Reflections on Pediatrics

A post from Marc:

I have just come to the end of 2 months of taking care of pediatric patients here at Galmi. I have posted very little in my time here about the medical care that I’ve been doing. These 2 months have been very difficult for me both professionally and personally. I have wrestled with a lot of different emotions and have had a hard time wanting to write much about what has been going on. I have never seen so many sick and dying patients in my life. I regularly feel inadequate to care for the patients that I see in the clinic and hospital. 

Day after day children are brought to Galmi from great distances by parents who are looking for answers to their medical problems. And many times I look at their sick children and have no answers to give. I don’t know why they are so sick, why that mass is growing or what it is, how to cure their seizures, or paralysis, or respiratory distress… 

Almost every day I admit a child who is critically ill. I look them over carefully, ask questions, do an exam, think through the list of possible diagnoses, think about the labs and imaging studies I would like to order. But because of the limitations of our hospital, or the parents’ resources, I usually cannot get all the labs and x-rays that I would like and that would be readily available in the Unites States. Or, I think about the specialists that I would like to consult: a pediatric cardiologist, or nephrologist, or pulmonologist, or neurologist. But there are none. The patient is stuck with me. So I make by best educated guess. I start medications, give IV fluids, pray…  

Often I think about these children during the night. Did I make the right diagnosis? Did I choose the right medications? Sometimes I go back to the hospital late at night to check on them. I pray some more. I look at Eli and Hailey and think about what these parents must be going through. I remember when Eli spent 3 days in the hospital. He wasn’t nearly this sick, and I was a wreck as I worried about him and grieved for him. What are these parents thinking as they see their children in such distress? 

Almost every morning when I get to the hospital to see the kids I admitted the day before, I find an empty bed. A child and mother are gone. I try to think positive, “Did they change beds? Are they getting an x-ray? Is the mother away buying food for the day?” But then reality sets in. I walk to the nurses’ station and pick up the black book that sits on the corner of the desk. I look for the bed number and the child’s name and my name as the admitting doctor. My heart sinks. The patient died during the night. 

Then the thoughts come, “What happened? Did I get the diagnosis wrong? The medications wrong? Not enough IV fluids? Too much IV fluids? Should I have given a blood transfusion? Not given a transfusion? Was the child too sick to save? Would they have survived in the U.S.?” I often talk to Ruth, a physician from Northern Ireland and my partner on pediatrics. We round together in the hospital and see patients together in the clinic. “Did I do the right thing?”,  I ask. “What could I have done differently? What can I change next time? Should that child have survived?” 

And then often she tells me her story. She lost a patient, too. We listen to each other and try to convince ourselves that we did our best.

The first 6 weeks were very hard. I felt depressed at times and wondered if I should even be here. "Am I cut out for this? Have I been trained well enough to take care of these people? Am I making a contribution?" But thankfully, I feel like the darkness has lifted. I am finding joy in my job again. I've learned a lot, and I think I provide better care now than when I first arrived. But I also think I am learning to handle the stress and the loss and the grief a little better. I can focus more on some of the good outcomes - the children who are still in their beds when I arrive in the morning. The patients who came in dehydrated, and febrile, and sick and who go home well. The smiling kids and moms that I see in clinic who are thriving. The patients in the malnutrition unit who are gaining weight and get to go home much healthier than when they first arrived. And I think about the spiritual implications of our work. Hundreds of patients a day come to the hospital and hear about God's love for them.They find compassion and a healing touch. They learn about a God who loves them so much that he sent his Son into the world to die for them. And they see people who were sent by that same God to care for them and heal them.

And so, at last, after nearly 10 weeks, I feel that I am finally settling in. I am making a positive contribution here. My presence matters. I feel satisfaction in my job. I have joy in the Lord. I am glad we have come. I feel back to myself. And so now I am ready to tell you about a day in the life of pediatrics...

I usually arrive to hospital around 8 am and enjoy a good laugh with the nurses as I try to greet them in Hausa. Most of them speak Hausa and French, but not English, so I am happy to find Tchissou or Mammane, my wonderful translators who are my mouth and ears in the hospital. I gather my charts and meet up with a nurse and with Ruth to start morning rounds. 

A nurse, Ruth, me and Tchissou 

We usually have 6 to 12 kids in the hospital each day. A pediatrician who worked previously at Galmi painted several large pictures depicting the story of Noah’s Ark. They hang on the walls above the children’s beds. Each morning as we do rounds a local evangelist and a missionary come by to talk about Jesus or tell a story from the Bible and to pray for the patients.

A missionary and evangelist doing morning rounds

This was a two week old who recovered from sepsis. This was the mother's 11th child. Five of her children have already died.

A 7 week old with gastroenteritis

A 10 month old recovering from malaria

A 1 month old with malaria and dysentery. This mother was mixing formula with contaminated water because she didn't have enough milk for her twins.

A 1 year old with vomiting and dehydration

After hospital rounds we make our way over to the pediatric clinic, or PMI (French acronym for Protection of Mothers and Infants) as it is known here. The building is also called Gidan Yara (“House of Children” in Hausa). 

Rufai, a local health worker, in front of Gidan Yara

Mothers and children in the waiting room

Abdu and Rufai - local health workers - screen all of the pediatric patients. They treat malaria, dehydration, pneumonia and many other illnesses. If they feel a child is too sick for them, they get referred to one of the doctors. They also manage the malnutrition unit and administer vaccines in local villages. I love these guys. We have become good friends.

Seeing patients in the clinic with Tasala - another wonderful translator

At 10 o’clock I head home for the morning break to visit Stephanie and the kids. I go back to the clinic at around 10:45. At some point in the morning, we usually visit the malnutrition unit to check on the patients there. We look at their growth charts to make sure they are gaining weight and see anyone the health workers have concerns about.

If someone looks sick we bring them to the outpatient department for a closer look and decide if they need to be admitted to the hospital.

A malnourished girl who was readmitted for refusal to eat. After a few days with a feeding tube she is now doing well and was sent back to the CREN this week.

At 1 o'clock we break for lunch. I get to spend 2 hours at home before going back to work from 3 until 6 to take care of little ones like this!

After the last clinic patient is seen, I usually go briefly to the hospital to check on lab work and any children I am worried about that I admitted earlier in the day.

11 month old with severe pneumonia

Then home at last (if I'm not on call!) to enjoy some family time after a day filled with blessings and joy, heartache and pain, life and death. I'm glad we are here. I think these little ones are, too.