A day at the hospital

It is still difficult for me to fully express all my thoughts regarding work at the hospital, but I thought I could start by at least describing a typical day for me.  The day starts at 7:30 AM with morning report, which is preceded by morning devotional time.  All the medical students and some of the staff gather in a small room where they sing a worship song in Kirundi.  This is my favorite part of the day.  I dont know what it is about Burundians, but man can they sing. 

After this song, there is a short message from the hospital pastor (also in Kirundi), then the medical student who was on call the previous night gives report on new admissions and issues with inpatients. This happens in French, so I at least have some small idea of what is going on.  After this I usually go on rounds with the surgery team.  

This is one of my favorite patients to visit on rounds  He has been in traction ever since I arrived here, with no ipad, no TV, and yet still with a smile on his face.

The muzungu (white man) in the middle of the photo is Jason, our general surgeon.  He is also our orthopedic surgeon, neurosurgeon, urologist, sometimes anesthetist, handyman, exterminator, and much more.  And he does all these things well.  Most of the time, Jason is surrounded by at least a dozen medical students.

After rounds, I head to the OR, where Jacky (the full time anesthetist) and her team of 4 students have started preparing the first patient for the day.  I try to teach the medical students and the anesthesia students as much as my limited French will allow me to.  Often I am reduced to using English with a French accent or just speaking English really loudly, hoping that somehow that will make them understand.

After our arrival, it was disovered by the other missionaries that I did a cardiac anesthesia fellowship.  Somehow, this qualified me to perform and interpret transthoracic echocardiograms.  Today I was requested by the ER to perform another one, my fifth since I have been here.  One of them was on a 1 day old baby.  Thankfully, todays patient was an adult.

The day I took these pictures and wrote this blog turned out to be a very difficult one.  For our second case of the day, Jason operated on a 1 year old with a giant abdominal mass.  Although the tumor turned out to be likely benign, there was another cancerous tumor on his liver which was not able to be resected.  And there is no chemotherapy in Burundi.  So, likely this child will die within a few months.  Then, around 2 PM, there was an emergency C section.  The baby was delivered quickly but came out not breathing.  After about 20 minutes of ventilating him with an ambu bag, I decided to intubate him,  I am not sure, but I think this may have been the first patient ever intubated at Kibuye (there are no ventilators here, and in fact, there are no ventilators anywhere in Burundi).  With a team of about 6 people (students and lab technicians), we worked on resuscitating this child for the next 3 hours.  For lack of IV access I tried things I have never done before (like attempting an intraosseous line as well as attempting a femoral cut-down ... both unsuccesfully).  To top things off, the phone network was down, so no one could get a hold of Alyssa, our pediatrician.  Finally we found a medical student to run to Alyssa's house to bring her to this very sick child.  By this point, the baby had started breathing on his own, so I removed the endotracheal tube.  However, he was still very weak and sluggish.  

Alyssa came up with a plan to keep the baby in a room next to the operating room so the baby could have oxygen overnight, and to have the mother stay with the baby.  When she went to talk to the mother, she discovered that after the C section, the mother had been found dead in bed, we don't know why.  The baby survived overnight but died the next day. 

This was a difficult day.  I am doing things here I am not qualified to do.  I am told by the other missionaries that this is just part of life here.  Now, if you will excuse me, I am going to curl up into the fetal positioin and dream of doing lap cholecystectomies on healthy patients with Mike Erie while getting prank phone calls from Tyler Leedom in the O.R. next to mine at good old Skagit Valley Hospital.