Return to Work

First day back to work! We are at King Edward’s Hospital and attached University of KwaZulu-Natal for the next two weeks. This week we are spending our time in the pediatric unit. We met a very nice doctor named Dr. Ramji, who brought us to the Infectious Disease clinic for the day. We will rejoin with him for the following days of the week. In the Infectious Disease clinic, we met an almost doctor; he finishes his fellowship in August, and then is done! He was great, but I didn’t catch his name. He was from the Democratic Republic of the Congo, and had a very heavy accent. We were only told his name once, and that one time I wasn’t able to understand. We met another fabulous doctor named Dr. Ramjee (must be very common here!) who allowed us to shadow her for the day. The consulting rooms of Dr. Ramjee and the Congo doctor were right across the hallway from each other, so we periodically switched rooms to see what was going on with each of them. We spent the first part of the morning with the “Congo Doctor”. He was just doing pretty routine and quick checkups. We saw quite a few HIV infected children who just had routine checkups (checking lymph nodes, mouth, heart rate and lungs, etc) and were there to pick up more medication to continue their ‘cocktail’ treatment. We saw a little girl who was on TB treatment and was there to see a gynecologist; she was six years old and had been sexually abused, with vaginal and anal mutilation and a strange discharge. I felt horrible for her. She was the most beautiful little girl too, and quite shy and reserved, I’m assuming partly stemming from the abuse. She is way too young for such a thing to happen; that breaks my heart. We sent some patients to get their blood drawn for new CD4 counts, and prescribed multivitamins and other medications to the children on HIV treatment. We switched rooms to work with Dr. Ramjee. We were immediately asked to help her draw the blood of a very young girl; two years old at the most. She was already crying and scared, as if she knew exactly what was coming because she had had it done so many times; poor little thing! The needle was in her wrist, and I can’t imagine that feeling too good to a small one. Blood drawing is a completely different thing over here! When I was getting my phlebotomy certification done, we practiced using vacutainers; the little tubes that hold blood that are placed onto the end of the needle tube for quick and clean transferring directly from the body. They had vacutainers here, but not the tube that is connected to the needle for transferring blood from the stream directly into the tube. Instead, the doctor held the needle with an end opening, and had Miles take the lid off of the vacutainer so that it’s just an open glass tube, and she let the blood drip from the back of the needle into the glass tube! Because there was no certainty in this other than the steadiness of her hand, some blood dripped onto her glove, the floor, and down the outside of the tube! She needed to fill three large tubes, so each time that she filled one up and needed the next, blood just dripped onto the floor until she got the next tube from Miles’ hand into the right position under the needle. I was absolutely dumbfounded. Some blood from the large tubes needed to be transferred to smaller tubes, and this was done without certainty as well! The lids of the smaller tubes were taken off, and blood from the large tubes was poured into the small ones. Blood got onto the exam table sheet, and instead of tearing it off and replacing it, she simply sanitized the area and left it there. This child was getting her CD4 count rechecked, meaning she was HIV positive. I cannot believe the insanitation of the hospitals here! It blows my mind, and all I can do is stand back and gasp at what is considered normal and okay in the hospitals. The last patient of the day was the cutest little boy, who was extremely sick. He was three or four years old, so very young, and had stage III HIV with a CD4 count of 344. He had chronic lung problems; at an early age he developed bronchitis that was left untreated, causing major breathing problems. He has a permanent wet cough, trouble breathing, clubbed fingertips, and discoloring and spotting on his head, back and chest. To top it all off, he was being treated to TB. Dr. Ramjee said that just with his chronic lung condition alone, he is only expected to live another 8-10 years, not to mention his TB infection and progressed HIV condition. How sad is that? And apparently each time he is brought in for his appointments, he is brought by a different person, who knows nothing about his health status. Because of his seemingly unstable home conditions, Dr. Ramjee was also expecting him to eventually default, or miss taking some of his medication, and this is extremely bad, especially in such an advanced stage of HIV. Your body practically becomes immune to the drug regime and it no longer has any affects for treatment. A patient then has to go on both more medication and higher doses, or a different drug regime to try and fight the strain, but once this pattern of defaulting occurs a few times, the patient is pretty much doomed and eventually all treatment is ineffective. It was kind of an awful way to end the day, seeing this cute little boy and knowing that he isn’t going to live for very much longer. That’s a daily occurrence here, something that I could never get used to. I am so grateful for the health that the majority of the United States is blessed with, and for the amazing health advancements, conditions, and treatment we have access to. I most certainly took all of it for advantage before I came here, but never will I do that again. I am absolutely blown away each day by the little things I see that you would never in the U.S. , and things that you wouldn’t even think twice about. For example, the exam table sheet I spoke about above. In the United States, you assume that a new sheet was laid out for you before you arrived and that nobody has used or soiled it; there should be no doubt in your mind that it is sanitary, and you often don’t even think about such a possibility of it not being. Here, every patient that comes in that day sits on that same exam table sheet. No matter if blood got on it, or if the patient has TB and coughed all over it (both happened today); each patient sits on the same dirty germ ridden sheet. And it probably even sits there for longer than a day. I would not be surprised to find this true. We take advantage of so many things in the United States, and I didn’t even realize how severely we do it until coming here.