Pop quiz, hot shot

Wish List

For my final days in Nicaragua I am running around trying to fulfill the wishes of the amazing people Ive worked with at the hospital. The head of nursing for pediatrics gave me a wishlist, which I was able to fulfill using money graciously donated by an anonymous donor and a member of one of the church brigades. So far I was asked for

1. An electric double burner to boil water (This purchase has answer my mother´s constant question "How do you have a hospital if there is no hot water?!")
2. Pots to boil said water
3. Standing fans to keep the patients cool
4. Pitchers of water to store boiled water

The residents will give me a list this afternoon. I am amazed at the simplicity of these requests and so happy to be able to provide these small conveniences. 

Heroes y Martires

Today at 9am (which really meant 10am) the entire hospital took a two hour break from work to celebrate the life of Dr. Oscar Danilo Rosales Arguello, for whom the hospital is named. El doctor was assasinated fighting for the Sandinista revolution again Somoza and today is the 45th anniversary of his death. There were lots of speeches about Dr. Rosales and some history about the war followed by about 30 minutes of songs supporting the current political party, the FSLN. While some of us go back to the wards, there is a large group of people going to visit his grave with snacks in hand. I didnt realize how many songs there could be supporting a political party. Are the Republicans singing songs today? I think they do it better in Nicaragua...

3 days until I´m home... hard to believe it.

Contact Precautions

 

I cannot believe that this is my last week in Leon. I spent the weekend relaxing at the beach and catching up on some reading and then it was back to work today.

Pictured above are two patients who have been on the Infectious Disease service for two weeks. They both have significant underlying diseases that leave them without good immune systems and are hospitalized for more acute issues.  Right next to each other. Yes. Because of a lack of space in the hospital all of the wards are open leaving airborne pathogens to fly freely around the room. Our kids with hepatitis are kept in another room together but there are no private rooms at all. While I dont think I will ever LIKE putting on yellow paper gowns before entering a patient's room, I am now truly humbled and grateful for their existence.

If I had a hundred dollars...

 

So a few posts ago I mentioned the small school that has opened in our hospital that was created to help children continue their education while hospitalized. Unfortunately, they are under funded and the teacher was easily able to give me a list of things that they could use.

 

Enter an anonymous friend and colleague of my mom's who generously donated $100 for me to buy art and school supplies for the children. Let me tell you... $100 goes a LONG way here.

 

How long?

1.  4 boxes of Legos
2. 3 story books
3. 20 boxes of crayons
4. 5 boxes of jumbo crayons
5. 12 coloring books
6. 10 word match games
7. 4 abicuses
8. 5 water color sets
9. 4 paint brush sets
10. 2 stencil kits with letters and shapes
11. 10 packages of modeling clay
12. 9 boxes of colored pencils
13. 3 reading/writing books for basic reading skills

 

 I am beyond grateful for this amazing contribution and cannot wait to get it to the hospital tomorrow!!!

If you give a kid an iPod...

He´s going to take some pictures. This is my amazingly wonderful patient who is admitted for IV antiviral medications to treat CMV - a viral infection that is common for most of us but hard for this guy because he has HIV. This infection has left him mostly deaf but we´ve been having a lot of fun anyway.

This week I`ve been teaching him to play solitaire and we´ve spent quite a lot of time on coloring books. Needless to say, the ID service has been a bit slow this week.

What has been amazing to me was how fast my patient picked up on the iPod after NEVER having seen one. It´s the total opposite of the toddlers we see in the US who are trying to swipe books to get them to act like iPads. It`s nice to see what kids are like without the technology distractions and I am giving him no more than 1 hour of `screen time`per day.

Today he has been making jewelry with his great aunt and I am the proud owner of some awesome earrings that I will never take off. 

Desfile

Not sure why but there was a huge parade outside of our door this morning. Nice way to wake up on a Sunday. We're off to breakfast down the street and then back to the beach for some serious relaxation

. 

Gracias

Weekend Travels and more

This is a bit delayed but my computer is still out of service. This means, however, I've been doing a lot more real things like reading books, writing postcards and traveling!

Last weekend we went to Matagalpa where a lot of the coffee plantations are. The trip was great and so was the weather... 75 degrees never felt so good. We went to the Selva Negra plantation on Saturday and took a great tour of the plantation and learned oh so much about the coffee industry. For those of you in Durham, Joe Van Gogh sells coffee from this plantation so you can buy some and think of me until I get home. We spent a lot of time at coffee shops throughout the weekend resting and getting over caffeinated while looking at the gorgeous mountain views.

