Tuesday

Today, we continued our daily routine of rounds in our respective wards in the morning and seeing patients in the clinic in the afternoon. On 8B which is the ward for patients older than two years of age, there are a lot of interesting cases that continue to be a work in progress. As we have commented before, many of the patients are waiting for imaging or for a subspeciality service to evaluate them which can sometimes take a long time. There is 2 year old boy who was admitted for evaluation of potential malignancy. He has had an extensive work-up including a lymph node biopsy and an abdominal/chest CT scan. We are still awaiting the biopsy results. His potential diagnosis is Histocytosis X based on the differential given by the radiologist who read the CT scan. He was supposed to have a bone marrow aspiration today however the correct supplies were not available at Katutura (the bone marrows are usually performed at Central Hospital) so the procedure was postponed until tomorrow. We also had a 3 year old female who was admitted with bilateral lower extremity weakness. All of the work-up including the LP was unremarkable therefore the potential diagnosis of Guillan-Barre Syndrome was made. The management here is simply supportive care. The weakness does seem to be improving and she will be discharged home soon.
Outpatient clinic continues to be an exciting place where we are getting to see a variety of illnesses that are not as common in the United States. Anna and I are getting the opportunity to see patients on our own and formulate a management plan. Each day, it gets a little easier trying to navigate through the medical passport that contains each child's medical information. I was very lucky today the the majority of my patients mothers spoke English which makes communication so much easier. Today, we saw a one year old female with varicella who was otherwise healthy. We also saw a patient with newly diagnosed Hepatitis B. We continue to see our share of many of the same diagnoses we see in the US including eczema, diarrhea and otitis media. The challenge here is trying to determine what medications are on the formulary and available to prescribe for treatment. Each day continues to be a tremendous learning experience.