Ward rounds
Today Reena and I made rounds in Migori District Hospital for the first time. We have been spending our time in the outpatient clinics up until now, as the hospital is staffed by clinicians from the Ministry of Health (MOH), not by the FACES* clinicians with whom we work. We joined one of the FACES doctors and the MOH clinical officer to round on the 10 or so patients on the male ward (nothing against the women: morning rounds on the female ward had already occurred; we plan to join rounds on that side on Wednesday).
Rounds were a sobering and intense experience-- the severity and complexity of the medical problems we encountered in most cases far exceeded the resources and subspecialty expertise available in this rural setting. One young boy with HIV/AIDS had suffered seizures and near-coma as a result of an unidentified infection in his brain. He was being treated empirically for cerebral malaria, cryptococcal meningitis and bacterial meningitis with little response, and he remains without meaningful communication or purposeful movement as his mother watches over him and hopes for a recovery that is unlikely to come.
We examined two young men who had both developed severe leg wounds after relatively minor injuries that should have healed under normal circumstances. Both men were found to have advanced AIDS, which was the cause behind their impaired wound healing. Without advanced wound care such as surgical debridement, an appliance called a “wound vac,” and skin grafting, it seemed their chances of keeping their legs and even their lives were not great.
Some cases provided a bit more room for hope. One young man had severe right upper quadrant abdominal pain concerning for cholecystitis (inflammation of the gallbladder) and needed an ultrasound and possibly surgical intervention. Ultrasound is available in the private hospital in Migori, but the patient would have to pay for it. Fortunately his family could afford the expense, and we are hopeful that the source of his pain will be known and potentially treated when we return to the hospital on Wednesday.
Reena and I struggled with feelings of hopelessness and helplessness, familiar to us from past experiences working in resource-poor settings, where the divide between what our patients need and what is available is so vast. We also found gratification in our ability to be of meaningful service to the patients and the other providers this time around. As third year residents, we were actually the most trained clinicians present in the hospital, and thus we helped to guide the clinical decision-making as we made our way around the ward. After eleven years of higher education, it is a relief to know that we have actually learned a thing or two along the way.
Tomorrow we go on a field visit to one of the smaller satellite clinics, which will make Migori District Hospital look resource-rich by comparison.
* FACES stands for Family AIDS Care and Education Services, and is the organization that we are working with through UCSF
- Meg
Rounds were a sobering and intense experience-- the severity and complexity of the medical problems we encountered in most cases far exceeded the resources and subspecialty expertise available in this rural setting. One young boy with HIV/AIDS had suffered seizures and near-coma as a result of an unidentified infection in his brain. He was being treated empirically for cerebral malaria, cryptococcal meningitis and bacterial meningitis with little response, and he remains without meaningful communication or purposeful movement as his mother watches over him and hopes for a recovery that is unlikely to come.
We examined two young men who had both developed severe leg wounds after relatively minor injuries that should have healed under normal circumstances. Both men were found to have advanced AIDS, which was the cause behind their impaired wound healing. Without advanced wound care such as surgical debridement, an appliance called a “wound vac,” and skin grafting, it seemed their chances of keeping their legs and even their lives were not great.
Some cases provided a bit more room for hope. One young man had severe right upper quadrant abdominal pain concerning for cholecystitis (inflammation of the gallbladder) and needed an ultrasound and possibly surgical intervention. Ultrasound is available in the private hospital in Migori, but the patient would have to pay for it. Fortunately his family could afford the expense, and we are hopeful that the source of his pain will be known and potentially treated when we return to the hospital on Wednesday.
Reena and I struggled with feelings of hopelessness and helplessness, familiar to us from past experiences working in resource-poor settings, where the divide between what our patients need and what is available is so vast. We also found gratification in our ability to be of meaningful service to the patients and the other providers this time around. As third year residents, we were actually the most trained clinicians present in the hospital, and thus we helped to guide the clinical decision-making as we made our way around the ward. After eleven years of higher education, it is a relief to know that we have actually learned a thing or two along the way.
Tomorrow we go on a field visit to one of the smaller satellite clinics, which will make Migori District Hospital look resource-rich by comparison.
* FACES stands for Family AIDS Care and Education Services, and is the organization that we are working with through UCSF
- Meg
posted by Meghul at 7:29 AM
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