1st Call

Last weekend was my first call here at Kapsowar Mission Hospital. Honestly, I didn’t know what to expect. I knew it would be busy mostly because I’m slow! The call schedule is set up here to be on call from Friday at 5pm until Monday morning at 8 or so. On Saturday and Sunday  the person on call rounds on all the medical patients.  I am thankfully only covering the medical patients as surgery has their own call system. Friday evening I was called to evaluate a 4 year old who had accidentally ingested organophosphates. Thankfully he threw up immediately and was only have lots of saliva. Then the unthinkable happened…no one called me through the night!!! I am so thankful for the answered prayers. I was called at 5:45am to come evaluate a patient who was not doing well. It was a patient that had been admitted the day before and I was surprised this was the 1^st call I had about him. He is a 70 year old with blood pressure of 70/40 with low oxygen saturation on 6 liters of oxygen. His WBC was 2.0 and HIV test was negative. CXR showed diffuse hazy infiltrates bilat. bases.  I gave him some fluids added flagyl to his ceftriaxone  and prayed for him. He had been moved to the recovery area of the OR due to the hospital being out of oxygen and there is a concentrator there. At this point it was close to 7am so I just started rounding. I went to the peds ward where there were 12 patients to round on there. I was unfamiliar with them all so I felt it took FOREVER to get though there.  The patients ranged from a 2 week old with neonatal sepsis to an 8 year old with an asthma attack. Most the peds patients are under 2 years old and the most common diagnosis here seems to be pneumonia.  Thankfully we don’t have malaria up here but the patients that come from the valley often have malaria and are really sick. So I read up on the patients, changed lots of kids from ceftriaxone to PO Augmentin, checked some post transfusion hemaglobins on malaria patients and probably didn’t finish there until 11 or so. The documentation is less here but not as little as I had expected. It’s probably 2/3rds as much documentation as I would do back home.  So writing notes and discharging patients still takes me quite a bit of time.

I went from there to the male ward where we only had 1 other patient other than the one I was called about that morning. It is a 84 year old guy with diffuse muscle rigidity, pneumonia, and some of what I’ll call private part problems.  He was making slow progress but progress nonetheless.  I wrapped up there and headed to the female ward. Only 6 or 8 patients there I was familiar with (not to be mistaken with me saying I knew what was going on with them… It seems I rarely am positive of a diagnosis here!) ranging from a 70 year old lady with a major stroke who we are treating conservatively as she can’t speak, swallow or move the right side of her body to a 25 year old lady with elevated creatinine, low sodium (116) and malaria. One particularly sad case is a 57 year old lady with advanced cervical cancer with uncontrollable pain who was admitted for IM/IV medicines (pethadine is all we have to offer, which is Demerol). No morphine here, I think it is being used up in the US! I did read that the US uses 90% of the world’s pain medicines. I digress. So I rounded there and saw a few surgical patients we were managing blood pressures and so forth. It was about 1pm by this time. I wanted to go home and eat but you never know what is coming next so I really wanted to finish my rounds. I only had 1 postpartum to round on. We don’t round on patients with uncomplicated vaginal deliveries nor on healthy newborns. The postpartum was a C-section patient that was 16 years old with her 1^st baby. Evidently this is becoming more and more common (teenage single girl pregnancy). She was doing well. Then I went to the neonatal  nursery which is probably where I feel the least knowledgeable. Everywhere else I feel like I am a 2.3 out of 10 in knowledge but here I feel about 0.5 out of 10! Six sick babies. 2 with birth asphyxia having seizures on and off and 4 premature babies. The smallest of which is 1.01 kg (2.2lbs). There is one baby there that has been there for 40 days that dropped as low as 0.7kg (1.5lbs) but is now up to 1.7kg and about to go from NG tube feeding to breast feeding. She’s truly a little miracle baby. So I held feeds on some babies who weren’t tolerating them well and increased feeds on most the others. 

It was 3pm by this time so I went home for “lunch”. Around 4pm I was called to evaluate a 9 month old in the outpatient dept who had a loud systolic murmur. On my way peds called and said they had an emergency. When I arrived there was a 10 hour old baby that was born on the way to a health center and referred to us due to the baby having a heartbeat of 60 and not breathing on his own. He had blood coming from his nose when I arrived and was gray. We bagged, gave epi, did compressions but the baby didn’t make it. It was the parent’s 2^nd baby and the 1^st had died a few hours after childbirth again. I tried to comfort the parents and prayed with them but culturally it’s hard to know what to say other than give them truth from God’s word but in reality everything else isn’t much use anyway.

By this time a 2 year old from the valley had arrived lethargic and the cbc returned showing the hemoglobin at 3.2. We also didn’t have an IV line and I was asked to place one. That is another big adjustment for me here. If the nurses can’t start an IV line they call us. My IV starting experience consists of putting one in another medical students arm 6 years ago… well I’ve had a bit more than that but not much. So after 3 attempts we called the CRNA on call and I realized I should have done that prior to my 3 sticks on the child! Once he was “stable” I checked on some of the babies again and headed home around 8pm. Not bad for a days work huh! Then there was Sunday!

So once again I didn’t have any calls through the night which is completely unheard of but I am SO grateful for it. It made the rounding on 34 patients on Sunday not seem as bad since I had a good nights rest prior to it. I was called again for the same patient from Saturday morning at 6:45am Sunday morning and told they were trying to resuscitate my patient.  When I arrived he had no pulse, no breathing. We don’t have any operating ventilators so intubating except for surgery (or a newborn who can be bagged for a short while) is the epitome of futile.  We gave 2 doses of epinephrine and one dose atropine but after 40 min we stopped.  

I was called at this point for a patient in labor whose baby heartbeat was 70 on Doppler so we called an emergent c-section. I was assisted with a Kenyan doctor but thankfully all went well and the mom and baby did great, thank the Lord.  Then rounding began again. I honestly felt like I had just finished  rounding from the day before! I tried to methodically move my way though the wards giving attention and detail to every patient but after awhile the 8 peds patients with either reactive airways or pneumonia began running together. I finished around 4pm and went for “lunch” which was actually breakfast and lunch but was called in for a “quick” admission to the peds ward. I ended up being there till about 7:30pm due to this child with hypoxia and shock. He pulled though thankfully. So I headed home after 12 hours of solid work and was smiled upon by God with a 3^rd night of good rest and only minimal interruptions from a few phone calls about patients that I could answer without having to go in.

I agree with Dr. Rhodes who said he was asked what it feels like to be helping so many people in the name of Jesus in an area of the world where many would die if this hospital and staff where not here. After this weekend I agree with his answer. He said “it feels like a lot of very hard work”. I am fulfilled knowing I am exactly where God has led me but when it’s 3:30am, I haven’t had an hour of sleep since my previous 2 nights with a combined 9 hours of interrupted sleep, I’m getting a call that a woman has had a miscarriage and is hemorrhaging and needs a D and C procedure (this was Thanksgiving night while I was on call again)… it does feel like a lot of hard work. But I am thankful. Thankful for my training, thankful for the group of doctors and nurses here in Kapsowar Kenya, thankful for a hospital that is ministering in Jesus’ name, and thankful that God has and is equipping my family to be here during this time.

Thanks for reading! And most of all thanks for praying!