new hospital day

Another day at the hospital...

New random thoughts:

1. Residents are all young- its like our system pretty much except without college. So I realized we are older than all the residents!

2. Females are scarce in the wards. And no female babies. I have not asked about this yet but I think the families who travel bring only sons this distance for the most part. The girls we see are more chronic issues who had not been treated as early as they should. Funnily enough, half the kids appear to be girls with pig tails and pink shirts. Only upon inspection...

3. Many babies up to 3 yrs are unnamed- they are labeled as ex. "Saratha's baby."

4. I forgot my toilet paper today. I had to try the Indian method and it wasn't too horrible. But I will remember from now on.

5. Taking pictures IN the ward is very hard. It seems flippant to take pictures when children are so ill. I have, however, gotten a picture of ricketts- it was not easy and took translation and many many thanks. I write to indicate to the donors why we have so few hospital pictures. It seems crass. Parents are already concerned about evil eye when you look at the children too long-pictures are often inappropriate.

Patients:

1. Neonatal seizures- EEG at 3 weeks once parents can rack up the $

2. 3 y/o intermittent fevers/seizures. This child was so drowsy during the exam and finally woke up to stare at me watching from the corner and cry, "protect me, spirit! protect me from these evil doers!" the residents thought that was pretty funny. He picked the pale ghost face. Sunscreen is working.

3. Lots more neonatal seizures- cosanguinous twins at one. Microcephaly, SGA. (Although there are lots of "term" babies here who are incredibly small looking). HypoCa, Hypogly- on phenobarb. Have these interesting covers for misting O2 over heads. One twin is in a big kid's bed; the other a crib. I think that might be Child Health II's only crib.

4. Ankita: the CXR is of her chest. She is the small girl with scoliosis and terrible dyspnea/tachy at rest. She will have an EKG today- I think this chronic infective process is the result of her pulm HTN combined with right heart failure due to likely anatomic abnormality. CT had mosaic multi-densities. I wish they would focus on cardio and get an echo. They are thinking weird alveolitis and rare interstitial disease although there is not fibrosis on CXR. Just huge vascular markings and slight lower lobe consolidation. Parents can't afford another study anyway. Too tachy to hear fixed split or loud S2.

More interesing:

At one bed they were recommending cow's milk over formula and I'm sure we made a funny face. It was explained that so many families can't keep bottles clean in any way and can only afford a little formula. So the children get watered down formula in unsanitary bottles (which often come with the fmla they buy). INstead, they just say go ahead with the cow's milk and boil with water or by itself- greater fat content than watered down fmla. Then they use a "birds beak" tiny metal cup which can more easily be cleaned and does not hold bacteria like rubber nipples. The beak rests in the baby's mouth and has some suckle function. All the mom's used these in the hospital and when caught bottle feeding, were in trouble!

Several children (one with cerebral palsy and neurogenic bladder) were on imipenem and meropenem. An attending said, "Did you know, we just found out we have e coli resistant to every abx in this hospital!!" I thought that would not be surprising when 100% are on cefotaxime and 20% on imipenem, but it seemed pretty new to him...

Also saw selective IgA deficiency and the ricketts- no renal cause and continued deformity. Perhaps an osteodystrophic syndrome.