Daeyang Luke, days 4 and 5

The last couple of days at Daeyang Luke we were beginning to feel like we understood the process.  Casualty (ED) is completely different in this hospital from US hospitals. However, I think the central hospital (Kamuzu Central - KCH) has more 'action' and more trauma. DLH is pretty quite, but with a lot of pediatric cases and medicine type cases. We have seen how they perform paracentesis here - they stick a large needle into the swollen, ascitic abdomen (no local anesthesia), attach some tubing, and drain it into a trash can. We saw one case that the clinical officer did, then he went off on another errand, not returning for a couple of hours - he drained over 5 liters off one guys belly (for the non-medical people out there - that is a LOT). The patient did fine (well, as fine as you can be with end stage liver disease). Most of the cases of liver cirrhosis have no known cause - they don't have the tools / tests or the time for look for the cause. In the US we always want to know 'why'. That does not seem to be an issue here. I have seen that in seizure patients, also - we (US doctors / students) want the 'why', here they just want to treat.  Considering their circumstances and lack of resources, just treating is an excellent option.... it is just hard for our US trained brains to get around it all.  There was also a displaced wrist fracture that came to Casualty. DLH has no ortho capibilites, so the usual process is a splint and send to KCH.  Jessica reduced the displacement and worked with the patient care technician to put on a more specialised splint. The patient was a nanny, and the employer did not want to pay for a post-reduction xray (something we do in the US).  However, as Jessica said - 'I felt the bones crunch and the wrist looked better, so I am sure it is as close as we will get it'.. an xray in the US at this point is to document what we did, not to really help with patient care. We sent the patient on her way, but her employer said they would not go to KCH that day, but go home and 'rest', spending another day waiting in line to be seen. There was also a 7 day old baby in maternity ward (where they keep neonates) who had a bloated abdomen and decreased passing of stool. The clinical officers did a nice investigation and found Hirschsprung's disease. It is apparently fairly common here (they see one / month in DLH). It is correctable by surgery. The parents refused surgery and took the child home. Pray for this little one! He will either die from complications / failure to thrive / aspiration, etc or his parents will bring him back for surgery.  We were not immediately involved in the case, but assessed the babe a couple of times, reviewed the history and the xrays.  Jessica also sat in on some of the VIAs done on Thursdays - a nurse is trained to examine the cervix with acetic acid swabbing to find abnormal cervical tissue. That tissue can then be 'frozen' off with liquid nitrogen. The nurse had told me she does about 20 VIAs a week, with about 8 being positive. When Jessica was there, the nurse said she had only recieved 2 cryo-tips (what is used to apply the nitrogen). When we return, we need to investigate and make sure this is not a common occurence, or they will never be able to treat all the positive VIAs!  Cervical cancer is the most common cancer in women in Malawi.

Thursday evening, Laci from the Pothawira project came into town. Laci and I went Friday to renew our visas - all went well, except the 'network was down' where you pay your visa fee.  We waiting about 30 minutes until someone decided they would need to proceed, using paper instead of 'the network'. Of course, after you pay, you go BACK to the immigration office for official stamps. A little tedious but not bad by Malawian standards.

Saturday we went to Steve Potani's village for a village clinic. I will try to blog and post photos on that adventure, but the internet, even for here, is horrifically slow right now!

Praise/thanksgiving/ prayers
Our continued safety in health and travel (both a praise, and a prayer request)
The relationships we are building at DLH and elsewhere
An uneventful visa renewal
Our patients, that we might reflect Christ and have the wisdom to treat them appropriately in such a resource limited environment.

For some reason, the internet is not allowing photos to post on this blog... please check my facebook for photos! Sorry!