Namibian Knapper

This morning we had rounds like the previous days. The picture is of a cute little guy with congenital heart disease in failure. They don't know what the lesion is because they are still waiting for an echocardiogram. That seems to be a recurring theme. Everytime we walk in the room, he holds his hand out.

After lunch, Stacey and I had our first afternoon at the OPD, basically Knapper Walk-ins Namibian style. In order to figure out how things were done, we hung out with one of the interns while he saw patients. I think we taught him more than we learned. Our first patient was a 2 month old with a cold. We prescribed nasal saline drops. The second patient was a very well hydrated 3 year old with diarrhea and vomiting. We gave him ORS, told his aunt not to feed him too much at a time, and sent him on his way. The third patient was scary. Had we been at the big G, we would have called a "peds 99." The nurse (we call them sisters here) rushed back and said "Doctors, we have a very sick baby you need to see. I already started and IV and drew blood!" It was a 4 month old severely emaciated female in respiratory distress (on the edge of failure.) The sisters told us that she was a "PWA" or person with AIDS. She came from an orphanage and weighed 3kg. It was really awful. She was so sick. All we could do was put oxygen on her, send her for an xray, and tell the caregivers to take her to the peds floor to be admitted. When she left the clinic, her breathing was slowing down and it started to sound agonal. I don't think she will be alive when we round tomorrow.

After we settled from that excitement, we saw a few more patients. One had major nasal congestion and respiratory distress secondary to tonsilar hypertrophy. We sent her to ENT. The last one of the day was a month old female with chief complaint of a cough. 2 days ago, she was put on amoxil for a URI. The coughing got worse. She was coughing so much that she would stop breathing and turn blue. The parents got very worried and her mother gave her a medicine from a friend (it was some kind of bronchodilator.) She still didn't improve, so they bought her to clinic. Stacey and I listened to the story (and to the baby coughing.) The intern turned to us and said "What do you think? An upper respiratory tract infection?" I said that we were more concerned about pertussis. The intern looked at us, slightly bewildered, and said "I think I'll need your assistance on this one!" We advised that he admit her, get an xray (she had crackles on the right), check a blood count, and start azithromycin. I'm not sure if they can check for pertussis here, but I suggested that he do that too.

Then our clinic day was over. I am constantly amazed and horrified at all we are seeing.