Hospital Lectures and Bumpy Roads- June 23

 Friday June 23 


We started the day at the weekly Friday morning meeting for all the doctors and staff. It was in a conference room and someone presented on sickle cell mothers and gave different statistics on neonatal deaths and different types of care for these mothers. 



Today was some sort of world sickle cell awareness day and lots of staff were wearing T shirts and they had a banner for it. Today I wore my dress that I got at the market since on Fridays people wear traditional clothes (last week the doctors asked why I wasn't wearing that!)


We went to another lecture in the conference room. It was a lecture on inpatient management of severe acute malnutrition (SAM). 


For young children with malnutrition (under 6 months), the goal is to get them back to breastfeeding. But, the doctor explained to us all the considerations like twins with not enough supply so they need to supplement with formula, or mothers who are HIV+ so they need to weigh the risks. 


Acute malnutrition is defined by the presence of bilateral pitting edema or by wasting or sudden weight loss. There are multiple ways to assess the child, by the middle upper arm circumference, weight for height, and things like nutrition history. 


Patients with SAM are deficient in potassium and magnesium but have excess sodium, which partly causes the edema. So you have to be careful about giving them electrolytes. The formula being provided has the correct amounts of this and also micronutrients and vitamins. The child may also have vitamin A deficiency (especially if they have eye issues) so they may be given vitamin A to prevent blindness (also given if they have measles). 


Something interesting is that they talked about how to treat hypothermia on patients and yesterday we even saw one who they think might have mild hypothermia! It’s hard for us to imagine how this can happen in a tropical place where it’s at least 80 degrees, but if kids are left under AC or fans uncovered, or get wet because it’s the rainy season, etc, it can happen. 


We sat in the malnutrition ward for a while and noticed that one of the mothers was eating some of the formula she was spoonfeeding her child. We later told the dietician and he said that they know and that they talked to the social welfare people and they’re gonna pay for food for the mother; apparently the mother said that she would eat it when her child wasn’t wanting it. 


One of the mothers had an operation Christmas child box which was interesting since I’ve sent those out before. 


We got lunch which was fish and rice and beans and noodles. 



Then, we went to the mall. It was super bumpy on the dirt road stretch and it took us an hour and a half to get there, we were sitting stopped in traffic for long periods.



There were lots of “head potters” selling things and we saw a couple times where they’d get money from someone in a car, then traffic would move and they’d have to run to catch up, etc. 


We got to the mall and bought some things like a tote bag made from local fabric and some other souvenir things. We also took out money from an atm and only about half the atms worked. 


We then got dinner at Burger King then went to the movie theater.


 We got our tickets but right after the movie was supposed to start, an usher came in and said there were technical difficulties and that they couldn’t play the movie. So, we eventually got a refund after talking to them then went home. 


We packed for the next day and Roland and I spent a lot of time trying to load more data onto my phone (100 cedis for 14 gigabytes) but the network wasn’t loading for a while, so hopefully it works and I have data tomorrow. 

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