instances parents decided to discharge their children against medical advice. They wanted to take their children upcountry, to treat them the traditional way. I guess they didn't think their children were improving quickly enough. One child was so weak he could barely walk. We tried to convince them that the best thing for the child would be to stay in the hospital but for some reason they didn't believe us. It was hard to see them go. We decided to send the child away with oral medication thinking it was better than nothing! Really though, I wanted the child to stay for a few more days. The other child was in respiratory distress, in need of oxygen, when the father and aunty decided to take the child home. The mother had no choice in the matter. Again, nothing we said made a difference and with great frustration we had to let the child go. I can't imagine either of those patients will make it at home. Tough.

Having spent about 15 hours on the ward last week I can say that I am happy to do some clinical work again, however, I can also say ICU is impossible to combine with non-clinical work. So I think, since I need to find a balance between the two, I'll try out the outpatient department and admissions! At least that way I can get my non-clinical work done without feeling like I'm abandoning patients. I'll keep you posted on how it goes...