Today at Morning Handover we discovered that the triplets had been born in the night! At first we were frustrated, because they said they would call us so we could see the births, but when the midwife read the report of what happened, it became clear that labor was incredibly fast. She had the first of the triplets in the ward, so they didn’t even have time to get her into the birthing room. They are all healthy thus far, and of good weight. 2.4 kg, 2.3 kg, and 1.8 kg. That is 5.3 lbs, 5 lbs, and 4 lbs. The last one was the smaller one, and that one is being monitored and the mother has been instructed to feed that baby first, as much as it wants, then move on to the other two, so that we can hopefully get his weight up. All three are boys, and they don’t name children until they’re about a week old and they are either baptized or go through some sort of naming ceremony, depending on the parents beliefs. So right now we are calling them Conteh baby 1, 2, or 3. Conteh is the father’s last name. Here in Sierra Leone, women keep the surname of their father when they are married, but all the children get their father’s name, whether he’s around or not.
On Wednesday mornings all the CHOs and head nurses join Dr. ABD, Dr. Erdi, and Dr. Abel on Big Rounds, where they review cases that are special in some way. This morning two of the CHOs didn’t show up, and after waiting for Dr. ABD for a couple minutes, Dr. Erdi found out from a nurse that Dr. ABD went to Freetown with Marcel without telling her! She was pretty upset, since that means a lot more work for her.
So we quickly went through big rounds, and didn’t really see anything that incredibly interesting. Then Dr. Erdi did rounds in maternity ward while Hasinatu and Alpha, the two CHOs who bothered to show up for work today, did rounds in the other wards. Dr. Erdi told them to make sure to make lists of patients that she was supposed to review. While Dr. Erdi was doing rounds in the female ward, we basically just cooed at the triplets. They are so cute!!!
Again from 11h00 to 13h00 I worked on my project. I am almost halfway done, and it’s definitely clear that there are more cases of Hepatitis then HIV. Once I have all the lab data, I’m going to go through the patient records to find that patients who tested positive for either HIV or Hep B. Hopefully I finish it before I go, or it may not be very useful.
After working on my project, I went back to the hospital to follow Dr. Erdi some more. We reviewed the patients that needed reviewing, and had to perform and D and C, which is a cleaning of the uterus to remove tissues that shouldn’t be there, whether they are a partially aborted pregnancy or a mola pregnancy. I got to scrub in on that one! It was pretty cool, and Dr. Erdi really let me help, so that was cool.
We were called down to the Maternity ward to check on an infant with an odd mass on his head, which Dr. Erdi thought was a hematoma, which is when blood collects in a tissue due to clotting. When she attempted to drain it, it turned out to be filled with puss, which class for a small incision to be made and the pus drained. Once that was done, Dr. Erdi let us feel the skull. Since baby’s heads grow so quickly and have so much growing to do, the skull bones are not fused and are fairly pliable, and they started to grow in such a way as to make room for the sac of pus. Where the pus had been the skull was slightly indented. Dr. Erdi said that very soon the skull would begin to grow normally, and go back to its normal shape.
After that, we went down to the TFC to check on a couple children there that needed review. One child’s hands and one foot were so swollen that she couldn’t lift her hands they were so heavy. Dr. Erdi thought perhaps there was an infection and that the swelling was caused by pus, so she used a needle to drain a small amount from one of the hands to confirm, then we took the child to the OR to make incisions and drain both hands and the foot. The mother was so scared, but when we told her that her baby would get some medicine to make her sleep through it and she wouldn’t feel it, she seemed so relieved. Dr. Erdi also told the mother that the child would sleep much better that night after the draining, and the mother had this look on her face like, “Thank goodness! Maybe I’ll be able to get some sleep, too!”
After that quick procedure, Dr. Erdi decided to go ahead and set the fracture in a young boy who came in with a fractured wrist, back, and hips. Luckily the fracture in his spine is an impression fracture, which is very stable, it just hurts. It also doesn’t normally cause nerve damage. He was hurt falling out of a mango tree, of course. Dr. Erdi had been hoping to get an X-ray of the wrist, but since it’d been all day and the boy was in pain she did it blind, which is not what she wanted to do but she was confident that she’d done a good job.
After a quick look at a child that came in on referral from another hospital, who turned out to have osteomyelitis (bone rot) in her femur and humerus, we went to review patients in the male and children’s wards. It was then that Dr. ABD showed up and kept talking about how tired he was. Dr. Erdi hinted that he had been sitting in a car all day, and that she was hoping to have an hour off to eat lunch and work on her lesson for that night at the same time. He either didn’t take the hint, or missed it. He did join us on our reviews though, and while we were in the children’s ward Marcel came by and was asking why this and that wasn’t done, and Dr. Erdi was like, “I’ve been the only one here today. I’m not ten people.” Then Marcel asked her if she could get around a list of medicine that the hospital needs. She asked him when he wanted her to do that, and he was like, “Oh, tonight will be fine.” And she actually laughed, and told him that when she finished working in an hour, around 17h00, she had been planning on working on her lesson for class that night, then eating, and then had to teach the class, and that she had hoped to sleep tonight. The loner I’m here, the more it’s clear that Dr. Erdi does EVERYTHING around here. Whenever someone doesn’t want to do something, they just leave it for Dr. Erdi. When she was trying to ask Marcel how she was supposed to get around a list of medicine they need when all the pharmacist where gone for the day, and she’s not ever in the pharmacy so she doesn’t know what they need, he just walked away.
I could tell that Dr. Erdi was getting frustrated, and when that happens it’s best for everyone except one to just get out of her way, and the one who stays is basically in charge of running interference. So Callum stayed with her, and when he got back told us that he’d gone with her to the lab to ask when a Lassa fever test that was ordered two days ago hadn’t been done. He lab technician made excuses about being understaffed because one of the lab workers went home sick. Dr. Erdi asked when they hadn’t cleared that with her, because she is the one who okays those kinds of things when Dr. ABD’s not around, and he just shrugged. When she asked what he had been doing all day, he said that he’d been doing X-rays. She got really upset, because she’d been told all day that they didn’t have any film. He just said, “No, we’re just out of the big film.” Then she really got upset. She told him that she’d set a wrist fracture blind because he’d told her that he couldn’t get her an X-ray of it. As she was trying to explain why it’s a problem that she’s practicing medicine without a lab or X-ray department, despite having both, he just sighed a lot and looked at the clock like “when are you going to be done woman?” When she was done, she was near tears, so Callum left before she got too upset. Erdi is the kind of person who would not like to cry in front of anyone.
After dinner, we all went to the class, and Dr. ABD and the CHOs who weren’t at work today weren’t there. We still had a nice time, and I felt like I learned a lot. It was great! Afterward we just hung out and talked about movies and such, and stayed up because a woman was scheduled to give birth around 23h30 or so. We went over at about 22h30 to be safe, but when we got there she’d already given birth! We were so frustrated, especially since she dilated four centimeters in about 45 minutes, which is insane. We made sure they know where our number is, so next time they will definitely call us. After we got back, I was exhausted so I went straight to bed.
This post is dedicated to the woman in female ward who died during the night.
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