Drepanocytose= Drepa= Sickle Cell Anemia

There is a lot of SSA here. It makes sense, hospital in Central Africa, but I didn't realize how prevalent it is. In a day, we easily see 5-10 "controlle" patients, those coming in for outpatient check up appointments. We take a look at how anemic they are, make sure their immunizations are up to date, and prescribe folic acid and other meds if necessary.

If you need to check to see if a patient has splenomegaly, I'm your gal. There is no screening for sickle cell here, and often an electrophoresis is not obtained to determine if there is sickle cell anemia until a patient has an exam finding (splenomegaly), or a funky infection, or anemia that won't improve. I have felt spleens that are halfway down the child's abdomen, and have seen kids who have their spleens removed.

I am supposed to give a talk to the nurses at some point during my time here (in french eek). I think I may talk about sickle cell anemia, because the nurses learn on the job (they don't have classes that teach them about the pathophysiology of disease). Many of the nurses have family members with SSA, and I think it would be useful to break down what happens from the molecular level to the clinical manifestations.

Oh, also, no hydroxyurea here! Mothers with children with sickle cell anemia haven't even heard of it.

TIA: This is Africa

I have been here for about a month, and I am struggling to start to tell you all of all the things I have seen here. So I will begin with a story.

Since I am a music lover, this can be the background music to this post:

http://www.youtube.com/watch?v=PzQmdTt5dPQ

One morning while rounding, we were about to leave "incubateur 1," the first of 2 rooms with premature babies, 2 to a room. Each baby is in an incubator. Before you are impressed that the hospital has incubators, let me inform you: they do not work. They serve as a theoretically stable home for the babies. To keep them warm, the mothers take empty 1L soda bottles and fill them with warm water (periodically, but some of the mothers neglect doing so). The mothers are in charge of taking care of the baby: feeding the baby, bathing the baby, changing the baby. So, in essence, the baby is out of the incubator a lot, and is in clothes purchased from the market (not sterile, but cute).

So back to the story: The team is about to leave the room, when a nurse, Annie, tugs at my scrubs. She just started and is quite shy. She didn't say anything but brought me to a baby who was lying on a bed being changed (by the way, the diapers come in one size, extra large, so that on these babies, the diaper comes up to their armpits). She pointed to the babies hand. I didn't have my glasses on, but i saw little dots on the babies hand. Very scared, I thought that it was petechiae, little hemorrhages that can result from severe sepsis (aka bad). I called my attending, and asked him to please look at the baby. He started to laugh, and told me to come take a closer look.

Those little dots in the babies hand? They were not, in fact, petechiae, but little ants crawling in the baby's hand!

TIA.

Diagnoses

Overall, the majority of the diagnoses I have seen thus far have been: malaria, infectious diarrhea, and surprisingly, bronchiolitis and asthma exacerbations! Who knew.

Diagnosis list:

HIV

malaria

Tb- lots

appendicitis

earring aspiration

diarrhea/dysentry

schistosomiasis

testicular torsion

sickle cell anemia

marasmus

hypospadias

appendicitis

laryngomalacia

congenital toxoplasmosis

scabies

hydrocephalus

retroperitoneal abscess

petrol aspiration

A Day in the Life

So of course, I have been here for 3 weeks now and have fallen behind on telling you all about my life here. I have an established routine now, which works like clockwork (+/- international standard time). Pictures have been somewhat difficult to post on the blog, so I will direct you to my facebook page to see pictures (facebook uploader is really quick here).

4:30 am: roosters crow, animals of unknown origin living in the walls/above my room start waking up. I wake up, realize it is dark, and sleep once more.

6:15 am: I wake up to an alarm, and hit snooze.

6:30: finally wake up, it is still dark out. Sometimes I receive a call from home, it is the best way to start the day :)

7:00: make lipton tea on our countertop burner, have breakfast. Breakfast these days might be a baguette w peanut butter and banana, an apple, imitation nutella, or the latest purchase, frosted flakes from dubai.

7:30: arrive at pediatrics. Copy lab values that haven't been written yet in the records. Look over to see if there were any events overnight, and to orient myself to the patients (i haven't found an easy way to keep pts straight, there are a lot of transient pts). Dr. Kokou arives, and along with the head nurse and other nurses, we see the patients. We see the premature babies in incubators first (attempt to avoid the spread of infections to the incubators), then the "private room," then to the general inpatient ward rooms. There are 10 rooms, each w 3 beds. These days, not all the beds are filled, and since patients are required to have a "guardian" who takes care of them in the hospital, the empty beds in the rooms are usually occupied by a parent/sibling.

