We're home!

Just wanted everyone to know that we made it back to Danville safe and sound. Thanks for all of your prayers and well wishes while we were in Africa. It was an amazing trip, much of it very hard to put into words. Thanks for reading our blog.

And that's a wrap!

Today was our last day at the hospital. The interns brought in cake for morning report. I asked for a group picture and they begrudgingly obliged (the guys wanted to keep eating cake.) Here is the group.

Its so hard to believe that we have been here for a month. Part of me feels like its been years, but another part feels like we just got off the plane. Its been an amazing month and I'm so glad that we got to come down. I am still saddened by the many devistating cases we saw. I know that will stick with us for a lifetime.

We are all packed and ready to fly home tomorrow. Our plane leaves Namibia at 410pm and arrives at JFK at 740am Sunday. Oh, just in case you were wondering, all of those kids DID turn our to have measels. So, you might want to steer clear of Stacey and I if we develop cough, coryza or conjunctivitis (and NO, you aren't allowed to check me for Koplik spots.)

See you all soon!

Coming to an End

Anna and I can't believe that we only have one more day left in the hospital. Our month has gone by so quickly! It seem like only yesterday that we stepped off the plane in Namibia. It is difficult to put into words the impact this trip has had on us. I can definitely say that our experiences have changed who we are as people as well as pediatricians. I will go back to the United States with a much greater appreciation for the resources that we have available not only in medicine but also in every day life.
This month has significantly enhanced our training in pediatrics. Here, we have to rely more on clincial skills and not simply lab values or imaging studies as these are not available when the diagnosis and treatment plan is formulated. We have been able to see diseases here such as TB, HIV/AIDS and even measles which are illnesses that we do not see often in the United States.
As we have described in this blog, we have experienced firsthand the devastation of HIV/AIDS. It has been very difficult to see the suffering of these children who are simply innocent victims. This has had one of the greatest impacts on me personally. I could not get used to the idea of so many innocent children dying from this disease.
As I reflect on this month, I believe that the memories that we made here will be ones that will last a lifetime and have a lasting impact on our practice as pediatricians.

Complacency

It doesn't matter how long I am in Africa, I just can't get used to the blase attitude toward death. Last week, we had a 9 year old girl admitted with epistaxis. She was found to have pancytopenia. No blasts were seen on the peripheral smear and she had a normal LDH. She was put on high dose steroids, but her counts never improved. I kept pressing for a bone marrow. I thought the girl either had ALL or aplastic anemia (the latter being more likely due to the normal LDH.) The last time I saw her, she looked sick but wasn't acutely ill. This morning, I asked Gigi (one of the interns) if they ever got a bone marrow on the girl. She said "Oh, she died." She said it with absolutly no emotion. I tried to ask questions about the death, but she kept saying "She just died." I could tell she was getting frustrated with my questioning, so I stopped. Later I found out that they think she died from sepsis. She was put on some big gun antibiotics (pip-tazo and amikacin) but it was too late. I found this whole thing frustrating. Had this girl been in the US, she would have had a bone marrow within 24 hours of admission followed by prompt treatment of the underlying cause of the pancytopenia. Plus she would have been covered with antibiotics from the beginning. But, she wasn't born in Pennsylvania with all of our state-of-the-art medical care. She was born and died in Africa.

Say what?

Several different languages are spoken in Namibia. English is the official language, but most people are at least trilingual. Africaans, German, and at least 10 tribal languages (some with clicks!) are spoken here. However, Stacey and I have learned that sometimes English is the most difficult to understand or at least to get used to. Here are some examples:

"Pleasure" means "you're welcome"
"Coke light" is diet coke (but it tastes more like Tab, which they have here too.)
"Braai" (Br with a long i) means barbeque. It is a noun and a verb.
"Is it?" means "really?"
Most Cs are pronounced as Ks. So hydrocephalus is pronounced "hydrokefalus"
"Sorry" means "excuse me" or "pardon"
"backi" is a pickup truck
Instead of CBC with diff, they order a "FBC."
Instead of a BMP, its a "UNE."
Panado or paracetamol is Tylenol.
Parents don't know what poop or stool means. They say "Kaka"
"Running stomach" means diarrhea.
"Now" means sometime in the next day or so. "Just now" means sometime soon. "Now now" means immediately.
"Tomato sauce" is ketchup.

On a sad note...

When people think of Africa, they often associate it with HIV/AIDS. Throughout our trip, we have seen the devastating effects of this illness on the children in Namibia. Today, I was able to see the effects right before my eyes. We had started rounding on patients in the high care unit on 8B when one of the nurses called the team over to the isolation unit. The intern was the first to arrive and I was following her. When I arrived to the room of this young infant who was HIV + and was admitted for respiratory distress, the intern was giving chest compressions. We were told that the baby had stopped breathing. The bag mask was not in the room so the nurse went to get it. When the bag-mask arrived, the intern tried to give breaths however we noticed that the baby had vomited and likely aspirated. More vomit came out of the mouth during the attempted positive pressure ventaliation. I informed the medical officer of the situation who advised that we were not going to proceed with any resusciation as this baby has HIV with a poor prognosis. At that point, it was unlikely that anything we could have done would have saved him. The medical officer examined him and pronounced him dead. In this hospital, if a patient has HIV they are not intubated. Although this death was not surprising as I have seen this baby over the last couple of days and watched him in such distress, it is still very different how death is approached here compared to in the United States. At Geisinger, we would have called a code immediately and a flurry of people would have arrived to start the code process. This approach is very different from what I am used to and somewhat difficult to understand due to the way we practice medicine in the US. As Anna and I have stated in previous blogs, death is something that occurs frequently here therefore people become almost indifferent to it; however, the bond between a mother and a child can be seen in any culture as I watched the mother crying and grieving over the death of her young son.

This is Africa

Ever since we stepped off the plane, and everytime something seems different or out of sorts, Dr. Brown says "TIA, this is Africa!" In clinic today, I had my very own TIA moment. A woman brought a baby in, sat down at my desk, and handed me the baby's medical passport. I looked at the birth date (July 09) and said "So, she is 2 months old." The woman replied "No, she is 4 months old." I must have looked confused because she pointed to the birth date and said "that's the day she was found in the river." I was quite surprised and I'm sure it showed on my face. The woman went on to explain that she worked at an orphanage and the baby was brought there by social services after someone found her in the river. (It is currently the dry season in Namibia, so she really meant the river bed. The rivers haven't run since March.) Baby dumping is a big problem in Africa. Women can't support their babies, so they just drop them off anywhere. Many babies are found in the bush. This little one was lucky people found her before the animals did. What really shocked me about this situation was the nonchalance when the woman told me about the baby. She said "She was found in the river" with about as much expression as I would say "We ate peanut butter sandwiches for lunch." It just goes to show that baby dumping is so common down here that its just accepted as the norm. TIA. This is Africa.