November 2013 Archives

Posted on behalf of Adam Foss, MedPeds 4th Year Resident

Bonjour from Port-Au-Prince, Haiti. We are settling into our routine and trying to learn quickly on our feet. It is a different pace than what we are used to, but we are adjusting well.

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Arriving in Haiti

Calla, Mahsa, and Hope have been spending their time at the adult hospital called St Luc (Luke), and I have been spending several days there as well. St Luc is a hospital built after the earthquake in 2010 in response to the immense influx of patients to St Damien's. The hospital houses an emergency area (Urgence), cholera treatment area, general medical ward, and an ICU. There is a radiology department that has the capability to do CT scans of the head and X-rays of any body part. In our short time here we have seen anything from strokes (ischemic and hemorrhagic), heart failure, HIV, advanced AIDs, Tuberculosis, PCP (a pneumonia seen in patients with late stage AIDS), diabetes and heart attacks. The hospital is a local safety net for the area and provides care for patients that would otherwise not receive any medical care.

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Adam Foss (MP4), Hope Pogemiller (MP4), & Calla Brown (MP3) at St Luc Hospital

Abby and I have been spending time at St Damien's, a pediatric hospital. We have been seeing a full range of pediatric patients from newborns with fevers, severe malnutrition, diarrhea, and pneumonia. The pediatric hospital has an emergency area (Urgence), PICU, NICU, oncology ward, and general pediatric ward areas. We have been spending time in Urgence working aside the local staff pediatricians and pediatric residents.

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Abby Montague (PL3) at Saint Damien Pediatric Hospital

Dr Trappey, our staff guide from the University of Minnesota, has been here several times and has been a great asset. He has been busy between both hospitals and helping us develop our ultrasound skills.

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Sunset at night near the hospital

Look for more to come!
Adam, Abby, Calla, Hope

Emily Hall's (PL3) Dreams Take Flight Again in Tanzania

Posted on behalf of Emily Hall (PL3)

If you had asked me 20 years ago what my life would look like if I were to become a doctor--flying into remote areas of Africa and providing medical care to those in need would have been on my short list of career ambitions. Decades later a dinner conversation and some networking led to the opportunity of a lifetime. 

I was invited by the Flying Medical Service (a NGO based in Arusha, Tanzania) to fill a last minute need to see patients in rural Tanzania. A pilot, a pilot in training, a local chief medical officer, and I traveled for two days landing in remote areas to see patients and provide medical care. Much of my role was to complete prenatal assessments and serve as a pharmacist of sorts--counting pills and dispensing medication. It wasn't pediatrics per say, but I was eager to be involved and willing to help in any capacity. Despite no formal plans to see pediatric patients there always seemed to be a sick child (or many) in each location inviting me to jump into a more familiar role.

We landed in various regions of the country and I felt literally "dropped" into the Maasai culture. The beauty of the villages and people mesmerized me. Their dress and way of life is so contrasting to anything I'd witnessed before. It was such a privilege to be immersed into the culture in this way. They believe pictures capture and take away their soul; so out of respect, I did not photograph any people during my visits. However, the images of the experience are imprinted in my memory. I apologize my writing ability cannot portray the pictures recollected in my mind--you'll just have to trust me: it was incredible.

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Aerial view of a Maasai village as we fly low alerting inhabitants that clinic will soon begin

Returning from this experience I couldn't contain my enthusiasm. Bush flying had proved to be all that my childhood dreams had imagined. It provided an element of danger, fulfilled the desire to do good work, and allowed me to be surrounded by like-minded people. A few weeks later I found myself discussing the opportunity with a midwife at the hospital over tea. She herself has lived quite an adventurous lifestyle, which is reflective in her career endeavors, and I was eager to hear her perspective of medical humanitarian aid. 

I left the conversation identifying with her ambitions and taking away a new understanding of why some people are drawn to global health. In a career field so formulaic -- blended with my personality that is anything but -- I crave to connect with people to have alternative medical perspectives. The global health community embodies this notion. People who have sought and created an alternative career path surround me here and being in Tanzania has allowed me to learn from many who have found their way in medicine despite not conforming to a linear trajectory. 

On reflection, I realized the rigors of medical school and residency had quickly quieted my childish idealism. The perceived ability to make a change in the world and the na├»ve enthusiasm that surrounds such big dreams was a feeling I had nearly forgotten. Returning to Africa has been oddly rejuvenating and in some ways has given me permission to again have lofty and alternative career goals. So again, I find myself making a list of career ambitions. This time, becoming a Bush Pilot/Physician in Africa probably won't make the shortlist but I'll credit the experience with making me a bit more prepared for whatever opportunity comes next. 