Rounds can take between 1-3 hours. My attending is the only pediatrician, so sometimes he has to take a break from rounds (yesterday he went to a c section during rounds).

~ 11:00 am: After rounds, I go to the maternity ward and examine newborn babies. Sometimes there are none, and once there were 10 babies, all from the weekend.

~11:30: I join Dr Kokou for consults. These are "controlle" appointments for patients who were hospitalized and for chronic problems (anemia, HIV, sickle cell) as well as urgent care visits. The number of patients vary, there isn't a process in which the number of patients are controlled. We don't turn anyone away, especially since some patients come from very far away.

~1:30 lunch! I walk to "le refectoire," our dining hall. It is about a 5 minute walk from the hospital. It is a nice set up. There is a wonderful team of women who cook for us, and without fail, there is a salad (usually one type of vegetable, for example, shredded carrots), a meal with meat, and fruit or yogurt for desert. There is always tea or coffee available.

~2 pm back to Pediatrie for consults. These can last until 4 pm. After, I get lab results and copy them into the charts.

~4 pm I go home. Usually, I do some cleaning (of the house, laundry, etc). I then shower (hot water! very relaxing). Then I usually try to read (shocking). Right now I am reading a book about Pakistan. I hope this habit will continue when I return. Sometimes I go to the computer lab, where there is internet.

~ 6:30 take a lazy walk to dinner

7:00 pm dinner. Again, same format.

9:30 pm: get into bed, read/ watch a dvd/ listen to music. I am getting more acclimated here. You will be proud to know that I now sleep without the lights on, and I can fall asleep to the sounds of nature here. I should take an audio recording, it is wild (hehe).

so there you have it!

Thoughts upon leaving

Honestly, I hadn’t gotten a chance to process what I was about to do. Up until the day before I left, I kept telling myself that I was, in fact, leaving the country. That I was going to be separating from my classmates and graduating a year later, including Faris and Diana, who have been in all my classes since junior year of college. That I was going to be working at a hospital in Pediatrics. In French.

The day I left the states, I was wondering what I was getting myself into. How could I be prepared to do this? What if I forgot all my French? What if I am not good at my job? Needless to say, I was nervous. Very very nervous.

Pre-departure

I heard about the Albert Schweitzer Lambarene Fellows Program my first year of medical school. I had studied abroad in Niger, West Africa, a year prior to coming to medical school, and fell in love with the culture. It also sparked my interest in international health, which I wanted to pursue in some way during medical school. One of my professors, Dr. Stanfield, was taking us to the wards one day, where we visited a French speaking patient. She told us later about her experience working at a hospital in Gabon during medical school, where she put her French skills to work. She gave me the name of the Albert Schweitzer Fellowship. I did some research on what the program was all about and stored it in the back of my head When third year of medical school came around, I applied, not certain of what would result. That was around September, and I was doing my psychiatry rotation at Boston Medical Center. In November, I started my Medicine rotation. I was invited to interview in December, and a week later, voila! Accepted. This was good news for me, because a month into medicine, I was feeling the “third year burnout”. I’m not sure if it’s really a thing that belongs in quotations, but if it isn’t a term that people use, I’m coining it, and using it.

A few weeks after I found out I was accepted, I was off for a week for winter break. Since I knew I was going to be gone for 3 months, I made an extra effort (not that it was necessary) to be lazy, not study, and not prepare. But it was well worth it! I spent the first weekend with my parents, Mubbin, Tamanna, and Afsana, Hana’s family skiing in New Hampshire. Then spent a couple of days in my hometown of Andover, caught up with friends, and then I was off to Texas, which was a cultural experience in itself! I was there for my friends’ Sarah and Alex’s wedding, and was able to have a mini college reunion. It was beautiful, and a much needed break.

So then came January, which was consumed by finishing my medicine rotation, studying for my shelf exam, and working things out with the administration. And then? One week off, spent preparing for this adventure, and then I was off!

The Albert Schweitzer Fellowship

"The mission of The Albert Schweitzer Fellowship is to develop "leaders in service": individuals who are dedicated and skilled in addressing the health needs of underserved communities, and whose example influences and inspires others.

The Fellowship achieves this through an interdisciplinary, service-learning model that fosters moral and professional development. This model combines:

• mentored, entrepreneurial, community-based service projects
• a curriculum that emphasizes values and leadership
• structured opportunities for individual and group reflection
• lifelong fellowship with service-oriented colleagues"

-The Albert Schweitzer Fellowship