Wed 28th Dec 2011
We got a lot done today - ward rounds with ICU, paediatrics, orthopaedics and then surgery.
We started the day with an ICU ward round. As Michael has already described, the ICU is basically just like a normal ward but only has 4 beds. There is no oxygen, no ventilators, and no barrier nursing. Most of the cases we saw today were severe pneumonia and asthma. For pneumonia, treatment is just penicillin. They don't have the facilities to do blood cultures, throat swabs and cultures. Only a chest xray. And monitoring these patients is quite different to back home. For the pneumonia case, they don't even listen to the chest.
After such a busy ICU morning we went on ward rounds with the paediatrician who has been on a non-authorised holiday for the whole time we've been here. We saw a few interesting cases, including malaria in a 12 month old girl and idiopathic lymphadenopathy.
When the consultant goes on ward rounds, he has no patient list. He goes to every ward in the hospital and asks the nurses if there are any patients for him to see. Luckily there are only 10 wards.
Surgical ward rounds were next. There was a diabetic patient with a 2 year old non-healing ulcer on his ankle. After removing the dirty socks he used to cover the wound, I saw the biggest tropic ulcer eroding bone. This was quite shocking!
The wards are very basic. Around 15 beds, crammed into a small room. The windows, if not smashed, are always open. The room is filled with heaps of flies and mozzies. The floor is always wet and sometimes there are needles lying around. Some beds are broken and held up with chairs.
We saw another case of a oldish female with a pelvic mass and ascites. A diagnosis of ovarian cancer was given, but because they have no way to confirm the diagnosis with biopsies... they just treat it as cancer. Palliative care here is also under resourced and patients really only get pain relief. Chemotherapy isn't available in northern Tanzania... so all patients have to travel to Dar es Salaam which is 9 hours by bus to get treatment.
The last case we saw really annoyed me. A female of 37 years presented with severe abdominal pain. She was short of breath at rest, and looked very ill. Her last LMP was over 6 weeks ago and I asked if she could be pregnant. The doctor told me that because her last period was 6 weeks ago, she couldn't be pregnant. So a -2 on SCT? Devitt would cry if he saw the management of this case.
We had a really long and tedious day.
Justin
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