Weekend!

We were in pediatric rounds again today with Dr. Ramji. A lot of the patients from yesterday had either been discharged or moved to a different ward during the night, so there were only a few patients left this morning to see. But, as this is a teaching hospital, and Dr. Ramji is very thorough, the same amount of time that we spent on all of the patients yesterday was spent on these few remaining patients; we were with each for a very long time! The same child from yesterday who had cardiac arrest was still here today. She was eight months old, HIV positive with pneumonia, malnutrition (including a potassium deficiency which had caused her muscles to be non-reactant, as well as sepsis), persistent diarrhea and had gone into shock from cardiac arrest. Dr. Ramji had explained to us that when a child is revived from cardiac arrest, they most often develop brain damage that manifests itself around six months later. She was getting tests done to figure out what exactly was going on with all of her illnesses, and being monitored for possible brain damage. We stayed with this one for a very long time. She was so sick and so tiny. I felt terrible for her; I’m not sure how great her chances are looking. We saw a young girl who had an abscess on her eye lid (!!) that needed draining that came in with respiratory abnormalities for monitoring. Then we also saw a nine year old boy that came in needing a blood transfusion. He was HIV positive, stage three, with terrible oral and esophageal thrush and sores. He was so weak and definitely needed the transfusion, plus couldn’t eat because of the pain the thrush and sores were causing him. He was administered medication to help the sores go away, and while looking through his files, Dr. Ramji discovered a slight issue with his CD4 count and medication; ARV’s are supposed to help keep your CD4 count higher and ranged from your viral load. If this is not the case, or if these two counts are coming closer together, that indicates that the strain is becoming resistant and treatment is becoming ineffective. Usually a doctor that keeps good track of their HIV patients would have put this child on a different ARV medication regime or upped the current doses to get these numbers back to where they need to be. But, this apparently didn’t happen because this little boy’s numbers had been steadily merging for the past few months, which is horrible news. Dr. Ramji ordered that his CD4 count and viral load be retested and that he be put on an upped dosage of medication to help him progress rather than digress; his condition is already bad enough. He needed a blood transfusion every three weeks! There was another little girl we saw that was in with abdominal pain, which was assumed to be some type of worm, that we also discovered had a heart murmur. A small child was there for diarrhea and fever; nothing too serious, but the final baby was quite a severe case. He was born with fluid in his brain because his mother declined to have surgery during her pregnancy to correct the problem. So, he has a very large elongated and deformed head; all of the extra fluid is at the bottom of his head, by the nape of his neck. It was the strangest shape and largest head I have ever seen. He had a shunt put into his scull to help drain the fluid, but because the mother didn’t take care of the problem in the womb, his head will never be a normal shape even once the fluid is removed. He was in the hospital to be monitored and because the ‘wound’ where the shunt was put in the back of his head was oozing pus and swelling, which is not good. If the pus gets into the bloodstream it will poison him. That was the last child of rotation.

Miles and I left a little early; we were successful in securing a car rental, and an automatic at that (you have no idea how hard it was—everything is manual here), and needed to quickly book a flat in St. Lucia so that we could head up there for the weekend. We were going to wrap up the plans at the university’s computer lab before coming to clinic, but every single computer in the whole university was reserved for test taking until one pm (can you imagine that happening at any other university???) and we didn’t have that time. So, we left clinic early to walk up to the mall for the internet café. And, luckily enough, we were able to find the perfect villa for our stay! We were so happy to finally get our plans set and worked out for St. Lucia. We picked up our rental and made the three hour drive to the resort. The drive out there was amazing; the land was beautiful—we actually got to see some African trees and grasslands that were uninhabited for the most part, as well as random clusters of mud huts off of the sides of the freeway. It was pretty incredible. Driving was also an interesting experience. Firstly, everything is on the left hand side, driving and the driver’s seat. And then, everyone drives rule-lessly! The shoulder of the freeway was made into an additional lane that people were driving on! And it wasn’t even wide enough for it to be a full lane, so the cars were driving over the yellow line, causing all of the drivers in the real lane to drive over their lane, which was right next to opposite traffic; scary! And, when there weren’t any cars coming up the opposite lanes, drivers even drove in those lanes! It was quite a scary, interesting and fun experience.

When we finally arrived, it was around 7 pm. To our surprise, our villa was amazing! It was huge; we had our own car garage, a very large living room, dining room, and kitchen, plus two huge bedrooms each with their own en-suite bathrooms. We also had a barbeque, a patio with a cute little table set, and a nice swimming pool right off of the front patio. We were so excited! Everything had worked out very nicely, which we weren’t quite expecting. We got all of our things put into the house and decided to go explore and get some food. There was an amazing thatched roof craft hut run by villagers down the road with huge fruit stands that we were anxious to visit. And of course, it was incredible to say the least. We bought amazing fresh fruit and tons of neat little African crafts for ourselves and for gifts. Then we went for dinner at this seafood/steak restaurant that was outside under a thatched cabana type deck. It was very yummy; Miles got ribs and prawns, and we were both very surprised to see his prawns arrive ‘un-skinned’. The ‘face’ and claws and skin were still on the meat instead of already peeled for you. He had to take a picture because we had never seen anything like it. It was actually kind of scary, I’m glad they weren’t mine! We headed back to our villa to get some sleep! Tomorrow we were planning on going to the beach and visiting our pool (we both want a nice tan to come home with), going on a hippo/crocodile safari cruise, booking a half day safari for Sunday to see the Big 5, and then getting groceries to cook in our huge kitchen.