17.01.2011 -How do you not feed a baby-

Today was, a day. Little bits of emotion are seeping in. My homestay mother left today because her brother died. Last night I was telling my homestay father that I was sad because a little boy died today and he said 'Ce La Vie' This is life. Whew, that's true, but man, it's rough here sometimes.
Doug let his fish loose in the well. hoping they will spawn and eat mosquito larva.
I started my day with a nice run. I didn't feel like getting out of bed... or off my cot. But once I get going I know I'll be glad I managed a cool morning sunset run through the sand paths. I visited a few of my favorite patients this morning. The kid we did the spinal tap on was still alive, although he had 5 seizures in the night. His test was positive for malaria, negative for meningitis. We are just hoping he doesn't suffer permanent brain damage. The boy who hadn't peed in 9 days but was only 12 days old was going to have his circumcision which was against the norm here, normally they are 7 years old or so. I saw the two burn patients and the boy with the healing abdomen. I rounded with Doug in Pediatrics Block and was taken by the malnurished children. I had the same words replaying in my head. HOW SIMPLE, just a little food. This one women was feeding her boy plain rice. he was so small. Maybe a year old. Benzeki was there and scolded her for not feeding him better, her husband had left them and she didn't have money. She came in hoping to get the boy some medicine and leave, but someone said he was too sick and was admitted. he had discolored skin and was SO skinny. SO SIMPLE!!!! Another malnurished boy was having contractions in his hands and his eyes were non responsive. Vitimin B defiancy. Another was 14 days old I asked he he was taking her breast milk, they said no. I asked for how long and it had been 4 days, FOUR DAYS, this baby wasn't eating!!!!!!!!!!!! I asked how long until breast milk will stop being produced and Doug said 4-7 days. Benzeki scolded her and told her right now to but the baby to her breast to see if he would eat. I left to give her some privacy, not sure why since women walk around with one boob out of their dress so the baby can feed. Although showing their knees is practically the same thing as being naked! ha!
I did rounds with Benzeki at the TB and HIV clinic, which was outside the hospital property. One women had Berkets and her neck was so swollen! Benzeki is so interested in these diseases. Compassionate, giving, kind, patient. Him and his wife Unice are amazing. He wants to study epidemiology in Washington and get his PHD hopefully, but would settle for his masters if that's was was available. Unic wants to study Psychology. They can't search the internet to see if scholarships are available because there isn't any internet here. He can't buy a modem because he doesn't make enough, it'd be half his monthly salary to buy one (he makes $200 a month). He can't take time off because the hospital won't let him.
I stop in to see the little boy who is burned so badly. (Still can't figure out his name.) He is having his wounds cleaned and is screaming and crying. I ask the nurse doing it in my broken french if he had Kedamene, he says no. I run to find Samadee at triage (the ER) he comes with me and stops the nurse saying the boy should have Kedemene, I follow him to the OR, he gives me the vial and a suringe, I go back and administer my 2nd shot. Unice was there at this time and comforted the boy as he started to cry when he saw the needle. He's so sweet, his two front teeth are missing and he has chubby cheeks and big brown doe eyes. The boy goes into lala land and Dulbay, the nurse can finish, I explain to Unice that the boy is in a happy place and she can relax.
James takes out some rods from some previous surgeries and I poke around and take a small break. There is AMAZING peanut butter here! Peanuts are good and you can pay someone to crush them, it's cheap and amazing.
I see a man with a huge swollen face, aparently it's nephrotic syndrome (again) I see a boy and a women with acites. A man that is painfully responsive from a motorcycle accident. Two men with prostate issues. One had been to 3 hospitals already, Cameroon, Chad, now he is here and can get the problem taken care of and not just an IV with fluids, Vit. B, and Quanide, like the other probably did. One man hasn't peed in a while and his bladder is HUGE. Finally a women with a fistula. She need surgery, even though James hasn't look at it, I open the OR and James tells me to to get her prepped for surgery with an IV and catheter. Before I can think twice he's gone. Sweet, haven't done either, but somehow it'll work out. She wobbles over to the OR with family members. She smells awful. I found some supplies that I think will work while rummanging around the OR. Finally Simione arrives and helps me start my first IV. We get her undressed to start the catheter, she spreads her legs and well, it's a horrible infection. James comes to look and he discovers her bladder is demolished, he could put his fingers through
there is nothing to do except start her on antibiotics and perhaps in one or two month there can be a repair surgery. For now, she just urinates everywhere because there is nothing to hold it in place.
We get her into a room and I leave feeling sad and emotional. This place isn't close to clean. Will her husband leave her? Her baby died during child birth, now this. I just keep saying the same mantra. At least she's here, at least she found the hospital and has the best care around. At least she found us.