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Emily beside the Foreign Medical Service plane

Posted on behalf of Danielle Brueck (PL3)

The task of trying to capture in words all the sights and sounds of this place is daunting.  The days have started to carry much familiarity yet never quite enough to feel like home. Tanzania - as a country and as a people - is beautiful.  I have felt very welcomed and am grateful to have this opportunity.

In an attempt to capture the experience of the past month, I will walk you through an average weekday.  Please allow for some creative licensing on my part to help condense the experience of many days down into one day, recognizing that each day is not actually as glamorous or exciting as this may lead you to believe. 

6:15 am: Wake up.  Eat some toast and surprisingly good peanut butter.

6:45 am:  We are supposed to be leaving.  I am living with Emily Hall (Peds Resident - PL3) and Caroline (Medical Student from Holland).  I realize I am the only one actually ready, probably because I wake up the earliest every day.  Then I realize this is because Emily and Caroline can actually walk much faster than I can and plan to make it to the hospital in less time than I thought possible.

6:55 am:  Actually leave our place and set out on our 7 km hike to Selian Hospital (uphill both ways, obviously).  During our walk, we have the excellent opportunity to practice our Swahili with the school children who are walking along the fairly car-devoid back road.  We are met with "mzungu" (Swahili for white person) and "how are you?" and are spontaneously hugged or touched.  This is often followed by much laughter from the children.

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Walking to Selian Lutheran Hospital

8:15 am:  Arrive at Selian and attend chapel.  The singing is beautiful and allows us all some time to relax after the long walk.  Chapel is attended mostly by the medical staff (nurses, interns, etc.) of the hospital, and they are most welcoming to us as we fumble to figure out which hymn number we are supposed to be singing.

Selian Lutheran Hospital

8:45 am:  Morning Report starts which entails a brief reading off of the admissions, discharges, and deaths for the past 24 hours.  I hold my breath a bit, hoping that the neonate with seizures and hypopnea is still alive.  He is not called out when the deaths are read, and I feel relieved.  An interesting admission of a patient with sagittal sinus bleeding after trauma is discussed.

9:00 am:  X-ray rounds.  The power is out so we step outside to view the x-rays in the light of the sun.  Interns take turns giving their impression of the films - pneumonia, congestive heart failure, femur fracture.

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X-ray Rounds at Selian Lutheran Hospital

9:20 am:  Round in the ICU.  There is just one Pediatric patient with likely bronchiolitis but requiring oxygen therapy.  We check her vitals and finagle the adult pulse oximeter to pick up a reading on the child's foot.  She looks better today.  Perhaps this whole bronchiolitis peaking on day 5 thing is true here too.  Maybe I have learned something in residency; I feel excited that Emily agrees that the right upper lobe infiltrate on the chest x-ray could just be shifting atelectasis.

9:40 am:  Chai break.  Besides, they are cleaning the hospital floors.  I begin to wonder whether it is a worldwide phenomenon to clean hospital floors during prime rounding hours.  Oh well, chai sounds great.  And the floors do need cleaning.  

10:00 am: General Pediatric Ward rounds.  Emily and I are working with a fabulous intern and his supervising equivalent of a senior resident.  We grab the paper files (charts) which the nurses have neatly stacked for us and the equivalent of a WOW (workstation on wheels) which is a huge cart with drawers filled with cotton swabs, discharge forms, pulse oximeter, etc.  The children, many of whom have been sitting outside in the grass, trickle back into their beds as they realize we are starting our rounds.  Some of the patients come with complaints that are familiar to us - chronic constipation, bronchiolitis, diabetic ketoacidosis.  Yet we are also challenged with more unfamiliar cases - Kwashiorkor malnutrition, cutaneous anthrax, tuberculosis.  We scratch our heads a bit about how to treat diabetic ketoacidosis with subcutaneous insulin and not an insulin drip.  The patients , their parents, and our fellow Tanzanian colleagues are kind and patient with us, answering our many questions.  The intern is eager to learn, explaining to us how he has been taught to approach a problem and then asking questions about how we would approach this problem.  The more senior resident helps guide and make management decisions on each patient.

