The lone resident

Friday I started rounding on pediatrics as well as maternity.  Emiley, my pediatrician counterpart, headed back to the US on Thursday, and since Dr. Bardin is an internist and geriatrician, he said he would be fine with me taking over Peds instead of him!  Karen left for the States as well yesterday, so I’ll be the only rotating resident for the next couple weeks until I depart.  It was great to have a couple other residents around to hang out with and to ask for second opinions on cases.

Dr. Bardin and his wife Debbie have been such great hosts for us here.  I can’t remember how much I’ve written about them, but they are (most recently) from Michigan where Dr. Bardin practiced in a large multi-specialty group with a large emphasis on medical missions.  They served for 10 years at a mission hospital in Nigeria back in the 1990s.  Debbie is a nurse and works with the HIV/AIDS care and treatment team here at Mbingo.  Dr. Bardin is an internist, but upon return to the States after their stent in Nigeria, he completed a pathology residency, a geriatrics fellowship, and some on-the-job training for endoscopy.  So, this guy does EGDs and c-scopes for patients who need them as well as the biopsies and FNAs (not just on endoscopy) to discover pathologic diagnoses as well.  For example, yesterday, we had a 33-year-old man with a 1-year hx of severe sciatica-like pain and now has developed progressive leg weakness.  He also noticed a large lymph node in his groin and presented to the surgery outpatient department for evaluation.  The resident referred him to Dr. Bardin, who did a modified needle aspiration of the mass, and just a couple hours later, we knew the guy had a rhabdomyosarcoma (muscle cancer).  While that is a horrible diagnosis and we don’t have the exact treatment he needs here at this hospital, we know what he has and we can refer him for proper treatment.  Most patients wouldn’t or couldn’t present to a larger facility for pathology investigations, so the fact that we can do the biopsy and get the read here is amazing.  Those who have diagnoses needing further treatment we can’t provide can know the options and be referred if possible.

Pediatrics has been a mixed bag so far.  Like on maternity, some of the cases are challenging, both diagnostically and emotionally.  My most difficult right now is a nine-year-old boy named Elvis with full-blown AIDS.  He was started on HIV medications only a few months ago, and his last lab work showed his disease was quite advanced.  He has multiple issues going on during this admission, and without cultures and some of the better diagnostic tests, honestly I’m not entirely sure what all we’re treating in him.  He’s still spiking fevers on several antibiotics, including those for most of the opportunistic infections AIDS patients develop.  It’s hard enough seeing any patient suffer with AIDS, but it’s especially difficult seeing kids go through it.  The Cameroonian residents were very surprised when I told them that I had never actually treated a child with HIV.  The rate of HIV infection here is, by some estimates, 50%.  FIFTY PERCENT!  That’s ridiculous!  But spending some time on the adult wards seems to confirm that statistic.  Debbie Bardin, however, was telling us the other day that working in the outpatient treatment area is a bit more encouraging.  While the inpatient cases are mostly complications and advanced disease processes, she reports some pretty exciting success stories for those patients who are following up regularly and taking their medications as prescribed.  I guess it would help me to remember that we are getting a somewhat skewed sample on the inpatient service.

 

Dr. Bardin's office/pathology lab

The staining setup

Needle biopsy in action

We've seen several goiters like this one

This is the CXR of the lady in the previous picture.  See how deviated her trachea is!

A elderly man with an impressive goiter

A young lady with Stevens-Johnson syndrome

Precious and Praise, twins that Emiley took care of on the pediatric ward.  Now the family is hanging out at the hospital until they are able to pay the hospital bill...which is quite common here.

Louisa Faith, one of the preemie success stories.  She was born shortly before I arrived to a mom who had severe pre-eclampsia, and now she is finally discharged home!

There is a deaf school on the hospital campus with ~150 students who attend.  They love snapping photos and grab whatever is nearby to show in the picture.  Emiley posed with them for a picture.

 I hope you enjoyed the picture update.  Thanks for your continued prayer support!  Talk to you all soon.