Final weeks at the hospital

My last two weeks at Mbale Regional were in the Pediatric Acute Care Ward and the Theatre (Operating Room - for those from the other side of the pond)

                                     ***** Warning- may be a bit gory for some ******

These last two weeks ended well. With my background being in pediatric critical care I enjoyed working in the Peds Acute Ward. They have strong leadership in the unit that shows in the way they approach and organize patient management. Just outside the ward on the veranda is a desk where two of the providers sit. They gather a quick history and physical exam and determine the patient's treatment. If they are really ill they slide into the 4-6 bed high acuity side. If not so ill the get in line for an IV placement. After their IV is placed they get in line for their first dose of antibiotics or any other treatment that is indicated. From there they find a bed and continue with their treatments.

It was nice to see the organization and the benefits of it. As I mentioned earlier the unit has a strong leadership base as well. The nursing staff is great and the physicians are involved in a fair bit of research. One past multicenter study was published in the New England Journal of Medicine. A current study is assessing the effectiveness of fluid resuscitation in children, and for this study the use of bedside ultrasound is used to assess their cardiac function. (For those who know me I was pretty excited about that!)

My following week was in the Theatre. There was a surgical team from western Uganda that was doing a cleft lip/ palate camp for 18 children. I was able to help out in the OR and get a feel for the anesthetic practices in Uganda.

One of the cleft lip cases. 

When the 3 day camp was complete I spent the rest of the time just hanging out in the OR seeing other cases. Thursday started out with an intestinal obstruction- a hernia with about 1 meter of necrotic bowel. The patient was quite ill and hypotensive throughout the case but pulled through after some work. 

Couldn't resist adding in the picture. 

I was able to have some good talks with the folks there. Resources are limited but they make do with what they have. For instance... there was a 1 month old that needed and exploratory laparotomy. Cutting into his abdomen, pulling out his intestines to look for any damaged spots and placing them all back inside his body.  This is a pretty big case for a small kid. They were out of oxygen so had to do the case with the child spontaneously breathing under ketamine with face mask oxygen from an O2 concentrator. The only monitoring that is available is a hand held pulse oximeter that shows you oxygen saturations and intermittent heart rate. (And I would complain when I could not see the ETCO2 waveform) If the child stopped breathing during the case they would just manually bag him up for a bit. I talked with the anesthetist  about this and the final conclusion was that you have to do the best work you can with what is at hand or else the child would have died in 12 hours if you never went forward with the case. 

I was glad that the last two weeks went well. I was thankful to the Lord for this as it was good to leave on a positive note. I was also thankful for the good relationships that I was able to start there. I plan to keep in the loop with how things are going there at MRRH.