The Peds Ward

Wednesday I spent the day on the peds ward with Dr. Fink (a pediatrician from Memphis), Bob (the clinical officer on the ward who functions like a PA), and one of the Kenyan residents. It was extremely interesting seeing the pathology of the patients admitted, how they are treated based on cost and what drugs are accessible, and really how long people go here before seeking treatment. Surprisingly, there is not much difference between here and home, so I surprisingly felt competent with how to treat some of the ailments. We don't have the tropical diseases fortunately though!



Here is a breakdown of some of the patients I saw:



10 yo male with a history of bloody diarrhea for a week, significant dehydration, as well as a reported weight loss of 10kg over the past month. HIV and malaria tests were negative (not that reliable I heard though) and likely had salmonella. The team came to the conclusion that the report from mom was likely exaggerated. Man though, it did not look like fun being a kid hospitalized for diarrhea as they have to lie on trash bags:(.



11 yo female with a history of shortness of breath and cough for a week. Her CBC revealed pancytopenia and they were trying to rule out aplastic anemia versus leukemia. I was able to assist with the bone marrow aspiration - uhh, not at all like it is done in the States. We gave ketamine and the some of the instruments were half missing. It was very make-shift and it was interesting to see that I was the only one who spoke to the child...definitely no child life services here!


9 mo old male from Somalia who was developing well until he started having a high fever and seizures. His mother took him to a hospital in Somalia where he was diagnosed with meningitis and treated with Streptomycin...which would not do anything for him. He continued to have seizures lasting up to one hour and 15 times per day. After about a week of this, the mom came to Kenya illegally where his antibiotics were switched to effective ones and he is now being fed through an ng tube and is neurologically devastated. Gtubes and nissens are not done here so this child will likely die from either aspiration pneumonia by the family trying to feed by mouth or replacing the tube incorrectly. The family is unable to return to Somalia so now the mom and baby will likely live in the slums of Nairobi where there is a large Somalian population (about 2 million people out of 5-6 million total live in the slums in Nairobi).


9 yo female with a history of right eye swelling and then developed fever and neck stiffness. She had meningitis and was doing very well on day 10 of 14 for antibiotic therapy.



3 yo male with a history of recurrent seizures for the past 8 months who was being treated for malaria - every child coming in with convulsions or history of seems to get treated for malaria. His aunt was his guardian as his parents had passed, and it was interesting to really figure out how to get him daily phenobarb as there is NO health insurance here unless you are wealthy.



12 yo male with a history of ascites and pleural effusions for several months. Jas had provided anesthesia when his lung was tapped showing exudate, which was pointing towards TB but he has not been responding to tx. A different pediatrician than the one I was with was thinking more of a cardiac pathology. The family denied any history of TB or chronic cough - but I have heard to take that as face value...kind of like when parents tell me they only smoke outside:). This poor guy was sick though and the outcome is not good.

9 yo female with a history of severe kyphosis and pectus excavatum. I don't think she had had this evaluated really before and now she has right sided heart failure and pulmonary hypertension. She had come to Kijabe satting 43% and was just sick. The ortho team decided she was not a candidate for surgery because of her heart and the pediatrician was having to translate this to the parents. They inquired about a second opinion from a cardiologist (there will not be a visiting peds cardiologist at Kijabe until July) and the transfer and evaluation in Nairobi would be about 10000+ Kenyan shillings (about $100) - this is huge for the majority of the families in Kenya as they live on about a $1 a day. It is was interesting to see the response of the parents in comparison to those in the US - this father was not angry, he was sad and wanted to know if this could have been treated earlier so he could share this information with others in his community to help treat another child with the same condition sooner. Also, I looked over the little girl and noticied she had a pressure ulcer to her right ear from the oxygen strap....unfortunately, no big deal to anyone else but me:(.

3 mo old female admitted for respiratory distress and had been to the ICU several times. She was doing great, ready to go home, and I think see honestly had RSV bronchiolitis - they are unable to isolate specific organisms here but they still have some of the same bugs.

3 yo female with a history of an abdominal mass which mom had discovered several months prior and was in fact a Wilm's tumor. She had a nephrectomy 2 weeks prior and was now in for chemo - they do follow a chemo regimen similar to CHOP. They have had 4 kids at Kijabe with leukemia in the past 3-4 years and only 1 is still living....all the rest came in so late and had every complication. This little girl was just adorable but did not like us! What amazed me the most is that she is given intravenous chemo through a peripheral IV! I asked if central lines or even PICCs were accessible would they use them and the pediatricians response was no bc the nurses would not be able to manage them and the risk of infections was just too great. The little girl was staying after her chemo because she was having vomiting and no stool....ended up going to the OR the next day due to a bowel obstruction and needed to have adhesions removed.

9 yo male with HIV and lymphoma:(...this little guy Emmanuel was just the coolest. I got to sit with him and his mom for a while before he received his chemo. He weighed nothing but was so stoic and even smiled when we started talking about playing outside. He obviously had complete alopecia and his head was covered with a fungal infection as the kids here really struggle with that anyway. The docs had to put their heads together as to when to give chemo and then add on his anti-retrovirals. He was doing amazingly well and this was his second to last burst of chemo. As expected he received his chemo through a peripheral and no thought of gloves were involved.

So in summary, these are the things I am learning:

Health care is not treated as a right here but a privilege. I am embarrassed to say that I have had the luxury of being picky when it has come to my own health care and I will really think twice before I complain about anything again.

Being in a remote area of a third world country gives you a different perspective about end of life issues. Here the supplies are so limited and they have to really evaluate who needs the supplies the most based on the likelihood of survival. In the states, all effort is made to keep someone alive even if the quality of life is drastically different. This experience has opened up some new conversations between Jas and I about these issues (probably more understanding on my side) that it is okay to let someone go when it is their time and not to not keep them alive for selfish reasons. You see here that the culture, stigma, quality of life, and financial state has such a huge impact and you are really not helping these families by intervening (going to all extremes) on a patient who will become or is already a total care/devastated patient.

Don't take antibiotics unless you need them! MRSA does not exist here, unfortunately it probably will as western medicine moves in. Despite the conditions in the OR, the infection rate is drastically less than the US and none of the operative patients are treated with prophylactic antibiotics....it is incredible to see that! They do have resistance to malaria drugs though as we have resistance to antibiotics.

I think that is plenty for now:). Hope as is well!