I went over to the Catholic hospital this afternoon to get a bit of help on the guidelines and phases of treatment for child malnutrition (you can easily see I am out of my depth). They have over 60 children in their nutritional feeding program and clearly some of the most severe cases. This little guy was brought by his mom from the Sudan - I think he is 3 years old. He is all swollen in his limbs (which makes them look bigger than they actually are) and you can see how wasted and thin he is in the face.
On the hospice side of things, I am trying to help them with the tough concept of curative versus palliative care. Even I am confused by this in Africa. An example is a 21 year old woman with AIDS and chronic diarrhea and wasting syndrome. She is on HIV medications and has had multiple treatments for possible causes of her diarrhea (where is Steve when I need him? Gastroenterology in Africa might even present him some challenges without an endoscope and without tests :) Anyway, the government hospital where she got her original diagnosis and HIV medications didn't have any answers for her so she came to our hospice. The staff nurses really want us to "fix" her, and the first few days, I went through everything they had tried for the last month, including various courses of antibiotics and antifungal medicines, but nothing has worked. She is losing ground, and probably weighs 50 pounds at most. I am trying to help them transition to comfort care, but it seems hard for them to accept. I understand completely, and yet using the valuable resources of IV fluids may not be the wise thing to do, and may just make her death more uncomfortable. So this is supposed to be my speciality area and I am still humbled.
There are a lot of tangible, small things I have done that hopefully will bear fruit. These include helping them standardize a pain scale that they use on patients every day, re-organizing their charting so it helps them avoid medication errors and keep a better connection between the disease and which medications are targeting for the disease or the symptom. (ok, now I know I am boring some of you)
I did the workshop with the nurses today that I told you about earlier. I started with asking them what their skills and talents were.... at first it was like pulling teeth, but then one said, "I am good at putting in IV lines", and then another said "I am a good at telling credos" I said what? - what is a credo? She explained it was a "local story". It turns out she is a great storyteller and often spends some of her shift telling patients a native story. What a great talent! I told her how important it is for people who are sick to have a way to be distracted from their discomfort and illness for a time. Maybe our hospice units in the US should have a resident story teller! We moved on to what things might be improved and I think the exercise was a good one - and I learned a lot. To bring it back to reality though - none of the nurses thought that all of them taking their break at the same time was a problem - arrrrrgh! Oh well, I'm trying.
I leave you with this image... a great young man I met while here. I think he has TB of his bones, which has caused his spine to fold over forward. He also has a shortened right leg that he has to adjust to by walking on his right toe. Would you believe he tries to run around and play basketball, and even is on a dance team? Absolutely incredible. I was able to ask him if he was in pain, and he nodded. So we talked more about where he hurt and I asked him to try some tylenol three times a day. (yeah, rocket science) He tried it and told me he feels better - so I got him a bottle of tylenol and set him up in the new clinic to get refills every month. Priceless.