Today we drove to the lake (Lake Malawi) to visit my friends, the Masekos. Peter is the pastor of the Baptist church and he is a clinical officer at the Salima district hospital. We took Leslie on a tour of the hospital. Peter is actually on 'holiday' but kindly agreed to show us around. Since it is dry season (hence little malaria and cholera) the hospital is not as crowded as usual. Peter is primarily over the pediatric and OB Gyn wards. He filled us in on some of the facts: the hospital serves about 500,000 people. They have clinical officers running the hospital. He said there is one doctor for the district, but they are not at the hospital. We walked through the hospital and saw the different wards. The picture is of a breezeway between the isolation / TB ward and the main hospital. Most of the people in the picture are TB patients. While we were walking through the pediatric area, we saw the bench (and floor) where the children and their Moms (or guardians) were waiting for treatment... one child with what looked like a broken elbow, another with second degree burns on her face and arm. We stepped into the very small 'treatment' room and came face to face with a possibly dying child. A 6 year old, essentially comatose, thin, and with white palms, soles and mucous membranes. Peter got the glucometer we left him last time and checked the blood sugar - it was 28! The nurse had drawn some blood and was starting an IV. The child likely has cerebral malaria, the biggest killer of under 5 year old kids in Malawi. The actual parasite, coupled with severe anemia, low blood sugar and dehydration kills them. It is Saturday. The lab is closed. The nurse had called for someone to come in and check his blood for malaria and to see if they can give him a blood transfusion. The power is out. The back up generator doesn't work. Peter gave him IV dextrose immediately and started him on IV fluids, dextrose and quinine. That is all we could do. It was distressing, as always, to see a child who is probably going to die. After that we stepped into the pediatric ICU - which I have nicknamed the pediatric intensive care closet - because I have a closet in my house bigger than this room. Two stretchers, each up against a wall, with enough room between then for a mother - or caretaker - to stand. I have seen this ICU with 8-10 kids - 4-5 to each stretcher, an oxygen 'splitter' to give them all oxygen from a concentrator, with infectious problems (TB, HIV, pneumonia, meningitis) all lying side by side.. today there were only 3 patients. Two looked pretty good. One was in obvious respiratory distress - I pulled out the mini pulse oximeter I am carrying and this child's oxygen level was only 81%, with all the symptoms of acute respiratory distress. Peter made sure he was on antibiotics, but it doesn't look good. At this point, I want to digress for a moment and say a special thank you to the folks who have donated funds, allowing me to buy and take some simple medical equipment with me. I will be leaving most of it, so you donors are impacting beyond our short stay!

On a brighter note, we did get to have lunch (traditional Malawian food) with the Masekos. Check out my next post for updates on the Maseko family!