One more week in Tanzania!
I spent this past week working mainly in the "Prime Unit" which is basically the NICU. I wanted to share a bit more about the hospital to showcase some of the differences and how little the doctors have to work with.
Mt. Meru Regional hospital is a government-run state hospital so all funding is allocated by the government. It is a tertiary hospital so it gets referrals from other smaller clinics and hospitals and offers surgical, OB-Gyn, and ophthalmology services in addition to pediatrics, medicine, and emergency services.
The pediatric wards (P-block) consists of an ICU area, P-1 which is for the kids who are sick and need observation but not really critical, P-2 which is for the kids who are almost well enough to go home, and the Malnutrition Ward. Then there is the Prime Unit with the critical babies, premature babies, babies under observation, and even a Kangaroo Mother Care unit (google it)!
Each ward is just one big room with a few beds, if there aren't enough beds then there are 2 kids to a bed. This is so scary to me because sometimes you have 2 really sicks kids sharing a bed, or you have one kid with TB meningitis in the bed next to a baby with pneumonia. There is also no such thing as heart monitors so if a child or baby in the NICU stops breathing... you don't know until someone goes to check...absolutely terrifying.
I spoke before a bit about how some of the pathologies I've seen here are ones not commonly seen in the US. All children are screened for HIV and malaria upon admission. There is an entire TB ward and all meningitis kids (which are a lot more than in the US) are also tested for TB. Diarrhea is usually a result of dysentery and typhoid. Most of the neonates admitted in the Prime Unit have "septic cords" after being delivered at home in non-sterile conditions. Even conditions that are typically seen as being pretty routine to treat in the US, like DKA, sickle cell, and pneumonia, become a lot more complicated and life-threatening when resources are so scarce.
Each morning all the mothers take the kids out into the courtyard so the nurses can clean the wards (except for the ICU) and then they come back in in time for rounds. If labwork is needed that our lab isn't able to do (which includes CBC differentials and basic metabolic panels...something done for almost every patient in the US) then the parents take the blood samples to other labs and bring back the results. The mothers also take the kids to radiology themselves if x-ray or ultrasound is needed (only imaging available here) and bring back the results. If they can't afford the cost, it doesn't get done.
The options for medicines are also pretty limited and the hospital's stock is extremely low so the doctors write prescriptions and the parents have to go to the pharmacy, buy the medicine, and bring it back to the hospital for the nurses to administer.
Because it is a government hospital it is where people come when they can't afford to go to a private hospital. Therefore, many patients are from poor rural areas, or are Maasai, which is the largest tribe in the area. This means that we see a lot of malnourished kids and kids who are really really sick after parents went several days or weeks without seeking treatment. Maasai are historically nomads and herders so there diet consists mostly of ugali (porridge made from cornmeal) which is also then sometimes mixed with cow blood (an intern asked if I wanted to try). So, basically, a diet without much protein and nutrients. Kids are then brought in bloated, severely underweight, anemic, and with Rickett's Disease (osteoporosis for kids...not good). More so if a new baby was just born in the family, then the next youngest may become more neglected. Yesterday I even saw a 2 day old with bloody gashes on his stomach that were Maasai tribal markings.
I don't mean to give the impression that anyone here is is unkind or neglectful. All the parents care about their children, all of these things are simply a part of their culture and they were never educated regarding the health risks that can result from some of these practices.
I must say the doctors here are quite astounding. The interns work incredibly hard and everyone makes the best of what is available to help provide the best care. It's certainly not easy.
I spent this past week working mainly in the "Prime Unit" which is basically the NICU. I wanted to share a bit more about the hospital to showcase some of the differences and how little the doctors have to work with.
Mt. Meru Regional hospital is a government-run state hospital so all funding is allocated by the government. It is a tertiary hospital so it gets referrals from other smaller clinics and hospitals and offers surgical, OB-Gyn, and ophthalmology services in addition to pediatrics, medicine, and emergency services.
The pediatric wards (P-block) consists of an ICU area, P-1 which is for the kids who are sick and need observation but not really critical, P-2 which is for the kids who are almost well enough to go home, and the Malnutrition Ward. Then there is the Prime Unit with the critical babies, premature babies, babies under observation, and even a Kangaroo Mother Care unit (google it)!
Each ward is just one big room with a few beds, if there aren't enough beds then there are 2 kids to a bed. This is so scary to me because sometimes you have 2 really sicks kids sharing a bed, or you have one kid with TB meningitis in the bed next to a baby with pneumonia. There is also no such thing as heart monitors so if a child or baby in the NICU stops breathing... you don't know until someone goes to check...absolutely terrifying.
I spoke before a bit about how some of the pathologies I've seen here are ones not commonly seen in the US. All children are screened for HIV and malaria upon admission. There is an entire TB ward and all meningitis kids (which are a lot more than in the US) are also tested for TB. Diarrhea is usually a result of dysentery and typhoid. Most of the neonates admitted in the Prime Unit have "septic cords" after being delivered at home in non-sterile conditions. Even conditions that are typically seen as being pretty routine to treat in the US, like DKA, sickle cell, and pneumonia, become a lot more complicated and life-threatening when resources are so scarce.
Each morning all the mothers take the kids out into the courtyard so the nurses can clean the wards (except for the ICU) and then they come back in in time for rounds. If labwork is needed that our lab isn't able to do (which includes CBC differentials and basic metabolic panels...something done for almost every patient in the US) then the parents take the blood samples to other labs and bring back the results. The mothers also take the kids to radiology themselves if x-ray or ultrasound is needed (only imaging available here) and bring back the results. If they can't afford the cost, it doesn't get done.
The options for medicines are also pretty limited and the hospital's stock is extremely low so the doctors write prescriptions and the parents have to go to the pharmacy, buy the medicine, and bring it back to the hospital for the nurses to administer.
Because it is a government hospital it is where people come when they can't afford to go to a private hospital. Therefore, many patients are from poor rural areas, or are Maasai, which is the largest tribe in the area. This means that we see a lot of malnourished kids and kids who are really really sick after parents went several days or weeks without seeking treatment. Maasai are historically nomads and herders so there diet consists mostly of ugali (porridge made from cornmeal) which is also then sometimes mixed with cow blood (an intern asked if I wanted to try). So, basically, a diet without much protein and nutrients. Kids are then brought in bloated, severely underweight, anemic, and with Rickett's Disease (osteoporosis for kids...not good). More so if a new baby was just born in the family, then the next youngest may become more neglected. Yesterday I even saw a 2 day old with bloody gashes on his stomach that were Maasai tribal markings.
I don't mean to give the impression that anyone here is is unkind or neglectful. All the parents care about their children, all of these things are simply a part of their culture and they were never educated regarding the health risks that can result from some of these practices.
I must say the doctors here are quite astounding. The interns work incredibly hard and everyone makes the best of what is available to help provide the best care. It's certainly not easy.
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