Another Day at the Office

Today was just another day. It started a littler earlier than usual (3:30 am), and it hasn't technically ended yet, but it has overall been pretty "routine." Here is what a routine day at Mbingo Baptist Hospital entails:

Chapel begins promptly at 6:40am. Chapel includes most of the staff from the overnight shift as well as the incoming shift of hospital workers - probably close to 500 people. Then we have morning report from 7:00-8:00am. On Tuesdays we actually have the resident Bible Study, and Thursdays we have the joint surgery/medicine Tumor Board case presentations. From 8:00-9:30am we attend clinic and then start ward rounds at 9:30am.

This morning in clinic before going to rounds I saw 5-6 patients. If anyone thinks that he didn't go into outpatient pediatrics because it was too boring, perhaps he is simply practicing in the wrong location. I saw a 6-mo with a patent ductus arteriosus (PDA) coming for a scheduled closure with our visiting pediatric surgeon, a 4-yo with a badly dislocated right hip and inability to walk (see picture below), a 12-yo male that we are managing for his seizures, and a 16-yo M (who was admitted) with likely glomerulonephritis and acute renal failure (Cr 10.0, BUN > 250, hypertensive at 190/110, and 3+ protein and RBCs in the urine).

The ward was where things finally began to get a little more interesting... Here is a rundown of what we currently have on the pediatrics ward:

• 2 patients with malaria, one simple, the other complicated (hemoglobin < 5, unresponsive, and requiring emergent resuscitation on rounds)
• 15-yo M with suspected leukemia. Pathology results pending.
• 7-yo F with a distal radius fracture an superinfection
• 12-yo M with suspected Guillain-Barre Syndrome (AIDP) - bilateral lower extremity paralysis and loss of reflexes
• 3 children admitted with severe malnutrition and edema
• 2 burn patients
• 9-yo M with typhoid fever
• 7-mo F with hydrocephalus and meningitis 
• 13-yo M with recent admission for hypertensive crisis (BP 200/110 and vomiting), now with right-lung white out and ultrasound showing a large retrocardiac mass (see picture below)
• 2-week M with tracheo-esophageal fistula and severe malnutrition, s/p GT placement - scheduled for surgery later this week
• 14-yo F with left heart failure (likely rheumatic heart disease), now presenting with acute renal failure (suspected glomerulonephritis) and initiating peritoneal dialysis (PD) 
• 12-yo M with a likely primary bone tumor and abdominal metastases who has a acute abdomen with a left lower quadrant volvulus.

I spent a good portion of the day working to resuscitate our severe malaria case (transfusing blood, positive pressure ventilation, drawing blood, etc), and then was visiting with the surgeons regarding a number of our cases. We had our afternoon rounds at 4:00pm after the afternoon lecture. 

Praise God that we have a neonatologist and a NICU nurse, Margaret and Pat, visiting us right now. They managed the preemies and the other babies on the maternity ward today, while I continued on the peds ward, in clinic, and then later seeing consult patients. Typically the work is split between myself and either Lindsay or Angela. But the Barriers are home expecting their second child, and Lindsay is in Yaounde picking up her cousin, Greer, who is coming to help watch Cathen, allowing both of us to attend work at the same time. It will be a blessing to have them both here tomorrow afternoon.

Most of the children that we see are really quite sick, and the pathology is astounding. However, what is truly amazing is how God takes scenarios that seem completely helpless and brings healing to many of these kids. Please pray that we would have wisdom in treating these children, that we would be compassionate and caring in our words and actions, and that we would not let our work become simply "routine." Please also pray for safe travels for Lindsay and Greer tomorrow as they drive up to Mbingo, and pray for the Barriers while they are home waiting for the new little one to come.

We miss you all, and thank you for your support and prayers. 

Blessings,

JR

Right hip dislocation

Right-sided pneumonia and pleural effusion and retrocardiac mass

Cathen. She is dressing herself these days... Rain boots, fortunately, are always appropriate here.