In August/September I went on a 3 week mission trip to Malawi Africa, this is an account of my trip from week 3!
Sunday, September 8: Today we went on a safari drive, it was really fun. We saw impala, water buck, hippos, crocodiles, elephants and other animals that I can’t remember what they were called.
Monday, September 9: Today was a good day. I went in to the ICU to check on our patient that we had extubated on Friday to see how he was coming along. He is looking amazing! He is only requiring a couple of liters of oxygen now and he is talking, eating and smiling. Dr. Priester is saying that tomorrow he should move out to the general ward. She also asked me about some stuff for airway clearance. I had brought a couple of Acapella's and Cornet's with me. So I showed him how to use the Acapella device and instructed the nurses on how to do it with him as well. I also told them how it worked and had them feel his chest as he did it so they could feel the vibration. Another thing that happened with him today that was very encouraging is that the physio-therapist came by and got him up and walked the unit with him. It was great to see him up and walking and to know that just last week he was so close to death. Other than that, today I just attended the classes that the Loma Linda team was putting on. There was a couple that was teaching BLS to the nursing staff and another couple that were teaching ACLS to the physicians. I attended and chimed in and helped out where possible. Then, tonight for dinner one of the surgeons invited everybody over to his place for dinner. We all had a good time hanging around and fellowshipping.
Tuesday and Wednesday, September 10 and 11: These past two days were pretty much carbon copies of each other. Tuesday, yesterday, my friend that was in the ICU got moved out to the general ward. He is looking great. Every time I stop in to visit him and see how he is doing he credits me with saving his life. I have to remind him that it wasn't me, that it was a team effort between the doctor, nurses and myself. But I ultimately give the credit to God for saving his life; but since he is Hindu, I don't know how much of that he comprehends. Other than checking on him, primarily just helped the Loma Linda team out with there classes. I helped with the ACLS class most of the time, giving a non-physician perspective to running a code, teaching compressing and bagging technique as well as timing. They really didn't need my help, they were doing a great job. But it was something to do. I also helped out another resident that was kinda on her own teaching BLS to the nurses. I think she actually appreciated the help. It is difficult to teach that stuff on your own while doing demonstrations and having them practice. She is also a first year resident, so she has just learned this stuff herself, now having to teach it without having much experience with it. I would feel slightly overwhelmed. Later she told me that the most difficult part was that she realized that even though she was talking in generalities and simple terms for medicine, it was still over some of their heads. She felt like she was building on nothing and didn't have time to go through and lay a foundation. Though, she did the best she could, which was really very good.
Thursday, September 12: Today Dr. Stokes (the first year Loma Linda resident) and I went with Dr. Saunders to Malamulo Mission Hospital. Once a week either Dr. Saunders or Dr. Priester will go out to Malamulo and round on patients. Malamulo only has a couple of physicians, it is mostly staffed by our equivalent to a physician assistant. Though they frequently have residents come through for a rotation to help out and gain experience. The staffing here is horrific by our standards, one nurse could have an entire ward of 60+ patients. Though, they are doing a phenominal work taking care of these patients as best they can. The reason for this, unfortunately, is because they serve a much poorer patient base. They receive referrals from rural Malawi and Mozambique. The grounds were very impressive and beautiful. It looked like an old Spanish mission except it was made of brick. My role there was to educate the nurses on oxygen therapy and airway clearance. The nurse matron got all of the nurses together and I started my talk and five minutes later everyone was gone except the physio-therapist. I can kinda understand their disappearing, though, because if its just them with a ton of patients, they need to get back to them. The physio-therapist was a very pleasant young lady from Brazil and she was eager to learn. So I went over with her the different oxygen delivery devices and when to use each one. I also taught her proper technique for postural drainage and percussion (chest physio-therapy). The hope was for her to be able to take her knowledge and pass it on the the nurses. After that, she took me on a tour of the grounds and told me about everything that they do there and how the hospital is run. After the tour she had to get back to work so I rejoined Dr. Saunders and Dr. Stokes as they were finishing up their rounds in the general ward. After rounding the wife of one of the surgeons hosted us for lunch and we then went back to Blantyre for the rest of the day. We took a detour on the way back, though, we went through one of the tea farms to view the tea fields. It was very pretty. When we got back I had to get ready to teach another class for the nursing staff, this one on trach care. Our pediatric trach patient came in for me to demonstrate on, the only problem was that he was late...very late. So I had to find ways to talk and fill in dead space without sounding like a broken record while waiting on him to arrive. I ended up drawing on the white board and making lists. This was the most interested I have seen them become in a topic during a training session, though, so that was good. Finally he arrived and I got to demonstrate on him. Overall, today was a good day.
Friday, September 13: Last night around 2200 I got a call from Dr. Priester asking me to come into the hospital, they had just intubated someone. Walking up to the hospital I see a huge crowd of people that I had to wade through to get inside. When I finally make it to the ICU I talk to Dr. Priester and get the story behind this patient. This one was a mother who was in her mid to late 30's with a history of uncontrolled hypertension. They had to send her out for a CT scan earlier that day due to an acute change in mental status, turns out she had stroked. After talking with Dr. Priester I go over and look at the ventilator, make a couple of adjustments and start talking to the Dr. Stokes and showing her some things on it, then the patient's family physician comes in and starts asking me questions. He was asking me my role, asking if I was a physician, what meds we had her on, why we were treating her the way we were. I had to keep repeating to him that I didn't do that stuff, all I did was manage her ventilator and treat her lungs. I was not a physician. Then he started yelling at me because we had her on some sedation saying that it was contraindicated due to her stroke...well she was also having seizures and we had to treat that as well. I finally said that I didn't know and instructed him to talk to somebody else. Today when I went in she was hyperventilating and putting out fluid faster than we can put it back in her. They had to put in a third I.V. and start pushing fluids through that one as well. Through out the day she remained around three liters negative. After pushing our twelfth liter, Shymol and I were brainstorming trying to think up anything that may help. The only think we could come up with was to ask Dr. Priester if we could switch to lactated ringers in hopes of putting something in that would help her retain some fluid. She answered that we should have done that a while ago, but we didn't have an order for it. So they made the switch. Then I was asked to go do some asthma teaching in the Emergency department. So I went over there and did some instruction with the nurses on emergency management of asthma, the hospital course of an asthmatic, the physiology, pathology and pharmacology of asthmatics. I also showed them how to use a spacer. They were very receptive to it and asked lots of questions, which was very encouraging. The rest of the day I just sat in the ICU with the vent patient.
Anyways, today is the day I start my flight time! After saying goodbye to my fellow housemate, Jewel, and her leaving for church, I sat and waited for a driver to come pick me up and take me to the airport. It ended up being the same driver that picked me up from the airport three weeks ago, how funny is that! On the flight to Addis Ababa I sat with two people from England, I couldn't make out what she did, but the man is a pediatric nurse and he was in Blantyre volunteering at the government hospital. So we shared stories and experiences. It was nice talking to them and sharing stories from our homes as well. Ahh, I cannot wait to land in Ohio and see my wife and daughter. It has been way to long...tomorrow!
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