11:30 am:  Baby checks.  We head over to the obstetrics unit and inquire if there are any neonates with acute concerns.  Two are currently being treated for likely sepsis with a presentation of fever and increasing fussiness.  There is no microbiology lab or ability to grow cultures so empiric therapy is given.  We are happy to see that the neonate with seizures and hypopnea is much improved today.  After seeing the neonates with acute concerns, we also do a routine exam on all new babies.

12:30 pm:  Lunch of rice and beans.

1:30 pm:  Follow up on interventions, labs, imaging.

3:00 pm:  Time for the long trek back home.  I think I am in better shape than I have been since residency began.  Maybe I will walk to work in Minnesota.  Then I remember it is at least 40 degrees colder in Minnesota, and I take that thought back.  We stop at a roadside stand along the way to buy some fresh vegetables for dinner.

4:00 pm:  Arrive home.  I am grateful we have such a wonderful place to stay with fairly consistent/reliable internet access.  Check emails, read.

6:00 pm:  Time to make dinner.  I realize the great amount of time and energy that this can require and remember why I cook so seldom at home.  I envision the many canisters of beans at our apartment in Minnesota and recount the innumerable times we have vowed to use these.  We all enjoy each other's company in the kitchen as we cut up our fresh vegetables and cook some rice and beans.  We actually sit at the kitchen table to eat and don't feel rushed to a flurry of other activities.

10:00 pm:  Time for bed.  I am starting to enjoy this whole sleeping thing.

There are already many exciting memories from this place, and I am eager for more to come as we finish up our second month here.  It has been a pleasure to work with, and learn from, our colleagues here.  I continue to think through how global health will have a role in my career moving forward.  Regardless, opportunities such as this strengthen my clinical skills, offer new perspective, and challenge my ability to think critically.  I am hopeful these moments will become a part of how I practice medicine and allow me to provide better care to the children I encounter, regardless of location.

Jambo from East Africa - Emily Hall in Tanzania

Blog Post written by Emily Hall, DO, 3rd Year Pediatric Resident

Jambo from East Africa!

I have spent the first few weeks in Arusha, Tanzania settling in and acquainting myself with the resources, medical facilities, and the community. As true with all my adventures abroad--this has not been what I expected, but equally holds exciting potential and opportunity. In future posts I hope to tell more tales of adventures. However, before things get too exciting...let me explain my perspective of life here in Arusha so if you are considering this as an International Elective you will know a bit of what to expect.

Danielle (another U of MN Pediatric Resident who most of you know) and I initially started our work at Arusha Lutheran Medical Centre, which is located in downtown Arusha and offers more specialty hospital and outpatient clinic care. They have a small NICU which was impressive to tour and have a total of 2 pediatricians on staff in addition to a pediatric registrar. In contrast, we observed and in the past few weeks have found our place at the Council Designated Hospital also known as Selian Lutheran Hospital (subtle name difference to the former mentioned). This hospital is in a semi-rural location in a village just outside Arusha serving both Maasai, Waarusha tribes, as well as people of Arusha. We walk to the hospital with beautiful views of Mt. Meru along the path. (see photo below) The resources here are limited in comparison to the Arusha Lutheran Medical Centre.

Mt Meru in TZ - Emily Hall.jpg

Mt Meru

We have been working with two Tanzanian trainees in pediatrics; one of which received his medical training in China the other from Dar es Salaam, Tanzania. Our primary physician contact here is from Australia; she has been a truly wonderful mentor. We round with two nurses and the four of us trainees. Together we have been discussing and collaborating on patient management decisions with particular consideration of differing International Guidelines of management and factors relating to a resource limited setting. This type of work and learning environment has taken a few weeks to develop, but has recently started to come together in an exciting and highly educational format. Later in the week the physician from Australia has been joining us--by this time we have had some autonomy to make decisions and can discuss in more details questions or concerns regarding patient care that have been debated in her absence. Additional training opportunities have included pediatric HIV clinic, pediatric general clinic, and serving at rural outreach clinics.

There have been several very interesting patients and cases, some of which are still a bit of a mystery. Perhaps in the coming weeks Danielle or I can write about one or two interesting patients to give you a taste of the variety of medicine and the diagnostic approach here at Selian.

Arusha provides quite the balance of work and fun. There are limitless things to do in the city and in the country. It is my hope in the coming weeks we can provide a bit of insight on both the medical and culture opportunities we have explored.

Until then, wishing you all well in Minnesota or wherever this missive finds you.

Emily Hall, DO, PL-3
U of MN Pediatric Resident