Last Day

After over a full week of Pediatrics, with visits to Internal Medicine and ER ocassionally, I feel like I can spot AIDs wasting stage from a mile away...
It's sad that our time is already up here, but I know we'll all be ready to go home and continue learning...

Lauren and I went into the ER on Saturday night to see what it would be like at the end of the month on a weekend. While we only stayed a few hours, we saw a man that had been attacked my bush knives, along with several other violent attacks that I won't share. We left around 10:30, but we talked to the surgeon yesterday and he said he saw about 72 patients that night, most of them assaults with knives. Most everyone injured was also intoxicated. We simply helped to keep the paper work under control by monitoring some patients and taking some histories... and filling out lots of police reports...

Fires are burning throughout the country due to the drought and the big fire up in Pigg's Peak in the north. A few people have already died and many more have been left homeless. The king has already requested food aid for parts of the country.
We hiked up execution rock Sunday and the mountain next to us starting burning up on our descent. I'll be sure to post pictures once I'm home...

A child came into the ER today DOA. He'd been sick for five months and malnurished. The family didn't think to bring him in until it was way past too late. Perhaps there wasn't money for transport...
Children die here every day. While I was waiting to do rounds this morning I read through some of the "expired" folders on the children's ward. The majority of them are due to mirasmus and "Kwash" (various forms of severe malnutrition) along with opportunistic infections from some of the patients being HIV immunocompromised. It's so far past sad here there aren't words for it sometimes.
One of our favorite surgeons was sort of despairing on Saturday night, going off about how there is no hope for this country because of the HIV rate and drinking-related violence. I refuse to believe that.

I visited the ART clinic yesterday, which treats HIV infected patients and monitors their therapy. I sat in on a session in which an HIV infected mother was told that her child was HIV negative due to the preventative antiviral therapy. There were tears in all our eyes, I think, as we all smiled with relief...

We had a three day weekend in Swaziland due to a holiday, so we went up to South Africa and then over to Mozambique on Monday. It was definitely an adventure, and I'm not just talking about the safari. We did make it to a beach finally Sunday night and Monday morning, which was really nice and relaxing. We worked in the hospital again this morning though. How crazy is it that the patients in the wards had not been seen since Friday?? The doctors don't round on the weekends or on holidays, so things were rather crazy today.
The people are very unhappy with the medical systems here, and it seems there is some scandal in the newspaper everyday about one of the hospitals in Swaziland.
I worked mostly in pediatrics today and saw a lot of pneumonia, bacterial meningitis, gastrointestinal infections, and some tuberculosis. Sometimes it seems like one in four patients has oral thrush due to the HIV being so immunocompromsing.
I saw an HIV + toddler today that had his stitches left in 4 extra days because the family was too far away to bring him in over the weekend. The surgeons were very upset at the father of the child because the child is so at risk for infection, etc. The father told us he had been at his brother's funeral over the weekend. The mother had already passed away from secondary infections due to HIV...
My time is running low so I will post more at a later date.

OB ward

We arrived safely last Wednesday into Manzini. Since then life has been flying by. I've done a couple days doing Internal Medicine and a couple more days working the OB labor ward. Although I was prepared to see a lot of HIV and tuberculosis patients it is still a shocking sight.
On a positive note, I delivered my first baby last night in the OB. It was a little girl born around 8:15pm weighing about 3 kilos. Lauren and I have seen about 10 births so far and are planning on pulling an all nighter tonight to see even more. We're also planning on going through some of the log books tonight to calculate the HIV rate of the mothers here. I would say from what we've seen so far the numbers are largely underestimated, although some of the mothers are on HIV medicines to prevent transmission to the baby. We'll see how effective that is when I work in pediatrics next week.
We've seen some babies born here that weight between 1.5-2 kilos (3-4.5 lbs) due to all the malnutrition, premature deliveries, and HIV. They don't even have proper oxygen masks to supply the babies effectively. Heart monitors don't seem to exist here, nor do defribrillators. I haven't seen an ultrasound machine, although I've heard they have them, but the tests are often to expensive for patients to afford. Even 20 or 30 dollars is way too much for a test.
Well, we're going to dinner at a doctor's house tonight, so we better get to the grocery store to buy some food to bring.

For more information on Swaziland, go to: http://news.bbc.co.uk/1/hi/world/africa/country_profiles/1069035.stm

Swaziland

I leave for Swaziland on Monday. I will travel around 36 hours through Detroit, Frankfurt, and Johannesburg to finally arrive in Manzini, Swaziland. Once there, I will begin work in a hospital with several fellow medical students.