The trip back was a little less pleasant and involved getting wrong bus times from our hostel, taking a bus that required a "transfer" (which means stand on the side of the highway and wait for another bus), and then a man vomiting on the floor of our refurbished school bus. Sigh. Despite all this we had a wonderful time and it was great to see another (cooler) part of the country.

This week has been pretty low key thanks to some major holidays. Tuesday was the Griteria Pequena, which celebrates the Virgin Mary for saving Leon from a volcano about 70 years ago. It's a lot like Halloween and everyone runs around asking "Que causa tanta alegria?" ("What causes such joy?") and then people give you candy. Lots and lots of fun. Today was another free day, which I happily spent at the beach.

Hoping to post more this week.

Coffee!!!!

We are off to the mountains where it is cooler and where they grow coffee. So very excited.

I leave you with the best picture of the kittens.

SCIN

This week I started working in the special care nursery. Most of the babies here are typical late preterm babies who need to feed, grow, and learn to breath a a normal rate. The patient pictured here has transient tachypnea (fast breathing) of the newborn. (Note the jar of thermometers that are the old school mercury kind and are sometimes washed between use)

Just like at Duke, this baby gets a fancy oxygen hood to help him out until he gets the hang of breathing. My attending is great and I´m learning a lot. 

These babies are not premature in any way but are getting extra cute!!!

Say a little prayer...

Sorry it´s taken awhile to post the story behind this picture... my computer had a run in with my friend´s cup of tea and i´m afraid to say the outcome has not been good. Also sorry for the errors in this post - I´m using a german keyboard that is not quite the same as ours.

Anyway... this is a picture of one of the many church service groups who come through the hospital from the US to give the children small gifts and the pray for them and their families. I´m still not sure how I feel about these groups. I´ve been able to watch them from afar because for whatever reason when i´m wearing my white coat people dont recognize me as a foreigner. Most of the people who come through do not speak Spanish and I can see all the wonder and some fear in their eyes - it reminds me a bit of the slum tourism I´ve heard about in other countries where people pay money to get the "third world experience." I am probably being too hard on them but I cannot help but feel protective of my patients when I feel as though they are being looked AT instead of looked after. 

Of note, the woman here in the blue shirt did give me quite a large monetary donation to help buy some supplies for the hospital. I will be asking out department chair to make a list for me and then we all can see just how far $100 will get you with medical supplies here.

From the personal side of this trip, we spent an amazing weekend in Granda and Masaya taking the time to enjoy to expat spa life and get some shopping done. Now I just have to figure out how to fit my hammock in the resident room...

One month old!!!

New results list

So when we order labs, there is generally a 3-4 hour delay in getting results. There also appears to be only one scheduled lab draw per day - I haven't totally figured this out yet. We stalk the new results just as well as any doctor anywhere. Getting them back can help decide management for our patients and, more importantly, whether or not they can go home. To get these results, however, requires walking down four flights of stairs to paw through this box of new results looking for your patient. Not ready yet? Walk back up and come back later. I will never complain about taking the stairs again.

Design

Shout out the the amazing Justine Haemmerli for helping me to spruce up the blog :)

You can find her @ http://makebigmoves.wordpress.com/

I will also take this opportunity to show pictures of the kittens who will be 1 month old tomorrow.

Trouble is coming...

Abandonado

Last night we admitted a patient with periorbital cellulitis - an infection of the skin and soft tissue around the eye.

Looks pretty uncomfortable but this two year old couldn't have cared less about not being able to open his left eye. Generally this infection is treatable with antibiotics but with the degree of swelling and the involvement of his right eye we thought it best to keep him in the hospital for IV antibiotics to make sure everything was being treated quickly and effectively. Hospitalizations are always hard on patients and their parents and this case was no exception. Around 10 am mom approached us at our work station and announced "Voy a abandonar" aka I'm leaving and taking my kid with me. 

While adult patients in the US are allowed to leave AMA (Against Medical Advice), it's relatively uncommon for us to have parents decide to take their children out of the hospital. This raises a number of issues given the fact that while the parents are the legal guardians and can make decisions for their child, children have a right to be protected from bad decision making on the part of their parents. In many cases all it takes is a good talk, involvement with social work and sometimes the patient resource manager before these issues get sorted out and we are all able to proceed with caring for the child in question. 

Here in Nicaragua, parents have the absolute right to remove their child from the hospital whenever they see fit. My co resident explained to me that this is actually very common. Almost every day when we are read the list of patients (who was admitted, who died, who was born), we are also told about how many "abandonados" there were. 

We explained to our patient's mother the serious nature of her son's infection and the possibility that it could affect his vision or spread to infect his brain. It's hard to have to explain these things in such blunt terms and it's even harder to do with a sobbing 17 year old mother. At the end of the day she decided to stay so he'll be getting good treatment and should get better soon :)